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Wonderful Week at Wa-Thik-Ane

2016 CAMPER INFORMATION PACKAGE

Dear Parent(s)/Guardians and Campers

Please find enclosed important information for the Wonderful Week at Wa-Thik-Ane 2016:

Wee Camp Together …………………………………………. July 15 – 17, 2016

Wee Camp Together …………………………………………. July 29 – 31, 2016

FORMS Please read the enclosed material carefully and return the following completed forms:

Registration Form - please complete AND return with full payment before April 29th

2016. A late fee of $25

applies for all registrations received after April 29th

2016.

Permission Form (SG2) - please complete AND give us the name of a family member or friend in case we

cannot reach the parents/guardian. (We will always try all primary numbers first!) For those coming to camp with a parent, please give us another parent or alternate emergency contact in case the adult at camp is affected by the emergency.

Health Form (H1) – PRINT DOUBLE SIDED if possible & current photo - please be as complete and

comprehensive as you can - this information remains confidential and is essential for the well being and proper care of your daughter. Please list any medications your daughter might or does need including all pertinent health or behaviour related details. Please note issues like bed wetting, nightmares, behavioural challenges or the best way to help your daughter if she has issues which arise when overtired, stressed etc. Information will only be used to help your daughter have the best possible camp experience. Please attach a small current picture to the form.

Health Form (H2) – all ADULT participants (Wee Camp Moms) must complete this form in case of medical

emergency. It can be submitted in a sealed envelope if desired and will only be accessed in the case where the adult is not responsive.

Legible colour copy of Medicare card will be collected with any medications on arrival at camp, please see

kit list for details. For anyone without a Medicare card, proof of medical insurance must be submitted.

Photo Release Form (IR1) It is possible that photos and/or videos may be taken of the activities at camp.

Please advise us if you are willing to have your child/ward’s photograph used for the promotion of Guiding or camp as outlined on the enclosed form.

General Medication permission (H7) - This form allows us to give your daughter Benadryl, Tylenol or Advil

if needed. It avoids you having to send this medication with your daughter.

Medication Administration form (H3) - This is for girls coming to camp with specific medication. Please

complete it and give it along with the medication to the First Aider upon arrival.

Relevé 24 Request – Please complete and return the attached form in order to receive a Relevé 24 form

for income tax purposes in early 2017.

FORMS and payment need to be returned as soon as possible and before April 29th, 2016 to:

Girl Guides of Canada, Quebec Council, 100 Alexis Nihon, Suite 270 St Laurent, QC, H4M 2N7

Please keep the following forms until your daughter has returned from camp: Activity Plan (SG.1) including camp contact information

Kit List details what clothing and equipment your daughter needs for her time at camp

CAMP TUCK SHOP & MONEY

There will be a camp tuck shop available during the camps. Camp crests and other trinkets ($0.50-$10.00) will be available for purchase; a small daily treat will be included in camper fees this year. Please bring cash should you wish to purchase anything.



SWIM TESTS Swim tests are administered by aquatic personnel. Before going in the water, Guiders must ensure that

each girl has completed the swim test in the previous three years and has it listed on her iMIS record OR

has proper equivalency. If your daughter does not have a completed swim test she can do the test on the first day of camp or apply for proper equivalency. In order to apply for proper equivalency your daughter will require Red Cross Aqua Quest 6, Swim Kids 5, Lifesaving Society 4 or equivalent. Proof must be sent in with the attached forms in order to be granted equivalency for the swim test.

CONDUCT AT CAMP Camp is a time for meeting new people and learning to live by the Girl Guide Promise and Law. Please

discuss appropriate behaviour with your camper and be aware that should a camper’s behaviour not be appropriate you will be called to review possible options which may include leaving from camp with no refund. For reference please refer to the Code of Conduct at www.girlguides.ca

TRANSPORTATION Please note that transportation is NOT provided. Please indicate who has permission to pick up your

daughter on the Health Form (H.1)

ARRIVAL/DEPARTURE INFORMATION

CAMP ARRIVAL DEPARTURE

Wee Camp Together Friday, July 15 – 3:00 pm Sunday, July 17 – 2:00 pm

Wee Camp Together Friday, July 29- 3:00 pm Sunday, July 31 – 2:00 pm

DIRECTIONS:

Camp Wa-Thik-Ane: 240 Lac Bouchette Rd, Morin Heights, QC, J0R 1H0

Autoroute 15 North of Montreal to Exit 60 (Saint Sauveur)

Turn left at light off exit, take overpass over Autoroute towards Saint Sauveur

Merge right, take Rte 364 West towards Morin Heights (you will be on Jean Adam)

Turn right at light onto rue du Village (IGA on corner)

Continue 1.6 km – Turn left onto Belisle Rd Continue 1 km, pass 2 stop signs – Turn right onto Lac Bouchette Road

Continue 1 km up hill along dirt road to camp parking lot Entrance on LEFT

Camp volunteers will meet you in the parking lot

Cars belonging to parents/volunteers staying at camp will be left in this parking area

ANIMALS There are ANIMALS at camp, primarily raccoons, skunks, chipmunks, mice, squirrels, etc.

BEFORE CAMP - please check all pockets and bags for leftover candy/gum/seeds/nuts before leaving home.

AT CAMP – please do not bring anything with candy smells or tastes (toothpaste, etc.) If flavoured toothpaste is the only option it will be collected and made available when needed. Any food brought to camp will be collected and stored in the food building for the duration of camp.

SAFETY – campers are reminded that the animals are wild and need to be respected and treated appropriately; they should not try to feed any animals.

PAYMENT & REFUNDS

Full payment is required with the registration forms by April 29, 2016. A late fee of $25.00 will be charged for

all registrations received after April 29, 2016

50% of the camp fee is non-refundable upon registration; the remaining 50% of the camp fee is only refundable

upon presentation of a note from the child’s doctor before the start of camp.

Registrations are processed on a first-come, first-served basis. Camps may fill up before the April 29th

registration deadline.

http://forms.girlguides.ca/Shared%20Documents/codeofconduct/code-of-conduct.pdf

http://www.girlguides.ca/



LICE PROTOCOL Parents must check their child's head for any signs of lice immediately before coming to camp. We would like to note that if lice are found, it is imperative that your child receive a lice treatment.

In the case that we find lice in your daughter’s hair while at camp we will ask that you to pick her up from camp. You may treat the lice and bring her back to camp if the treatment is successful. Please note, there will be no refunds from days missed from camp.

Girls with long hair must come to camp with it braided. If it isn’t braided, we will ask you to do so at sign-in before she goes to her site. Please discuss the importance of your daughter’s hair being braided for the duration of camp with her. Girls must also be wearing a hat. The hat is not only to protect from the sun, but to deter the passage of lice and to keep bugs away.

If you would like more information about detection and treatment of head lice, you can read the guide produced by the Canadian Paediatric Society here: http://www.cps.ca/english/statements/id/id08-06.htm

Si vous désirez plus d'informations sur la détection ou le traitement de poux, vous pouvez aller sur le site de la société canadienne de pédiatrie en cliquant ici: http://www.cps.ca/francais/enonces/ID/id08-06.htm

EQUIPMENT FOR CAMP & TIPS FOR EFFECTIVE PACKING

Follow the attached equipment list to ensure your camper has enough clothing and the appropriate gear for the camp she is attending.

Use a proper size bag. Please avoid HOCKEY BAGS. Girls may need to carry her personal gear. She should have her daypack on her back, her sleeping gear in one hand and a sport bag in the other hand. Please be sure that ALL equipment fits into a ZIPPER or CLIP closed bag – NO reusable grocery bags or plastic bags and please pack ALL items into the bags (i.e. no dishes, boots etc. hanging off the outside)

LABEL all clothing, equipment items, and bags. Iron on labels work well or permanent marker (Sharpie) is effective; please use full name or initial and last name.

Waterproof gear by putting all clothes in zip-lock bags. They are cheap, transparent and waterproof.

Collect all the items on the list and group the items together for packing. You can either put the clothing for one day in a bag. Ex: For Saturday; socks, underwear, t-shirt in one zip-lock bag. OR Put all of one item together. Ex: All underwear in one bag, all socks in one bag. Toilet articles are in one zip-lock bag.

Pack swim suit, towel, raincoat & flashlight last so they are ready to use. Pack PJs & stuffy near the top or in a side pocket so they can be found easily in the dark.

Roll rain boots or fit them into each other for packing in the bag.

Practice living out of their pack. Nothing comes out until it is needed and what is not needed goes back in the pack. Ex: Dirty clothes in the plastic bag they brought. If your daughter finds this difficult – she may need a larger, roomier bag.

Pack WITH your camper. Girls should know where the items are in her pack. She needs to know what she has brought and where to find what she needs.

Make the best use of the space. Things not needed immediately go at the bottom, things needed in a hurry go at the top or in outside pockets.

Do NOT send anything which cannot get dirty or wet. Please do not send things which cannot get lost (ex. the extra special stuffy). Remember to send older clothes to camp, it is not a fashion show and many “name brands” are not durable enough for camp life.

Please DO NOT allow your daughter to bring a cell phone, iPod, MP3 player, electronic game system etc.

2016 CAMP CALENDAR

You may notice our camp calendar has shifted for 2016. This summer, many camp volunteers are involved in a

national camp event at Sylvan Lake, AB which has affected our available dates. CONTACT INFORMATION: Please contact the camp through the Provincial Office at 514-933-5839

Office hours Monday to Friday 9am to 5pm; outside of these times, from July 15 – August 6, the camp can be called

directly at 450- 226-9707. Remember the camp is busy and the volunteers are not sitting by the phone at all times, so please

let it ring. You may have to call several times before someone is available to answer it.

http://www.cps.ca/english/statements/id/id08-06.htm

http://www.cps.ca/francais/enonces/ID/id08-06.htm



REGISTRATION FORM

Please refer to camp descriptions document for details of each camp.

CAMP (Camp fees include taxes)

Wee Camp Together (5-8 years with accompanying female adult). Friday, July 15 – Sunday, July 17, 2016 $200.00 for adult and child, tax incl. *See note below

Friday, July 29 – Sunday, July 31, 2016 $200.00 for adult and child, tax incl. *See note below

Brownie Camp – 3 nights

Sunday, July 24 – Wednesday, July 27, 2016 $200.00, tax incl. *See note below

Spark/Brownie Camp

Sunday, July 31 – Wednesday, August 3, 2016 $200.00, tax incl. *See note below

Week 1 – Experience Wa-Thik-Ane

Brownies: Sunday, July 17 – Saturday, July 23, 2016 $375.00 tax incl.*See note below

Guides: Sunday, July 17 – Saturday, July 23, 2016 $375.00 tax incl.*See note below

Pathfinder/Ranger: Sunday, July 17 – Saturday, July 23, 2016 $375.00 tax incl.*See note below


Guides: Sunday, July 24 – Saturday, July 30, 2016

$375.00 tax incl.*See note below


Guides: Pathfinder/Ranger:

Sunday, July 31 – Saturday, August 6, 2016 Sunday, July 31 – Saturday, August 6, 2016



Adventure Camp Week for Guides , Pathfinders and Rangers

Guides: Sunday, July 24 – Saturday, July 30, 2016 $475.00 tax incl. *See note below

Pathfinders: Sunday, July 24 – Saturday, July 30, 2016 $475.00 tax incl. *See note below

Rangers: Sunday, July 24 – Saturday, July 30, 2016 $475.00 tax incl. *See note below

Number of years camp experience as a: Spark Brownie Guide Pathfinder Ranger (We will use this information to judge what level of programming for her week will suit her best; basic or experienced.)

CAMPER INFORMATION (Please PRINT)

FIRST NAME FAMILY NAME

IMIS #: DATE OF BIRTH AGE Parent/Guardian EMAIL :

Day Month Year

ADDRESS HOME TELEPHONE

Street City Province Postal Code

FOR WEE CAMP TOGETHER ONLY – DETAILS FOR FEMALE ADULT CAMPER – please complete family information section below

NAME iMIS # (if applicable) RELATIONSHIP

FAMILY INFORMATION PARENT 1/GUARDIAN’S NAME (First and Family) PARENT 2/GUARDIAN’S NAME (First and Family)

ADDRESS (IF DIFFERENT FROM ABOVE) Street


City, Province, Postal Code City, Province, Postal Code

CONTACT CONTACT

Home Work Home Work

The deadline for registrations is April 29, 2016.

*Note: A late fee of $25.00 will be charged for all registrations received after April 29, 2016



EMERGENCY CONTACT

NAME RELATIONSHIP


CONTACT Home

Work

City, Province, Postal Code Cellular Email/Other

OTHER

Are you coming to camp with a particular friend(s)?

Full payment is required with the registration forms by April 29, 2016. I understand that 50% of the camp fee is non-refundable upon registration. I also understand that 50% of the camp fee is only refundable upon presentation of a note from the child’s doctor before the start of camp.

Parent Signature:

Date:

PAYMENT BY CHEQUE

Cheques made payable to:

GGC-Québec Council

Amount:

$

PAYMENT BY CREDIT CARD Name on Credit Card

Visa □ Mastercard □ Credit Card Number

Expiry Date /

Cardholder Signature**:

Date:

** Typed name is equivalent to signature.

Please forward completed form and cheque if applicable by:

Mail: Addressed to GGC-Québec Council

Attn: Summer Camp 2016 100 boul. Alexis Nihon, Suite 270 St. Laurent, QC H4M 2N7

Email: Addressed to [email protected]

Subject: Summer Camp 2016 registration

Fax: Addressed to GGC Québec Council, 514-933-7591

Subject: Summer Camp 2016 registration

Deadline for registrations is April 29, 2016. Please note camps may fill up before the registration deadline.

*Note: A late fee of $25.00 will be charged for all registrations received after April 29, 2016.

mailto:[email protected]

(in case of emergency)

ACTIVITY PLAN (SG.1) For parents, Guiders and assessors

Activities are organized according to Girl Guides of Canada’s Safe Guide. The Safe Guide sets procedures for activity management including supervision, training, equipment and health matters. A copy of Safe Guide is available from your daughter’s Guider for your review upon request.

If your daughter/ward has any disabilities that may require accommodation, disclosing and discussing them with us will help us accommodate her.

Unit: Québec Council Of Girl Guides Of Canada Today’s Date: January 26, 2016

Activity/event/camp Wee Camp - Wonderful Week At Wa-Thik-Ane Cost (if relevant): $200.00

Responsible Guider: Joanne Cardinal (See contact info below)

Activity Description:

Summer Girl Guide Camp (2 nights) based on the age appropriate Guiding program. Activities will include nature study, outdoor cooking, games, campfire, creative activities (arts & crafts, drama, singing) and waterfront activities (may include beach play, swimming, boating)

For overnights, type of accommodation:

Meeting hall Camp residence Tent Hotel Hostel Other (please list) :

Purpose of Activity: (Guiders – please provide a brief explanation of how the girls will benefit from participating in the activity.)

Camp skill development, independence and leadership in a fun female environment.

Activity Date/Time: From Fri July 15 to Sun. July 17 Time: Start time 3:00pm End time 2:00pm # of nights 2

Location: (facility name) Camp Wa-Thik-Ane

Contact Number: 514-933-5839

240 Lac Bouchette Rd, Morin Heights, QC

Street Address/PO Box City/Town Postal code

Established camp location, campers will sleep in tents with lodge facilities for cooking, eating and Brief description of facility/site: indoor activities. Established waterfront for swimming/boating

Number of participants expected: 30 The minimum supervision ratios will be: 1:1

Supervision will be provided as follows: (Guiders – please briefly explain how supervision will be managed.)

Experienced, fully screened Guiders will be planning and supervising camp activities. Each Camper will be directly supervised and live with her Mom or other female adult for the camp

Arrangements for transportation (if applicable):

Time and place of departure: Meet in camp parking lot- Friday, 3:00 pm Return: Depart camp – Sunday 2:00 pm

Mode of transportation: parents or guardian

Transportation note: Automobile insurance is not provided by Girl Guides of Canada for the owner of the vehicle, even if it is used during a sanctioned event.

The registered owner of the vehicle is responsible for maintaining adequate automobile insurance. Any physical damage to the vehicle, or liability resulting

from its use during participation in or travel to and from a sanctioned activity is the responsibility of the vehicle owner.

Specific activities will include: (Guiders – please list the different activities the girls will be doing)

Girls will require the following: (Guiders – please attach a kit list if more space is required)

Nature Exploration Money: $see letter

Camp Living And Skills Equipment: see kit list

Outdoor Cooking, Meal Preparation Food: none

Swimming And Boating Clothing: see kit list

Arts, Crafts And Games Other:

A detailed itinerary is attached. Yes No If you require more information please contact:

Kit list attached: Yes No

Parents – please retain this sheet for your information!

We protect and respect your privacy. Your personal information is used only for the purposes stated on or indicated by the form. For complete details, see our Privacy

Statement at www.girlguides.ca or contact your provincial office or the national office for a copy.

2008/09/01 (Rev. 2009/07; 2012/09) C+3

Guider’s name: Joanne Cardinal Guider’s name: Provincial Office

Phone number: 514-453-2547 Phone number: 514-933-5839

E-mail: [email protected] E-mail: [email protected]




PARENT/ GUARDIAN PERMISSION (SG.2) Non-regular unit activities

Your daughter/ward has the opportunity to participate in the following Girl Guides of Canada activity/event.

Activity – Guiders please complete this activity section.

Activity/event/camp: Wee Camp Together, Provincial Camp Date(s): From July 15

th to July 17th 2016

Location: (facility name)

Camp Wa-Thik-Ane, Quebec Council Camp, 240 Lac Bouchette Road, Morin Heights

The details of this activity/event/camp are explained on the attached Activity Plan (SG.1).

The activity/event indicated above falls outside what Girl Guides of Canada considers to be a “regular unit activity.” Our procedures require that you review the planned activity(ies) and consider the following:

In all activities there is an element of risk. While Girl Guides of Canada and your daughter’s/ward’s Guider(s) take reasonable precautions to minimize these risks, this is no guarantee against injury or loss.

Some of the risks associated with these types of activities include (but are not limited to): scrapes, cuts or bruises; sprains, strains or possible broken bones; illness from known or unknown sources; theft or loss of possessions; and unforeseen injuries from activities, equipment or actions of your daughter, other participants or other people, including negligent actions. Although it is unlikely, the potential also exists for debilitating injury, long-term incapacity and death.

Your daughter/ward’s Guiders will be following Girl Guides of Canada’s Safe Guide which outlines safety management practices. You are welcome and encouraged to review this document. A copy of Safe Guide is available from your daughter’s/ward’s Guider upon request.

Participants are expected to conduct themselves in a safe manner and to abide by the Girl Guides of Canada Safe Guide procedures and Code of Conduct. Anyone who does not or whose actions jeopardize their safety or the safety of the group will be dealt with immediately. If appropriate, she may be sent home at the expense of parents/guardians.

Permission Please return this page to the Guider by April 29th

2016 (mm-dd-yy)

Name of girl: has my permission to participate in Wee Camp Together

Name of activity/event/camp

on July 15 - July 17, 2016 with the supervision arrangements outlined on the Activity Plan (SG.1). List dates and times

Contacts during activity: During the duration of the activity, I may be reached at:

Camp -- Name Alternate Contact:

Address Phone Alternate Phone

In the event of an emergency, if I cannot be reached, the following person is hereby authorized to act on my behalf:

Name: Relationship to participant:

Address Phone Alternate Phone

I have read and understood the information provided with this form as well as the details on the attached Activity Plan (SG.1). I understand that there is a degree of risk involved in these activities. After carefully considering all the risks involved, and having full confidence that reasonable precautions will be taken for the safety and well-being of my child/ward, I authorize my child/ward to participate in the activity as described above and on the Activity Plan (SG.1).

I agree to provide up-to-date health information that may not be on the Personal Health Form (H.1) completed at registration. If my daughter/ward requires medical treatment, I understand that Girl Guides of Canada will take initial steps to secure medical advice and services and that I will be contacted as soon as possible, or if unavailable, the emergency contact person noted above.

Custodial parent or guardian Date:

Relationship to girl:

Print name Signature

Parents – please return this sheet to the Guider!

We protect and respect your privacy. Your personal information is used only for the purposes stated on or indicated by the form. For complete details, see our Privacy

Statement at www.girlguides.ca or contact your provincial office or the national office for a copy.

2008/09/01 C+3


Image Release IR.1 Name: iMIS No.

Address: Telephone:

City: Province Postal Code

For Official Use Only Date of data entry:

This release is for the use of all Members of Girl Guides of Canada-Guides du Canada (GGC). It will remain in effect from the time of signing until girl/youth Members reach the age of majority or for adult Members it will remain in effect indefinitely. This information will be recorded in iMIS, the Girl Guides of Canada’s membership database. To change consent you must complete a new IR.1.

1. Parent(s)/guardian(s): Sign this release for girl Members under the age of majority. This release is effective

until the girl turns the age of majority, at which time she will be required to provide consent on her own as an adult Member.

2. Adult Members: Send this form for data entry with the membership registration forms (A.1, A.3 or A.5)

Applicant/Member’s Name:

Birth Date (if a minor):

In the course of activities, representatives of Girl Guides of Canada-Guides du Canada, Guiders, Members, non- member participants and staff may take photographs or otherwise record events. These photographs and recordings are sometimes submitted to GGC to be used to promote Guiding. Please advise us if you are willing to have your own image and voice and/or your child or ward’s image and voice used for promotional purposes by GGC, as indicated below:

I, on my own behalf and/or on behalf of my child/ward, give permission to the Girl Guides of Canada-Guides du Canada to photograph and record me and/or my child/ward’s image and voice on still photographs, motion picture film, audio tape, video tape or digital media and to use this material, and/or similar material provided to GGC by me or third parties involved in Guiding events, in whole or in part, now and in the future, through the media of television, film, Internet, multi-media presentation, radio, audiotape, videotape, in printed form and display form for the promotion of Guiding. I, on my own behalf and/or on behalf of my child/ward assign and transfer to Girl Guides of Canada–Guides du Canada any and all proprietary rights, including copyright, and waive all personality rights, which I may have or my child/ward may have in this material.

Girl Guides of Canada-Guides du Canada is only responsible for official uses of photographs and recordings. Any personal uses by Guiders, Members and non-members outside of the promotional uses outlined above are not monitored by or the responsibility of GGC.

NOTE: It is mandatory that you complete this section. Please check and sign to confirm your selection.

I, on my own behalf and/or on behalf of my child/ward:

Name of applicant/Member or parent/guardian signing form:

Signature of applicant or parent/guardian:

Relationship to child/ward Date

We protect and respect your privacy. Your personal information is used only for the purposes stated on or indicated by the form. For complete details, see our Privacy Statement at www.girlguides.ca or contact your provincial office or the national office.

Give my permission as set out above OR

DO NOT give my permission as set out above


Personal Health Form - Girl Members (H.1)

Note to parent/guardian 1. The information on this form may be used by GGC representatives or medical personnel to administer or

authorize appropriate health care or medical attention for the participant; and to obtain your permission on who may pick-up your child/ward.

2. Please return this form to the responsible Guider. You may be asked to review and update health information on this form periodically throughout the year. Please initial any changes.

3. It is recommended that you attach a photo on the reverse side of this form.

Girl’s Name: Last name

Birth date: Height: year/month/date

Address:

First name

Weight:

Phone:

No. Street Apt. No. P.O. Box or R. R. No. City Province /Territory

Home ( )

Business

Cell

Postal Code

( )

( )

Contact information of custodial parent or guardian: E-mail Phone: Home

Business

Cell

( ) Last name Given name

Address (if different from above)

( )

( )

No. Street Apt. No. P.O. Box or R. R. No.

City Province/Territory Postal Code

If parent/guardian unavailable, for emergencies, please notify:

1.

Phone: Home ( ) Last Given Name Relationship

Business ( )

Address (if different from above) Cell ( )

No. Street Apt. No P.O. Box or R. R. No.

City Province /Territory Postal Code

2. Phone: Home ( ) Last Given Name Relationship

Business ( )

Address (if different from above) Cell ( )

No. Street Apt. No P.O. Box or R. R. No.


1. Family doctor Phone ( )

2. Provincial health insurance number (optional)

3. The activity/event/camp may include swimming hiking, boating, pitching tents, etc. Does the participant have any physical, cognitive, emotional or behavioural limitations/challenges that would require assistance and/or modifications to the program to enable her to participate fully? Yes No If yes, please state particulars:

4. Do you have any special instructions for Guiders/staff regarding the participant’s health care and/or diet? Yes No If yes, please explain:

5. Does she know about menstruation? Yes No 6. Are corrective lenses required? Yes No Contact lenses? Yes No

We protect and respect your privacy. Your personal information is used only for the purposes stated on or indicated by the form. For complete details, see our Privacy Statement at www.girlguides.ca or contact your provincial office or the national office for a copy.

2008/09/01-v.2 (Rev 2009/07; 2010/07) Page 1 of 2 C

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Personal Health Form - Girl Members (H.1)

Name of participant: 7. If the participant has allergic reactions to such things as food, insect stings, etc., please complete the following:

Allergy : Life-Threatening? Allergy : Life-Threatening?

Yes No Yes No

Yes No Yes No

Yes No Yes No

8. Is the participant subject to any of the following? (Please check all that apply) Arthritis Convulsions Motion sickness Diabetes Respiratory ailments Ear trouble Nightmares Other – please specify Bed wetting Headaches Sleepwalking

9. Chronic conditions or recent illnesses of which the Guiders/staff should be aware:

10. Please provide details of treatment required and name of medications she will be bringing with her if required for the above mentioned condition(s).

11. Are there any medications that your child/ward should carry themselves (e.g., asthma pump, Epi-pen).

Yes No If yes, please specify:

Medications: Any medication (over-the-counter and/or prescribed) required by girl Members must be brought with her in original packaging with dosage instructions and clearly labeled with her name. Medications are given to the Guider or first aid provider upon arrival at the activity/event/camp for storage. The Guider or first aid provider will supervise the taking of medication by girls according to instructions provided. Participants must be willing to take their medication. They will not be given any medication that is not provided by parents/guardians.

Other comments:

Note: If the participant has been treated by a physician for an illness or injury within one month of the date of the activity ,it is recommended that the Wellness Statement (H.5) is completed and signed by a physician.

Every care and attention will be given to the health and comfort of the participant. I hereby authorize a Girl Guides of Canada representative to secure such medical advice and services (e.g., contacting EMS/ambulance) as may be deemed necessary for the health and safety of myself or my daughter/ward during activities. I agree to accept financial responsibility in excess of the benefits allowed by my provincial/territorial health plan or the Girl Guides of Canada insurance plan.

Date: Signature of Participant (or custodial parent/guardian if participant is under provincial/territorial age of majority)

PHOTOGRAPH OF PARTICIPANT

Place photo here

A picture is required when a girl Member is attending any activity/event/camp at which she may not be known (e.g., area camps, outings, district rallies, etc.)

PERMISSION TO PICK UP GIRL MEMBER Girl Guides of Canada strives to provide the safest possible environment for your daughter. In keeping with that goal, Unit Guiders will only release your daughter/ward to individuals who have been authorized by you to pick up your daughter/ward after Guiding activities. a) My daughter/ward has my permission to make her own way home: Please initial b) In the space below, please list up to four people (including yourself) who may pick up your daughter/ward.

1. 2. 3. 4. *Please note that individuals on the list may be required to show photo identification if they are not known to the Unit Guiders. If there is a need for someone other than those listed above to pick up your daughter/ward, please inform the Unit Guider in writing. In an emergency situation, the unit Guider may accept verbal authorization from you.

NOTE TO GUIDERS: Securely destroy this form at the end of the Guiding year or return to parent/guardian.

We protect and respect your privacy. Your personal information is used only for the purposes stated on or indicated by the form. For complete details,

see our Privacy Statement at www.girlguides.ca or contact your provincial office or the national office for a copy.

2008/09/01-v.2 (Rev 2009/07; 2010/07) Page 2 of 2 C


PERSONAL HEALTH FORM FOR ADULTS H.2


2008/09/01(Rev: 2015/09) of 19 C

Notes: 1. The information on this form may be used by and shared with GGC representatives or medical personnel

to administer or authorize appropriate health care or medical attention for the participant, if needed. 2. Completion of this form is required for overnight activities and Red level activities. Please keep this form

in your purse/with your belongings and inform the responsible Guider or another participant of its location (or you may hand it in to responsible Guider for the activity). For Adventure camping and adventure tripping it must be provided to the first aider.

3. If you have a life-threatening or health related condition that could affect your ability to supervise girls, please see Safe Guide for further information.

4. If you have any disabilities that may require accommodation, disclosing and discussing them with us will help us accommodate you.

5. You may need to review and update this form periodically throughout the year.

Name

Last name First name

Address No. Street Apt. No. P.O. Box or R. R. No.

City Province/Territory Postal Code Phone: Home ( ) Cell ( ) Business ( )

In an emergency, please notify:

Last name First name Relationship

Phone: Home ( ) Cell ( ) Business ( )

Address (if different from above) No. Street Apt. No. P.O. Box or R. R. No.


Family doctor Phone ( )

Provincial health insurance number (optional)

The activity/event/camp may include swimming hiking, boating, pitching tents, etc. Do you have any physical, cognitive, emotional or behavioural limitations/challenges that would require assistance and/or modifications to enable you to participate fully? Yes No If yes, please provide details:

Do you have any special instructions for Guiders/staff regarding your health care and/or diet? Yes No If yes, please explain:

Are corrective lenses required? Yes No Contact lenses? Yes No

If you have allergic reactions to such things as food, insect stings, etc., please complete the following:

Allergy Life-Threatening? Allergy Life-Threatening?

Yes No Yes No

Yes No Yes No

Yes No Yes No

Medications: Any medication (over-the-counter and/or prescribed) must be brought by you. Do you carry an asthma pump, Epi-pen or other medication?

Yes No If yes, please specify: Continued on next page ….

PERSONAL HEALTH FORM FOR ADULTS H.2


2008/09/01(Rev: 2015/09) of 19 C

Only complete the following for Adventure Camping or Adventure Tripping

Are you subject to any of the following? (Please check all that apply):

Arthritis Convulsions Motion sickness Diabetes Respiratory ailments Ear trouble Headaches Sleep walking Nightmares Other – please specify:

Chronic conditions or recent illnesses:

Please provide details of treatment required and name of medications you are bringing with you and which of the above condition(s) they are for

Note: If you have been treated by a physician for an illness or injury within one month of the date of the activity, it is recommended that you provide the Wellness Statement (H.5) is completed and signed by a physician

N. B. Every care and attention will be given to the health and comfort of the participant.

I hereby authorize a GGC representative to provide first aid and/or secure such medical advice and services (e.g., contacting EMS/ambulance) as may be deemed necessary for my health and safety. I agree to accept financial responsibility in excess of the benefits allowed by my provincial/territorial health plan and the Girl Guides of Canada insurance plan:

Signature of participant: Date:

UPDATED:

Signature of participant: Date:

This form is valid for one year. Update may be required during this period.


2008/09/01(Rev: 2015/09) of 19 C

Medication Plan and Administration Record (H.3)

Location/dates of activity/event/camp: Participant’s name:

1. The information on this form may be used by GGC representatives or medical personnel to administer or authorize appropriate health care or medical attention for the participant, if needed. 2. PARENTS: All medications should be placed in a resealable bag (e.g., Ziploc) with the participant’s name on the outside of the bag. Medications must be in original packaging, clearly

labelled with the participant’s name and dosage instructions. Medications are to be self-administered by the participant except in cases where supervisors may need to assist younger girls or when an Epi- pen needs to be used. Medications are to be given to the first aider or designated Guider upon arrival at the activity. The first aider or Guider will supervise participants when they are taking their medication.

Medication (name, dosage & instructions)

Scheduled times to be taken:

Date: Date: Date: Date: Date: Date: Date:

Actual Time

Initials Actual Time






Initials

Name of Guider supervising medications: Signature

My daughter/ward is 12 years or older and has

my permission to carry her own medications Parent guardian name Signature Date 2008/09/01 v.2 page 1of 2 C+3

Medication Column –Write in all medications (including those taken only as needed, sometime noted on prescriptions as PRN), dosage & times when medications are to be self-administered. This includes all prescription or over-the-counter medications (oral or topical). To be completed by parent/guardian or Girl Guides of Canada representative.

Date Box –Write in the date of each day of the activity/camp across the top. When medication is taken, supervisors put the actual time it was taken in the appropriate columns and their initials.


2008/09/01(Rev: 2015/09) of 19 C

About Medications

Medication Plan and Administration Record (H.3)

All medication must be provided by participants. All medications should be placed in a resealable bag (e.g., Ziploc) with the participant’s name on the outside of the bag. Medications must be in original packaging, clearly labelled with the participant’s name and dosage instructions. Medications are to be given to the First Aider or designated Guider upon arrival at the activity. Medications are to be self-administered by the participant except in cases where supervisors may need to assist younger girls.

In the case of life-threatening conditions, supervisors are obligated to provide the girls they supervise the ‘standard of care’ of a careful or prudent parent adults and will need to administer an Epi-pen or assist with an inhaler if the girl is incapacitated. Anaphylaxis Canada has information on living with anaphylaxis at www.anaphylaxis.org. Safe4Kids at http://www.safe4kids.ca/ is their site specifically for children with anaphylaxis.

C+3

http://www.anaphylaxis.org/

http://www.safe4kids.ca/

H.7 Double-sided

2009/01/01 Page 1 of 2

MEDICATIONS CONSENT

The information on this form may be used by GGC representatives or medical personnel to administer or authorize appropriate health care or medical attention for the participant, if needed.

The Medications Consent is used only for Red level activities/camps more than four hours away from emergency medical assistance. The Medications Consent form may also be used for international travel (72 hours or more) or large events (e.g., provincial, national or international camp).

Information for Guiders:

Medication is only offered to participants if it is absolutely necessary to continue the activity. Provide parent(s)/guardian(s) with the list of medications that will be in the first aid kit using the chart on the next page. You must include the brand name of the actual medication that you will be carrying. Parent(s)/guardian(s) are to place their initials by each medication to indicate that it may be given to their daughter/ward. This information must be carried along with the first aid provisions and consulted when medications are offered. The Medications Consent must be renewed before each applicable activity/camp. Consult with your local pharmacist for advice on directions for medications listed and brand selection.

Information for Parents/Guardians:

Guiders are not permitted to give any medication to your daughter without your permission. In the event of an emergency, every effort will be made to contact you. However, due to the nature of the activity, the group may not be within range for a phone or cell phone. Please complete this form to grant us permission to administer medication in the event that we are unable to reach you and your daughter is unable to continue the activity without medication. If your daughter/ward is known to have anaphylactic reactions, it is strongly recommended that she carry two EpiPens and that you discuss with the first aider the capacity of the group to safely manage her well-being and health in the environment she will be traveling through.

As parent/guardian to , I

(name of participant) (name of parent/guardian)

hereby give permission to the first aider listed below to administer medication to my child/ward as outlined on the reverse.

Name of first aider:

Joanne Cardinal

Parent’s/guardian’s signature:

Relationship: Date:

Renewal: This form is valid for one year. It must be reviewed prior to all activities. If there are no changes, parents/guardians indicate renewal by signing below. If there are changes, please complete and submit a new H.7 form.

Name of first aider:

Parent’s/guardian’s signature:

Relationship: Date:

Pa

rticip

an

t’s n

am

e: _

__

__

__

__

__

__

__

__

__

__

__

__

__

__

__

__

__

H.7 Double-sided

2009/01/01 Page 2 of 2

Participant’s name:

Medications Note: Only the brands listed on this form may be used. Follow the dosage instructions on the packaging.

Medication

Brand in First Aid Kit

(Brand name must be listed)

Use

Parent/guardians initial medications that can be given to their daughter/ward.

Topical antibiotic ointment (e.g., Polysporin)

Polysporin +pain relief

Non-greasy Cream

For abrasions or minor infection

Aloe vera gel Life brand Essentials

Aloe Vera Gel

For soothing skin irritation

Hydrocortisone cream .5%

Equate brand

Hydrocortisone Cream USP

0.5 %

For soothing skin irritation, itching and swelling, if indicated

Calcium carbonate

(e.g., TUMS)

Antacid for stomach upset, indigestion, heartburn

Loperamide

(e.g., Immodium)

Anti-diarrheal

Dimenhydrinate

(e.g., Gravol)

Gravol, quick dissolve chewables, Cherry flavor

Anti-nauseant for motion sickness and nausea

Diphenhydramine

(e.g., Benadryl)

Children's Benadryl Allergy Liquid, under 12 Bubble Gum flavor

Antihistamine for allergic reactions such as hives, redness and swelling

Pseudoephedrine

(e.g., Sudafed)

Decongestant for congestion due to cold or flu

Cough drops Halls Centers, Cherry favor For cough and sore throat, as needed

Acetaminophen

(e.g., Tylenol, or

Paracetamol)

Children's Tylenol liquid form, Berry flavor

Regular strength Tylenol, tablets

Analgesic for pain and fever

Ibuprofen

(e.g., Advil - Not

appropriate for some forms of

asthma.)

Advil Junior, chewable tablets, raspberry flavor

Anti-inflammatory for pain and swelling.



Camp Wa-Thik-Ane Relevé 24 2016

A Tax Credit for Child-Care Expenses is available from the Ministère du Revenu. For your 2016 tax return, the following section must be completed in full.

Daughter Family Name: _________________________ Given Name: _____________________

Daughter's date of birth (YYYY / MM / DD): _______ / _______ / _______

Total camp fees paid by parent: $ _____________

Parent claiming the credit

Family Name: ____________________________ Given Name: _____________________

Social Insurance Number of this parent: ______ ______ ______

Parent's Address: ______________________________________________________

Postal Code: ______ ______

Vous pouvez obtenir un crédit d’impôt pour frais de garde d’enfant du Ministère du Revenu. Pour votre déclaration de revenus de 2016, veuillez remplir les renseignements suivants.

Nom de famille (fille) : ________________________ Prénom (fille) : ______________________

Date de naissance de votre fille (AAAA / MM / JJ): _______ / _______ / _______

Total des frais de camp payés par le parent: _____________

Parent demandant le crédit:

Nom de famille : __________________________ Prénom : ______________________

No d’assurance sociale du parent : ______ ______ ______

Adresse complète du parent : ______________________________________________________

Code postale: ______ ______

Veuillez compléter et retourner ce formulaire avant le 29 avril à:

GGC Conseil du Québec, 100 boul. Alexis-Nihon, Suite 270, Saint-Laurent,

QC H4M 2N7 [email protected] ou par faxe à (514) 933-7591

Please complete and return this form by April 29th, 2016:

GGC Québec Council, 100 boul. Alexis-Nihon, Suite 270, Saint-Laurent, QC

H4M 2N7 Scan and email to : [email protected] or fax to (514) 933-7591



Wonderful Wee Camp at Wa-Thik-Ane Wee Camp Together (2 nights)

Personal Kit List

EACH PERSON (Adult and Girl) requires each of the following equipment items

BEDROLL which includes: 1 warm sleeping bag 1 groundsheet or plastic sheet

1 insulating pad 1 stuff pack for stuffing sleeping bag

Extra lightweight blanket 1 pillow (optional) Bedroll MUST be in a stuff bag or rolled in plastic & tied with rope.

NO GARBAGE BAGS NO DOUBLE AIR MATTRESSES

CLOTHING: Please check the weather report - July can be chilly at night

3 t-shirts 2 pair of shorts

1 long sleeve shirt or sweatshirt 1 long pants (Not jeans)

3 sets of underwear 1 Sweater or fleece

3 pairs of socks 1 wind breaker (nylon jacket)

1 pair of warm socks 2 pairs of pajamas (1 warm/1 lightweight)

camp hat for sun Winter hat and light gloves

swimsuit 2 beach towels

1 pair of sturdy running shoes 1 pair of rain boots A MUST

1 good raincoat (with hood) and rain pants OR reusable rain poncho (Raingear should be water PROOF not just resistant)

crocs/sport sandals may come to camp for use ON-SITE as “slipper” type footwear. However, girls must have close- toed

RUNNING SHOES or HIKING BOOTS for activities. NO FLIP FLOPS

TOILET ARTICLES: Toothbrush and paste Comb, brush, elastics: Hair must be tied up

Soap Face cloth

Non-aerosol insect repellent Non-aerosol deodorant (adults)

Sanitary supplies/Sleeping pants Sun screen & lip balm (unscented)

Kleenex Portable personal First Aid kit

DISHES: (Strong non breakable dishes in a mesh bag (so air can flow through to dry them)

Plate, bowl, plastic mug for hot drinks, juice cup, knife, fork, spoon

Dish towel (for drying) Oven mitt for outdoor cooking

MISCELLANEOUS: Leak-proof water bottle Sit upon (foam/ newspaper in plastic bag)

Flashlight and extra batteries Camera (optional)

Pencils and note book Whistle

Plastic bag/stuff sack for dirty clothes 1 orange garbage bag (for camper)

6 clothes pegs Small stuffed bed friend

Program Book (if you have) Reading book/cards, etc. for quiet time

Daypack/knapsack (school bag size) Camp blanket or poncho

MEDICARE CARD – please bring Medicare cards for both MOM and CAMPER.

MEDICATIONS – for Camper and MOM - MUST COME to camp in a closed NAMED bag (cosmetic bag, pencil case

or ziplock) – all medication must be in original packaging or with prescription. This bag will be collected by our FIRST AIDER and stored in a lock box for safe keeping.

Benadryl (topical or liquid) Girls often react to bug bites and having this on hand will alleviate the itchiness. ELECTRONICS including MP3/iPods, phones and games; MAKE-UP; JEWELRY; and SNACKS

(gum, candy, etc.) are NOT PERMITTED OR NEEDED.

New this year we have sweat pants and a

Mom and Me camp shirt!

CAMP WA-THIK-ANE GIRL GUIDES

of Québec has proudly selected Positive Identity to be our camp wear supplier. To order simply navigate the e-store and add to the shopping basket.

This year we will have Camp Wa-Thik-Ane 90

th anniversary clothing!

COMING SOON!