Inside: Registration & Medical FormsInside: Registration & Medical Forms
Early Bird
Special
10% Registration
Discount
before Saturday,
May 15.
CROSS ISLANDYMCA DAY CAMP
Summer 2011June 29 - August 26
LETTER FROM THE EXECUTIVE DIRECTOR
Welcome to the Summer of 2011! Our youth programs are the core of all that we do at theCross Island YMCA, which is reflected in the vast array of options available to your child thisyear in Summer Day Camp. We are excited to offer you our recreational and specialtycamps such as Teen Trip Camp, Tennis Camp, Dance Camp, and In-Depth Drama Camp.
Our mission of building the spirit, mind, and body of all our campers is reflected in ourhighly qualified staff, unique activity schedule, and unsurpassed safety protocol. Thank youfor considering the Cross Island YMCA for your child’s summer experience. We are confidentthat 2011 will be our best summer yet!
Sincerely,
Dana Feinberg
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OUR CAMP MISSIONThe Cross Island YMCA summer day camp provides youth withsupervised activities that teach core values, conflict resolu-tion and leadership skills. Kids have fun while making newfriends, developing new skills, learning core values, buildingself-confidence, appreciating teamwork and growing in self-reliance. For kids, Y camps is a fun and happy place to enjoythe summer. YMCA Day Camp gives children the opportunityto play games, create arts and crafts, explore science andtechnology, swim, participate in field trips, appreciate natureand discover and value our many cultures. The Cross IslandYMCA is licensed by the New York City Department of Healthand accredited by the American Camping Association.
CAMP DATES TO REMEMBERRegistration Begins February 1
Financial Assistance Deadline April 30
Camp Open HouseSaturday, 10am-4pm March 12
April 16 May 14
Early Bird Deadline May 14
Payment Due DatesSessions I & II May 1Sessions III, IV June 1
Transportation Registration May 31Deadline
Completed Medical Form June 20 Deadline
CONTACT INFORMATIONFor more information on Early Childhood Summer Camp, contact Early Childhood Director at 718-551-9313. For moreinformation on all other camps, contact Javon Clark at 718-551-9316 or email [email protected].
CAMP LOCATIONCROSS ISLAND YMCA238-10 Hillside Ave.Bellerose, NY 11426Tel: 718-479-0505 Fax: 718-468-9568Web: ymcanyc.org/crossisland
FINANCIAL AIDAt the YMCA, we work to ensure that no child is ever turnedaway for inability to pay. Every year, our Strong KidsCampaign raises funds to support YMCA youth programs likeday camp and sleepaway camp, and enable us to offer need-based scholarships to participants on a case by case basis.Applications are available at the Membership Office and mustbe submitted with the proper documents by April 30.
STRONG KIDS CAMPAIGNThe Cross Island YMCA Annual Strong Kids Campaign raisesmoney for youth programs and scholarships at the Cross IslandYMCA. The scholarships allow young people in financial needto experience the Cross Island YMCA through memberships inTeen Programs, After-School activities and Summer Camp. Asa non-profit organization, we depend upon yearly contribu-tions from our members and other friends to help us provideeducational, health-enhancing programs for the youth in ourcommunity. With the Strong Kids Campaign, 100% of thesecontributed dollars goes to support youth programs and schol-arships in our YMCA. Please Donate Today! For more infor-mation about this campaign, to volunteer, or to make a dona-tion, please contact Jamé Cohn, Fund Development Directorat 718-551-9314 or [email protected].
STRONG KIDS CARDThe YMCA Strong Kids Card is part of the YMCA of GreaterNew York’s commitment to improving the health and fitnessof New York City’s kids age 5-17. Every YMCA branch in NewYork City is reaching out to kids in their neighborhood pro-grams to enroll them in the YMCA Strong Kids Card initiative.To register your child for a free YMCA Strong Kids Card, simplypick up a brochure at the membership desk, fill it out, andsend it with your child to their YMCA program. Then we’lltake their picture and print their very own Strong Kids Card.They’ll use their card to access their local YMCA during desig-nated days and times of the Strong Kids Card activities.
CHILDHOOD CAMPAges 2 - 5.8 • Sessions I - IV
Our primary goal is for each child to develop a positiveself-image. The staff is made up of carefully selectedteachers and assistant teachers. They provide guidanceand supervision so that each child can achieve self-con-fidence and awareness.
Our camp offers air-conditioned classrooms, outdoorplayground, picnic area, indoor pool and gym. Childrenparticipate in a wide variety of activities, including arts& crafts, swim, gym, music, and organized games. Eachweek will feature a special theme, and each session willhave a trip to the zoo, children's museum or park. Allactivities are geared to meet individual needs, abilities,and interests.
DAY CAMP SESSIONMonday - Friday, Monday, Wednesday & Friday Tuesday & Thursday
DAY CAMP HOURS9:00am - 4:00pm Extended hours morning and evening available
TRANSPORTATIONCall Early Childhood for Transportation Services.
EARLY CHILDHOOD CAMP Call 718 551-9313 or 718-479-0505 for more info.
FEES$50 - Registration fee for campers who are not YMCAmembers or currently enrolled in the Cross Island YMCAEarly Childhood Center $100 - Deposit for each session.(both non-refundable)
EARLY CHILDHOOD MEDICAL FORM Completed Medical Form deadline June 14.
CROSS ISLA
ND
YMCA
CHILD
HO
OD
CAM
P
Session Dates Final Payment Due
I * June 29 - July 15* May 1
II July 18 - July 29 May 1
III Aug 1 - Aug 12 June 1
IV Aug 15 - Aug 26 June 1
*Session I is adjusted to reflect 12 days.
CHILDHOOD CAMP SESSIONS
Session AM / PM Time Fee per session
Session I
(12 days)
AM 7:00am -9:00am $102
PM 4:00pm-6:00pm $102
AM & PM 7:00am-6:00pm $204
Session II,
III, IV
(10 days)
AM 7:00am -9:00am $85
PM 4:00pm-6:00pm $85
AM & PM 7:00am-6:00pm $170
CHILDHOOD EXTENDED HOURS
5 Days (Mon - Fri) Payment
Session I (12 days) $570
Session II, III, IV (10 days) $475
3 day (M,W,F)Session II, III, IV
Payment$345
2 day (T,TH)Session II, III, IV
Payment$265
PreSchool Program CAMP RATES 3 to 4.5 years
5 Days (Mon - Fri) Payment
Session I (12 days) $564
Session II, III, IV (10 days) $470
Early Childhood CAMP RATES4.5-5.8 years
CROSS ISLAND YMCA CHILDHOOD CAMP
Cross Island YMCA * 238-10 Hillside Ave * Bellerose, NY 11426
5 Days (Mon - Fri) Payment
Session I (12 days) $600
Session II, III, IV (10 days) $500
3 day (M,W,F)Session II, III, IV
Payment$365
2 day (T,TH)Session II, III, IV
Payment$285
Toddler Program CAMP RATES 2-3.4 years
Sessions and Fee Schedule Check all sessions and circle all prices that apply to you.
Cross Island YMCA Summer Day Camp 2011 2 to 5.8 years Registration Form
Name: ________________________________________________________________________________________ Last First MI
Age: ________________________ DOB: _______________________________ Sex: _________________
Home Address: __________________________________________________________________________________ Street City-Town Zip
Home Phone Number: ___________________________ Parent’s Business Phone: ___________________________
Attention all members of 1199 and TWU: Please staple your voucher to this form. We will not accept any registration forms that are not accompanied by a voucher.
Session I (6/29 - 7/15) runs 12 days and is adjusted for camps and services as listed above.
A non-refundable deposit of $100 per session is required at the time of regis-tration.
A $50 non-refundable registration fee is required for campers who are not YMCA members.
Accepted forms of payment are cash or credit card.
Financial Aid is available to those that qualify. Forms are available at the Members Services Desk.
Toddler Camp 2 to 3.4 years 5 Days (Monday—Friday) □ Session I 6/29 - 7/15 $600 □ Session II 7/18 - 7/29 $500
□ Session III 8/1 - 8/12 $500 □ Session IV 8/15 - 8/26 $500
Fees
(12 Days) Session I $______________
Session II $______________
Session III $______________
Session IV $______________
— Discounts $______________
Extended Hours (Rate multiplied by # of sessions) $______________
Total Session Fee $______________
$50 Registration Fee (applies to non-members only) $______________
Grand Total $______________
Additional Services
Extended Hours AM only PM only Both
Session I Only $102 $102 $204
Sessions II, III, IV $85 $85 $170
3 Days (Monday, Wednesday, Friday)
□ Session II 7/18 - 7/29 $365
□ Session III 8/1 - 8/12 $365
□ Session IV 8/15 - 8/26 $365
2 Days (Tuesday, Thursday) □ Session II 7/18 - 7/29 $285
□ Session III 8/1 - 8/12 $285
□ Session IV 8/15 - 8/26 $285
PreSchool Camp 3 to 4.5 years 5 Days (Monday—Friday) □ Session I 6/29 - 7/15 $570 □ Session II 7/18 - 7/29 $475
□ Session III 8/1 - 8/12 $475 □ Session IV 8/15 - 8/26 $475
3 Days (Monday, Wednesday, Friday)
□ Session II 7/18 - 7/29 $345
□ Session III 8/1 - 8/12 $345 □ Session IV 8/15 - 8/26 $345
2 Days (Tuesday, Thursday) □ Session II 7/18 - 7/29 $265 □ Session III 8/1 - 8/12 $265
□ Session IV 8/15 - 8/26 $265
Early Childhood Camp 4.5 to 5.8 years 5 Days (Monday—Friday) □ Session I 6/29 - 7/15 $564 □ Session II 7/18 - 7/29 $470 □ Session III 8/1 - 8/12 $470 □ Session IV 8/15 - 8/26 $470
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TYPE OF EXAM: NAE Current NAE Prior Year(s)
Comments
REVIEWER:
Date Reviewed:
DOHMHONLY
PROVIDER I.D.
__ __ / ___ ___ / ___ ___
I.D. NUMBER
Health Care Provider Signature Date__ __ / ___ ___ / ___ ___
Health Care Provider Name and Degree (print) Provider License No. and State
Facility Name National Provider Identifier (NPI)
Address City State Zip
Telephone ( __ __ __ ) ___ ___ ___ – ___ ___ ___ ___
Fax ( __ __ __ ) ___ ___ ___ – ___ ___ ___ ___
Hep B __ __ / ___ ___ / ___ ___ __ __ / ___ ___ / ___ ___ __ __ / ___ ___ / ___ ___ __ __ / ___ ___ / ___ ___
Rotavirus __ __ / ___ ___ / ___ ___ __ __ / ___ ___ / ___ ___ __ __ / ___ ___ / ___ ___
DTP/DTaP/DT __ __ / ___ ___ / ___ ___ __ __ / ___ ___ / ___ ___ __ __ / ___ ___ / ___ ___
__ __ / ___ ___ / ___ ___ __ __ / ___ ___ / ___ ___ __ __ / ___ ___ / ___ ___
Hib __ __ / ___ ___ / ___ ___ __ __ / ___ ___ / ___ ___ __ __ / ___ ___ / ___ ___ __ __ / ___ ___ / ___ ___
PCV __ __ / ___ ___ / ___ ___ __ __ / ___ ___ / ___ ___ __ __ / ___ ___ / ___ ___ __ __ / ___ ___ / ___ ___
Polio __ __ / ___ ___ / ___ ___ __ __ / ___ ___ / ___ ___ __ __ / ___ ___ / ___ ___ __ __ / ___ ___ / ___ ___
RECOMMENDATIONS � Full physical activity � Full diet
� Restrictions (specify) ___________________________________________________________________________
Follow-up Needed � No � Yes, for _________________________ Appt. date: __ __ / ___ ___ / ___ ___
Referral(s): � None � Early Intervention � Special Education � Dental � Vision
� Other ________________________________________________________________________
ASSESSMENT � Well Child (V20.2) � Diagnoses/Problems (list) ICD-9 Code
_____________________________________________________________ __ __ __ __ __
_____________________________________________________________ __ __ __ __ __
_____________________________________________________________ __ __ __ __ __
Health insurance � Yes(including Medicaid)? � No
Does the child/adolescent have a past or present medical history of the following?
� Asthma (check severity and attach MAF/Asthma Action Plan): � Intermittent � Mild Persistent � Moderate Persistent � Severe PersistentIf persistent, check all current medication(s): � Inhaled corticosteriod � Other controller � Quick relief med � Oral steroid � None
� Attention Deficit Hyperactivity Disorder � Orthopedic injury/disability� Chronic or recurrent otitis media � Seizure disorder� Congenital or acquired heart disorder � Speech, hearing, or visual impairment� Developmental/learning problem � Tuberculosis (latent infection or disease)
� Diabetes (attach MAF) � Other (specify) ___________________
Explain all checked items above or on addendum
Birth history (age 0-6 yrs)
� Uncomplicated � Premature: ________ weeks gestation
� Complicated by _______________________________
Allergies � None � Epi pen prescribed
� Drugs (list)
� Foods (list)
� Other (list)
STUDENT ID NUMBEROSIS
CHILD & ADOLESCENT HEALTH EXAMINATION FORMNYC DEPARTMENT OF HEALTH & MENTAL HYGIENE — DEPARTMENT OF EDUCATION
Please Print Clearly
Press Hard
Child’s Last Name First Name Middle Name
Child’s Address
City/Borough State Zip Code
� Parent/Guardian Last Name First Name� Foster Parent
School/Center/Camp Name
Sex � Female � Male
Hispanic/Latino?
� Yes � NoRace (Check ALL that apply) � American Indian � Asian � Black � White
� Native Hawaiian/Pacific Islander � Other ____________________________
PHYSICAL EXAMINATION
Height ____________________ cm ( ___ ___ %ile)
Weight ____________________ kg ( ___ ___ %ile)
BMI ____________________ kg/m2 ( ___ ___ %ile)
Head Circumference (age ≤2 yrs) ______________ cm ( ___ ___ %ile)
Blood Pressure (age ≥3 yrs) _________ / __________
DEVELOPMENTAL (age 0-6 yrs) � Within normal limits
If delay suspected, specify below
� Cognitive (e.g., play skills) ____________________________
� Communication/Language _________________________
� Social/Emotional __________________________________
� Adaptive/Self-Help ________________________________
� Motor ___________________________________________
SCREENING TESTS Date Done Results
Blood Lead Level (BLL)__ __ / ___ ___ / ___ ___ _________ μg/dL
(required at age 1 yr and 2 yrsand for those at risk) __ __ / ___ ___ / ___ ___ _________ μg/dL
Lead Risk Assessment � At risk (do BLL)(annually, age 6 mo-6 yrs)
__ __ / ___ ___ / ___ ___ � Not at risk
Hearing
� Pure tone audiometry � Normal� OAE __ __ / ___ ___ / ___ ___ � Abnormal
—— Head Start Only ——
Hemoglobin or __________ g/dLHematocrit (age 9–12 mo)
__ __ / ___ ___ / ___ ___ __________ %
Date Done Results
Tuberculosis Only required for students entering intermediate/middle/junior or high schoolwho have not previously attended any NYC public or private school
PPD/Mantoux placed __ __ / ___ ___ / ___ ___ Induration ______mm
PPD/Mantoux read __ __ / ___ ___ / ___ ___ � Neg � Pos
Interferon Test __ __ / ___ ___ / ___ ___ � Neg � Pos
Chest x-ray � Nl � Not(if PPD or Interferon positive)
__ __ / ___ ___ / ___ ___� Abnl Indicated
Vision
__ __ / ___ ___ / ___ ___
Acuity Right ___ / ___(required for new school entrants Left ___ / ___and children age 4–7 yrs) � with glasses Strabismus � No � Yes
General Appearance:
Nl Abnl Nl Abnl Nl Abnl Nl Abnl Nl Abnl
� � HEENT � � Lymph nodes � � Abdomen � � Skin � � Psychosocial Development� � Dental � � Lungs � � Genitourinary � � Neurological � � Language� � Neck � � Cardiovascular � � Extremities � � Back/spine � � Behavioral
Date of Birth (Month/Day/Year )__ __ / ___ ___ / ___ ___ ___ ___
Phone Numbers
Home _____________________
Cell ______________________
Work ______________________
TO BE COMPLETED BY PARENT OR GUARDIAN
TO BE COMPLETED BY HEALTH CARE PROVIDER If “yes” to any item, please explain (attach addendum, if needed)
CH-205 (5/08) Copies: White School/Child Care/Early Intervention/Camp, Canary Health Care Provider, Pink Parent/Guardian
Medications (attach MAF if in-school medication needed)
� None � Yes (list below)
Dietary Restrictions
� None � Yes (list below)
Influenza __ __ / ___ ___ / ___ ___ __ __ / ___ ___ / ___ ___ __ __ / ___ ___ / ___ ___
MMR __ __ / ___ ___ / ___ ___ __ __ / ___ ___ / ___ ___ __ __ / ___ ___ / ___ ___
Varicella __ __ / ___ ___ / ___ ___ __ __ / ___ ___ / ___ ___
Td __ __ / ___ ___ / ___ ___ __ __ / ___ ___ / ___ ___ __ __ / ___ ___ / ___ ___
Tdap __ __ / ___ ___ / ___ ___ Hep A __ __ / ___ ___ / ___ ___ __ __ / ___ ___ / ___ ___
Meningococcal __ __ / ___ ___ / ___ ___ __ __ / ___ ___ / ___ ___
HPV __ __ / ___ ___ / ___ ___ __ __ / ___ ___ / ___ ___ __ __ / ___ ___ / ___ ___
Other, specify: ____________ __ __ / ___ ___ / ___ ___ ; _______________ __ __ / ___ ___ / ___ ___
IMMUNIZATIONS – DATES CIR Number of Child
Describe abnormalities:
District __ __Number __ __ __
EARLY CHILDHOOD CAMP & SCHOOL MEDICAL FORM ONLY
EARLY CHILDHOOD CENTER (AGES 2 - 5.8)Our teachers will welcome your child in a warm and safe, licensed environment. With a wide range of activities to stimulate your child's creativity, self-esteem, and independence, our YMCA values-based program willhelp your young child learn the essential social, physical, and intellectual building blocks.
NURSERY SCHOOL (JANUARY 2010 - AUGUST 2010)The Early Childhood Center is licensed with the New York Division of Day Care and registeredwith the New York State Education Department. Classrooms are staffed with an Early Childhoodteacher and a qualified teacher's assistant. All voucher programs are welcome. Children attending 3or 5 day Preschool program will swim 1 day a week. Not available for 2 day option. Please Note:Children in Toddler Program need not be fully toilet trained. Children in Preschool programs mustbe toilet trained.
EXTENDED HOURSAM: 7:30am - 9:00am PM: 4:00pm - 6:00pmAM: 5 Day - $80 3 Day - $50 2 Day - $35PM: 5 Day - $105 3 Day - $65 2 Day - $45
PAYMENT AND REGISTRATION PROCEDURETo register, a $50 Registration Fee and a $100 Deposit are required. Both are non-refundable.Tuition for each month is due one month ahead on the first of the month. Completed medical formwith proof of immunization is required 2 weeks before the first day of school. Automatic Monthlydraft is available through checking account or credit card.Month Payment Due DateJuly June 1, 2010August July 1, 2010
NURSERY SCHOOL (SEPTEMBER 2011 - AUGUST 2012)Registration for the 2011 - 2012 School Year starts March 1, 2011. For more information and fees or to arrange a tour, call the Early Childhood Director at 718-551-9313.
Monthly Rates Full Y Members Program Members
5 day $460 $485
3 day (M,W,F) $350 $370
2 day (T,TH) $270 $290
TODDLER PROGRAM (Ages 2.0 - 3.4 years)Half Day 9:00am - 12:00pm
Monthly Rates Full Y Members Program Members
5 day $430 $450
3 day (M,W,F) $325 $345
2 day (T,TH) $260 $275
PRESCHOOL PROGRAM (Ages 3.0 - 5.8 years) Half Day
9:00am - 12:00pm or 1:00pm - 4:00pm
Monthly Rates Full Y Members Program Members
5 day $840 $860
3 day (M,W,F) $645 $665
2 day (T,TH) $500 $520
PRESCHOOL PROGRAM (Ages 3.0 - 5.8 years) Full Day
9:00am - 4:00pm
Monthly Rates Full Y Members Program Members
5 day $910 $935
3 day (M,W,F) $695 $725
2 day (T,TH) $550 $565
TODDLER PROGRAM (Ages 2.0 - 3.4 years)Full Day 9:00am - 4:00pm
4
EARLY CH
ILDH
OO
D CEN
TER
2008
Outstanding Early ChildhoodProgram Award from
the NYSDepartment of
Education
RECREATIONAL CAMPSAges 6 - 12 • Sessions I - IV Recreational Camp is split into age groups. All Units participate in the following activities: Morning Assembly • Arts & Crafts • Swimming •Academic Enhancement • Trips • Lunch • Character Development • Sports & Games
DAY CAMP SESSIONMonday - Friday
DAY CAMP HOURS9:00am - 4:00pm Extended hours morning and evening available
UNITSUnit I: Campers born in 2005
who are 6 years old or have completed Kindergarten.
Unit II: Campers born in 2003 & 2004who are 7 or 8 years old.
Unit III: Campers born in 2001 & 2002who are 9 or 10 years old.
Unit IV: Campers born in 1999 & 2000who are 11 or 12 years old.
Teen: Campers born in 1996 - 1998who are 13 to 15 years old.
TEEN CAMPAges 13 - 15 • Sessions I - IVAt the Cross Island YMCA, we recognize that teenagershave a variety of changing interests. This awarenessprovides the foundation for our approach to the 2011camping experience for young adults. Teen Camp willhave three major components: sports and recreation,visual and performing arts, and leadership training. Allactivities, trips, and additional programming will be anoutgrowth of these three components. See page 7 for Teen Specialty Camps.
5
Session Dates Final Payment Due
I * June 29 - July 15* May 1
II July 18 - July 29 May 1
III Aug 1 - Aug 12 June 1
IV Aug 15 - Aug 26 June 1
*Session I is adjusted to reflect 12 days. See Pg. 10
CAMP SESSIONS
5 Day (Mon - Fri) AM Only PM Only Both
Session I
(12 days)$144 $144 $288
Session II, III, IV
(10 days)$120 $120 $240
TRANSPORTATION*Subject to change pending fuel costs
Session AM / PM Time Fee per session
Session I
(12 days)
AM 7:00am -9:00am $102
PM 4:00pm-6:00pm $102
AM & PM 7:00am-6:00pm $204
Session II,
III, IV
(10 days)
AM 7:00am -9:00am $85
PM 4:00pm-6:00pm $85
AM & PM 7:00am-6:00pm $170
EXTENDED HOURS
5 Days (Mon - Fri) Payment
Session I
(12 days)$444
Session II, III, IV
(10 days)$370
CAMP FEES
6
RECREATION
AL &
SPECIALTY CA
MPS
ADVENTURE CAMPAdventure campers enjoy & participate in: Hiking,Environmental awareness, Songs, Nature-based arts & crafts,Basic first aid, Team building challenges, Basic survival skills,Swimming & more! See Pg. 10
OUTDOOR CAMP LOCATIONOutdoor Adventure Camp is held at the Queens County Farmon Little Neck Parkway, which is just a couple of miles fromthe Cross Island YMCA. With plenty of outdoor open space,the Queens County Farm provides the opportunity to grow,learn, and appreciate the outdoors. Campers are to bedropped off and picked up at Queens County Farm. Allextended day programs take place on-site, not at the YMCA.
OUTDOOR ADVENTUREAges 6 - 14 • Sessions I - IVThe farm provides children with memorable and exciting out-door experiences. The setting enables each camper to enjoymore individualized attention from staff members. Childrenwill be provided with hands-on experiences and challenges,both physically and intellectually. The philosophy behind thiscamp is that the children will develop self-esteem, respect fornature and lasting friendships. Rates: $504 Session I (12 days)
$420 Session II, III, IV (10 days)
CREATIVE CAMPS At the Cross Island YMCA, we strive to build the spirit, mind,and body of every child in our programs. This mission wouldnot be fulfilled without allowing our children to explore theircreative side. Our Creative Camps do just that! These campwill allow campers to explore their interest in the arts on adeeper level. Try all three camps or master your favorite.
DANCE CAMPAges 6 - 12 • Sessions I & IISharpen your sense of rhythm, flexibility, and coordination inCross Island YMCA’s Dance Camp! In addition to learning thenewest moves on the hip hop scene, young dancers will beexposed to ballet, modern, and basic ballroom dance moves.Dancing improves self-esteem and total health. Join us for afun and exciting camp experience which will culminate in aperformance at each session’s end. Rates: $504 Session I (12 days)
$420 Session II (10 days)
CRAFTS CAMPAges 6 - 12 • Sessions III - IV Cross Island YMCA Crafts Camp will expose youngsters ages 6-12 to a vast array of creative arts, including sculpture, paint-ing, collaging, scrapbooking, drawing, and more. This proj-ect-based camp will give young artists hands on experiencetrying new mediums. Campers will make different art proj-ects every day, learn new skills, and develop lasting friend-ships in Crafts Camp! Rate: $420 per session
IN-DEPTH DRAMA CAMP Ages 6 - 12 • Sessions II & III(Campers MUST sign up for both sessions to be in this camp)Give your young performer the chance to be on stage inDrama Camp! Campers will learn the fundamentals of acting,character study, and more, as they prepare to perform in aculminating production. Children will learn the ins and outsof theatre, do improvisation exercises, and even try scriptwriting. The campers will have a stage performance for theCross Island YMCA every 2 weeks. Rate: $840 (2 sessions)
7
TEEN SPECIALTY CAMPS Adventure Camps Enjoy & Participate in: Hiking,Environmental awareness, Songs, Nature-based arts & crafts,Basic first aid, Team building challenges, Basic survival skills,Swimming & more! See Pg. 10See page 5 for Teen Recreation Camp
LEADERS-IN-TRAININGAges 16 - 17 • Sessions I - III Leaders are responsible for assisting Day Camp staff in provid-ing a variety of activities in a safe and well-supervised envi-ronment. The LIT program provides practical learning experi-ence for working with children. Interested teens must com-plete the application process and demonstrate the maturitynecessary to serve as a staff trainee. LITs will attend weeklytrainings revolving around each of the following themes: Howto Get a Job, Child Development, and Business Management.Each week LITs will be assigned to work with counselors invarious age groups. Note: LITs can be removed for lack ofparticipation To be eligible for the L.I.T. program, an applicant: • Must be at least 16 yrs.• Three letters of recommendation from a teacher/ guidancecounselor or community leader • Demonstrate a willingness to learn and work Rate: $100 per session
SPORTSAges 13 - 15 • Sessions I - III The Teen Sports camp gives active teens, both girls and boysthe opportunity to practice teamwork and play competitivesports. The camp will also focus on teaching fitness andhealthy lifestyles. Rates: $504 Session I (12 days)
$420 Session II & III (10 days)
TEEN TRIPAges 11 - 15 • Sessions II - III Join us as we go on a fun trip every single day of the session.Trips will not repeat, and campers will get to experienceplaces they have never gone before! Come travel Long Island,Connecticut, and NYC each and every day! Please note:Campers in Trip Camp will not participate in swimming, asthey will not be on site to do so. Trip camp children mustprovide their own lunch or bring money to purchase lunch onthe trips. Lunch is not provided for this camp.Rate: $600 per session
LISA BETH GERSTMAN CAMPFOR CHILDREN WITHPHYSICAL CHALLENGESAges 6 – 14 Session A & B The Cross Island YMCA is extremely proudto offer The Lisa Beth Gerstman YMCASummer Day Camp program serving chil-dren with physical challenges in an inte-grated setting. Every child deserves theopportunity to participate in a safe, car-ing, and fun learning environment. Ourgoal is to develop each child’s spirit,mind, and body through quality driven programs. This spe-cial camp is made possible through the generous support ofthe Lisa Beth Gerstman Foundation. Its donation has offsetthe expenses of equipment, transportation and staffingrequired to serve youngsters with physical disabilities. Allchildren will receive wheelchair accessible transportation,one-on-one swimming instruction, adaptive physical activitiesand equipment. One coordinator and a minimum of five per-sonal assistants will be available for every 10 campers. Rates: Session A: $607 (14 days) Session B: $650 (15 days)
LBG DAY CAMP SESSION DATESMonday - Friday Session A July 5 - July 22Session B July 25 - Aug. 12
LBG DAY CAMP HOURS9:00am - 4:00pm
LBG CONTACT INFORMATIONJean Dattner at 718-551-9325, [email protected] Dianne DiPeri at 718-551-9319, [email protected]
If you have a child that is developmentally disabledplease contact Jean Dattner or Dianne DiPeri.
TEEN &
SPECIALTY CA
MPS
8
SPORTS CAMPSOur Sports Camps aim to challenge young people to developtheir skills, enhance their knowledge and practice sportsman-ship and teamwork. To illustrate this concept, the CrossIsland YMCA is implementing an evaluation process of allSports Camps. By measuring levels of ability through an initial“skills assessment,” campers can spend each session focusingon their specific areas of need. At the end of the session,another evaluation will be administered so that children cansee how much they have improved. These campers will worktowards a culminating event for each session. *Session Iprices are adjusted to reflect 12 days. See Pg. 10
BOYS TEAM SPORTS CAMPAges 6 - 12 • Sessions I - IV Team Sports Camp will incorporate four sports for boys:Baseball, Basketball, Soccer and Flag Football. Campers willlearn basic fundamentals and rules for each of the sports.Each day of the week our staff will focus on one of the foursports. Our goal is to expose the children to a variety ofsports. Join us as we take our sports camps to a new level.Camper should bring proper equipment for each sport. Rates: $504 Session I (12 days)
$420 Session II & III & IV (10 days)
GIRLS TEAM SPORTS CAMP Ages 6 - 12 • Sessions I - IVThis summer Team Sports Camp will incorporate four popularsports for girls: Softball, Basketball, Soccer and Volleyball.Campers will learn basic fundamentals, rules and skills foreach of the sports. Each day of the week our staff will focuson one of the four sports. Our goal is to expose the childrento a variety of sports. Join us as we take our sports camps toa new level. Campers should bring proper equipment for eachsport. Rates: $504 Session I (12 days)
$420 Session II & III & IV (10 days)
PROGRESSIVE BASKETBALLAges 6 - 12 • Sessions I - IVClasses are based on appropriate age and level of play. Allability levels are welcomed. Offensive and defensive skillsand team concepts develop the most complete basketballplayer possible. Rates: $504 Session I (12 days)
$420 Session II & III & IV (10 days)
BASEBALL CAMPAges 6 - 12 • Session I In this brand new camp, children will practice hitting, pitch-ing, fielding, and other defensive and offensive techniques.They will review the rules of baseball and practice teamworkand sportsmanship. Campers should bring their own glove! Rates: $504 Session I (12 days)
GYMNASTICS CAMPAges 6 - 12 • Session II Drills and skills in all Olympic events, following a progressiveprogram. Dance, conditioning, stretching and performancetips will focus on fun for gymnasts of every level. The lastday exhibition will give gymnasts an opportunity to show theirnew skills. Rate: $420 Session II (10 days)
MARTIAL ARTS CAMPAges 6 - 12 • Session IIIIn this camp, participants will learn techniques and positivecharacteristics such as self-respect, self-discipline, honor, andrighteousness, Martial arts has been proven to be effective indefense situations. There will be an exhibition on the lastday.Rate: $420 Session III (10 days)
TENNIS CAMPAges 6 - 12 • Session I - IIIThe Tennis Camp offers drills and activities carefully designedfor different developmental levels so each camper will have asuccessful learning experience. The camp will focus on posi-tioning, court layout and rules and regulations. The camperswill also learn about the basic fore-hand and back handstrokes and compete in both singles and doubles activities. Campers must bring a racket and a sun visor or hat. Rates: $504 Session I (12 days)
$420 Session II & III (10 days)
9
REGISTRATIO
N FO
RM
Sessions and Fee Schedule Check all sessions and circle all prices that apply to you.
Cross Island YMCA Summer Day Camp 2011 Registration Form
Name: ________________________________________________________________________________________ Last First MI Age: ________________________ DOB: _______________________________ Sex: _________________
Home Address: __________________________________________________________________________________ Street City-Town Zip Home Phone Number: ___________________________ Parent’s Business Phone: ___________________________
Attention all members of 1199 and TWU: Please staple your voucher to this form. We will not accept any registration forms that are not accompanied by a voucher.
Session I (6/29 - 7/15) runs 12 days and is adjusted for camps and services as listed above. Days and sessions may be split for recreational camp (units 1-4 & teen camp) but NOT specialty camps. A non-refundable deposit of $100 per session is required at the time of registration. A $50 non-refundable registration fee is required for campers who are not YMCA members. Accepted forms of payment are cash or credit card. Financial Aid is available to those that qualify. Forms are available at the Members Services Desk.
Recreational Camps
Early Childhood Camp *Register at Desk for the Monthly Early Childhood program
Session I 6/29 - 7/15 $564 Session II 7/18 - 7/29 $470 Session III 8/1 - 8/12 $470 Session IV 8/15 - 8/26 $470
Recreational Camp (Units 1-4 & Teen Camp)
Session I 6/29 - 7/15 $444 Session II 7/18 - 7/29 $370 Session III 8/1 - 8/12 $370 Session IV 8/15 - 8/26 $370
Specialty Camps Baseball Camp Tennis
Session I 6/29 - 7/15 $504 Session I 6/29 - 7/15 $504 Session II 7/18 - 7/29 $420
Session III 8/1 - 8/12 $420 Session I 6/29 - 7/15 $504 Session II 7/18 - 7/29 $420 Crafts Camp Session III $420 Session III 8/1 - 8/12 $420 Session IV 8/15 - 8/26 $420 Session IV 8/15 - 8/26 $420
Boys Team Sports Gymnastics Camp
Session I 6/29 - 7/15 $504 Session II 7/18 - 7/29 $420 Session II 7/18 - 7/29 $420 Session III $420 In-Depth Drama Camp
Session IV 8/15 - 8/26 $420 Session II &III 7/18 - 8/12 $840
Girls Team Sports Teen Trip Camp Session I 6/29 - 7/15 $504 Session II 7/18 - 7/29 $600 Session II 7/18 - 7/29 $420 Session III 8/1 - 8/12 $600 Session III $420 Session IV 8/15 - 8/26 $420
Teen Sports Dance Camp Session I 6/29 - 7/15 $504
Session I $504 Session II 7/18 - 7/29 $420 Session II 7/18 - 7/29 $420 Session III 8/1 - 8/12 $420
Martial Arts Camp Leaders In Training
Session III 8/1 - 8/12 $420 Session I 6/29 - 7/15 $100 Session II 7/18 - 7/29 $100
Outdoor Adventure Camp Session III 8/1 - 8/12 $100 Session I 6/29 - 7/15 $504 Session II 7/18 - 7/29 $420 Lisa Beth Gerstman Camp
Session III 8/1 - 8/12 $420 Session A 7/5 - 7/22 $607 Session IV 8/15 - 8/26 $420 Session B 7/25 - 8/12 $650
Basketball Camp
8/1 - 8/12
8/1 - 8/12
8/1 - 8/12
6/29 - 7/15
Fees
(12 Days) Session I $______________
Session II $______________
Session III $______________
Session IV $______________
Mini Camp $______________
— Discounts $______________ Extended Hours
(Rate multiplied by # of sessions) $______________ Transportation
(Rate multiplied by # of sessions) $______________
Total Session Fee $______________ $50 Registration Fee (applies to non-members only) $______________
Grand Total $______________
Additional Services Extended Hours AM only PM only Both Session I Only $102 $102 $204 Sessions II, III, IV $85 $85 $170 Transportation (ages 6+ only) AM only PM only Both Session I Only $144 $144 $288 Sessions II, III, IV $120 $120 $240
Registrati
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SummYMCAA and
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11
Address:emHo
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Additional Ser
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rvices
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ISession 6/29 - 7IISession 7/18 - 7
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Dance Camp
ISession IISession 7/18 - 7
8/1 - 8/
6/29 - 7
oth 04 70
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Teen Trip Cam
7/15 $504 II Session 7/29 $420 I IInSessio
$420 8/26 $420
Teen Sports
I Session $504 II Session
7/29 $420 I IInSessio
/12
7/15
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7/18 - 7/29 $600 8/1 - 8/12 $600
6/29 - 7/15 $504 7/18 - 7/29 $420 8/1 - 8/12 $420
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Fees
IionsSes) _____________ $______
IIionsSes _____________ $______
IIInSessio _____________ $______
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Session I (6/29 7/15) r
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6/29 - 7/15 $100 7/18 - 7/29 $100 8/1 - 8/12 $100
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10
11
Cross Island YMCA Summer Day Camp Emergency Contact Form
Name: ______________________________________________________________________________________
Last First MI
Age: ________________________ DOB: _______________________________ Sex: _______________
Home Address: ________________________________________________________________________________ Street City-Town Zip Home Phone Number: __________________________ Cell Phone Number: _____________________________
Mother’s Name: _______________________________ Mother’s Work Number: __________________________
Father’s Name: ________________________________ Father’s Work Number: ___________________________
IF THERE IS AN EMERGENCY AND PARENTS CANNOT BE REACHED:
Name: _____________________________ Phone Number: ____________________ Relationship: ___________
Name: _____________________________ Phone Number: ____________________ Relationship: ___________
Name: _____________________________ Phone Number: ____________________ Relationship: ___________
IF MEDICAL CARE IS NEEDED:
Doctor’s Name: _______________________________ Phone Number: __________________________________
Does your child have any allergies? Please list them here: ______________________________________________
Is your child currently taking any medication? (If so, list type and what for): ______________________________
I am the legal parent/guardian of ______________________________ and do hereby give my permission for any medical treatment deemed necessary in case of an emergency.
All information concerning your child will be available to the Camp Supervisory Staff as well as their Counselors, at the discretion of the Camp Director. I acknowledge that I have received the Parent Handbook and Health Examination Form to be returned before the child attends camp.
I assume all financial responsibilities for my child. I understand that camp deposit and registration fees are non-refundable. I give permission for my child to attend field trips under the supervision of the Cross Island YMCA staff. My child is permitted to participate in all camp activities as described in the camp brochure and Parent Handbook. Standard Release Form - I HEREBY CONSENT to the use, publication, and display, by or on behalf of the Cross Island YMCA, any photograph, digital image or videotape and any reproduction thereof in which I or my minor child may be portrayed or identified by name. It is understood that the YMCA of Greater New York and member organizations may use, publish and display such photographs or digital images or reproductions thereof, in whole or in part, for any business purpose in their individual discretion. I waive all claim for any compensation for such use. I understand that my child will participate in all camp activities.
____________________________________________ ______________________
Signature Date
Alternate Escorts: (We will not release your child to anyone not listed below without your written consent.)
1. ________________________________________ 2. ________________________________________
3. ________________________________________ 4. ________________________________________
Emergencylanoss IsCr
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Address: __emHo
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_______: _______erbmuhone NP
_______: _______erbmuhone NP
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Relationship:__________________
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12
CON
TACT &
MED
ICAL FO
RM
R R R R R R is si e to e i e in arent e ore presentation to si ian
_________________________________________________________________________________________________ R R : ______________________________________________ Permit No. 85: ________________
______________________________ _____________________________ ____/____/____ Male Female Child’s Last Name First Name Date of Birth Sex Home Address: ________________________________________________ Tel. No. _______________________
Parent or Guardian: _____________________________________________ Tel. No. _______________________
Place of Employment:
Father Guardian: _________________________________________ Tel. No. _______________________
Mother Guardian: ________________________________________ Tel. No. _______________________
In Case of Emergency, please notify: _______________________________ Tel. No. _______________________
If Parent/Guardian are not available in an emergency, please notify: 1. ___________________________________________________________ Tel. No. _______________________ 2. ___________________________________________________________ Tel. No. _______________________ Important: Has this camper been exposed to any communicable disease during the three weeks prior to camp attendance. Yes No If yes, state type of exposure: _________________________________________________
R : (Check and give approximate dates) Allergies Diseases
Ear Infections __________________ Hay Fever _____________________ Check Pox ____________________ Rheumatic Fever _______________ Ivy Poisoning, etc. ______________ Measles ______________________ Convulsion ___________________ Insect Stings ___________________ German Measles _______________ Diabetes _____________________ Penicillin ______________________ Mumps ______________________ Behavior _____________________ Other Drugs ____________________ Other Contagious Illnesses _______ Asthmas ____________________ ____________________________ Other Past Illnesses: ________________________________________________________________________________
Operations or Serious Injuries (Dates): _________________________________________________________________
Hospitalization (Dates): _____________________________________________________________________________
Chronic or Recurring Illness: ________________________________________________________________________
Any specific activities to be encouraged? _______________________________________________________________
Conditions that require activity to be restricted? __________________________________________________________
Permission for all program activities unless otherwise noted by doctor: ________________________________________
Appliance worn (glasses, contacts, etc.): _________________________________________________________________
Medication taken: __________________________________________________________________________________
Suggestion from Parent/Guardian: _____________________________________________________________________
R R R I do hereby give authority to the Day Camp and Year Round Afterschool and Youth Center Program staff to obtain necessary emergency medical treatment for my child with the understanding that the family will be notified as soon as possible. ________________________ _________________________________ _______________ _________________________ Relationship Signature Date Telephone No.
CAMP MEDICAL FORM (EARLY CHILDHOOD CAMP USE PG. 3 ONLY)
CAMP MEDICAL FORM (EARLY CHILDHOOD CAMP USE PG. 3 ONLY)
13
(To be filled out by Physician. Please note information on reverse side)
The purpose of this health record is to provide the staff with pertinent information, which will help to serve the needs of this child in Day Camps and Afterschool and Youth Center programs.
R : This is a record of dates of basic immunization and most recent booster doses.
Type Date Date Date Date Date
DtaP, DTP or TD
OPV/IPV
MMRHemophilus Influenza Type
Hepatitis B
Varicella
Other (Specify):
: To be filled out by license physician Examination is acceptable when performed no more than 12 months prior to arrival at camp.
Code: S = SatisfactoryX = Not Satisfactory, Explain: O = Not examined
General Appearance: ________________________________________________________________________________ Height: __________ Weight: _________ Blood Pressure: _____________ Hgb Test (Date): ____________________Urinalysis: Date: _______________ Posture & Spine: _______________ Throat & Tonsils: ______________________ Eyes ________ Vision __________ W/ Glasses ____________ Extremities ___________ Heart ___________________ Ears ________ Hearing _________ Feet: _________ Lungs _______________ Skin __________________________Nose _____________ Teeth __________________ Abdomen _______________ Hernia _________________________Genitalia __________________________________________________________________________________________ Neurological Findings _______________________________________________________________________________ Describe Abnormal Findings and/or Handicapped Conditions _______________________________________________ __________________________________________________________________________________________________ Has child ever received products containing horse serum? __________________________________________________ Allergy: (Please specify) _____________________________________________________________________________
Recommendations and restrictions while in After-school: Special Diet: _______________________________________________________________________________ Special Medicine (Name it) ____________________________________________________________________ Is parent/guardian sending special medicine? ______________________________________________________ Swimming _________________________________ Diving _________________________________________ Activity Restrictions __________________________________________________________________________
General Appraisal: ____________________________________________________________________________________________________________________________________________________________________________________ __________________________________________________________________________________________________
I have examined the person herein described, reviewed his/her health history and it is my opinion that he/she is physically able to engage in Day Camp/Year Round Afterschool and Youth Center activities, except as noted above.
___________________________________MD _________________________________________________ Physician’s Name (PLEASE PRINT) Examining Physician’s Signature
Telephone: ____________________________ Address: _________________________________________ Date of Examination: ____________________ _________________________________________
14
REGISTRATIO
N &
PAYMEN
TREGISTRATION & PAYMENTPOLICY• The enclosed registration form must be submitted at theMembership Office at the Cross Island YMCA. Registrationbegins on February 1, 2011. You must register in person. • Prior to First Day of Camp you must provide a completedmedical form, which must be filled out by a doctor and signedby parent or guardian. Your child/children cannot attendcamp without this form. The forms are enclosed or availableonline.• To reserve a space, a non-refundable deposit of $100 persession must be submitted with the application. This paymentwill be applied to your child’s first week of camp. • $50 non-refundable registration fee is required for camperswho are not YMCA members at the time of registration. • Accepted forms of payment are cash or credit card. • Refunds - YMCA Day Camp fees are non-refundable. In theevent of illness or injury, a doctor's note would be necessaryfor withdrawal. • There will be a $25 (per change) transaction fee for anychanges made with regard to camp or transportation afterregistration is completed.
DISCOUNTS AND FINANCIAL ASSISTANCE • 10% Early Bird Registration Discount when registration iscompleted before Saturday, May 14.• 10% Sibling Discount - discount on camp and transportationrates applies to the second child from the same family livingin the same household. Only siblings qualify for the discount.The discount applies to the lowest fee. Cannot be combinedwith early bird discount.• Financial Aid is available to those that qualify. Applicationscan be obtained from the Member Registration Desk and aredue back to the desk by April 30.
TRANSPORTATION The Cross Island YMCA has partnered with the RivlabTransportation to provide our summer campers with the besttransportation service possible. Each bus will meet all DOTsafety requirements. Transportation to and from the CrossIsland YMCA is available only to campers in Recreational orSpecialty Camps (not Early Childhood Camp, contact directly)who attend regular hours (9:00am – 4:00pm). We do not offertransportation for our “Extended Hours” campers. The registration deadline for transportation service isTuesday, May 31. The Cross Island YMCA offers transportation within the follow-ing communities:
ABOUT YOUR Y DAY CAMPSTAFF • Staff are hired based on experience and commitment toworking with children from varied backgrounds. Lead coun-selors are at least 18 and have certification in CPR, First Aidand Water Safety. • All camp staff receives a minimum of 40 hours of pre-camptraining. Employment applications will be available at theMember Registration Desk beginning Feb. 1, 2011.
LUNCH • On trip days campers receive a cold lunch consisting of asandwich, fruit and a drink. Hot lunch is served on all otherdays. Lunches & menus are provided by the Department ofEducation. • Early Childhood Camp and Center will not provide lunch.Lunch must be provided by the parent or guardian of eachcamper.
SNACK • Snack must be provided by the parent or guardian of eachcamper. The Cross Island YMCA will not be distributing snacks.
WHAT TO BRING • It is suggested to wear shorts, sneakers and T-shirts. Forsafety purposes, do not wear skirts or sandals. • Bathing suit, bathing cap and towel are required on swimdays; however, it is recommended that swim items be broughtevery day. • Sunscreen and water bottles are also recommended. • Bathing caps are available for purchase at the MemberRegistration Desk. • Campers are to wear a camp shirt everyday. Campers willreceive two camp shirts on their first day. • Additional YMCA camp t-shirts available for purchase in thecamp office.
FAMILY NIGHTS • Occur on special dates throughout the summer. Informationwill be distributed to campers as it becomes available.
ArverneBaysideBelleroseCambria HeightsDouglastonElmontFar RockawayFloral ParkFlushingForest HillsFranklin Square
Fresh MeadowsGlen OaksHempsteadHollisJamaicaJamaica EstatesKew GardensLaureltonLittle NeckNew Hyde ParkOzone Park
Queens Village Rego ParkRochdaleRosedaleSt. AlbansSpringfieldGardensValley Stream West Hempstead
REGISTER
Non-ProfitOrganizationU.S. Postage
PAIDJamaica, NY
Permit No. 871
CROSS ISLAND YMCA238-10 Hillside Ave.Bellerose, NY 11426Tel: 718-479-0505 Fax: 718-468-9568Web: ymcanyc.org/crossisland