Glacier Hills Day Camp July 15 - 19, 2013 | Camp Winding River, Neosho Outdoor Cookin g • Arts • Cr afts • Games • Outdoor Skil l s • Te a m B u i lding
A rc he ry R an ge • Sp or ts Fi el d • C am p fi re s •
Camp Winding River Offers: • Volunteer-led day camp for grades K-12 • Trained & experienced directors • Beautiful natural setting • Scenic nature trails • Fun and enriching experiences
Sw im m in g • C an oe in g • R iv er Tr ai l
Glacier Hills Day Camp July 15 - 19, 2013 | Camp Winding River 9:00 a.m. - 3:30 p.m. Volunteer Directors: Pam “ Woodstock” Brandt gresbrandt5@yahoo.com | 262-644-6495 (H) 262-384-1335 (C) Elise “Pieces” Brandt lc.brandt@yahoo.com | 262-644-6495 (H) 262-384-1336 (C)
Camp: Where Imagination Comes Alive Come to our girl-led camp and let your imagination come to life. Chef? Olympic Swimmer? Captain of the ship or sailor? Astronomer? Rock star? Explore endless career possibilities and cool off with snow cones. Enjoy swimming, archery, nature, crafts, LOST (Learning Outdoor Skills Together), fire building, cooking, songs, and games, all led by our amazing teen
role models. Earn a special Glacier Hills patch as you discover new friends and reconnect with old ones. Gain confidence as you advance your skills, challenge yourself with new experiences in the great outdoors, and grow as a leader. The week will conclude with an awesome all-camp activity.
Volunteer Opportunities
Camp cannot happen without adults like you. We need you, a family member, friend, or even a neighbor to volunteer even if it is only for a day or two. If you cannot volunteer during the week of camp, please offer to help with pre-camp preparations or camp set-up or take-down. In most troops, parents share the adult volunteer responsibilities. Our volunteers tell us that their favorite part about being at camp is spending time with their camper, getting to know her friends, and seeing her build new skills and have fun.
Adults Needed
• Each day one adult is needed for every five girls. • Specific Roles: Five-day Volunteers, Unit Volunteers, Peewee Unit Volunteers, Bus Captains, Overnight Coordinators, Overnight First Aiders, Canoeing and Archery Instructors (training provided), Chaperones, Camp set-up (Sunday) and take-down (Friday)
Be a Superhero!
Program Aide (PA)
Close to 1,000 teen Girl Scouts spend part of their summer leading activities at day camp, becoming real-life superheroes to younger Girl Scouts.
As a Program Aide, you will continue to mentor younger campers and help adults with activities and/or in a unit with campers. PA training and camp training are required. Check the website for PA training dates and your day camp’s web page for camp training dates. There is no fee to be a PA. PAs pay the overnight fee, if applicable.
Te e n Le a d e r s h i p O p p o r t u n i t i e s
90% of teens agreed that “at Girl Scout camp, my experiences have helped prepare me to be a better leader.”
Entering Grades 8-9
Program Aide-in-Training (PAIT)
Counselor-in-Training I and II (CIT I and II)
Build your leadership skills as you learn how to be an effective Program Aide. In addition to participating in camp activities with other PAITs, you get the chance to show your leadership skills as you help and lead younger campers. PAITs pay the camper fee.
Be a CIT…your next leadership step. CITs lead activities or lead a unit with an adult mentor. CIT training and camp training are required. Check the website for CIT training dates and your day camp’s web page for camp training dates. There is no fee to be a CIT. CITs pay the overnight fee, if applicable.
Entering Grade 7
Entering Grade 10 - Graduating Seniors
For more information on day camp go to www.girlscoutdaycamp.com • 800-565-4475
A Typical Day at Camp 9:00 a.m. Campers arrive and opening flag ceremony 9:15 a.m. Water games, art, nature, skill building, team building and fun 11:00 a.m. Lunch 1:00 p.m. More water games, art, nature, skill building, team building and fun 3:15 p.m. Songs, closing flag ceremony 3:30 p.m. Campers depart
Camp Sneak-A-Peek Saturday, March 9 2:00 - 4:00 p.m. Camp Winding River
Daisy and Brownie Families and Troops
Get a sneak peek at all the fun you’ll have at day camp this summer. Girls will enjoy games, songs, crafts, and a camp snack, while parents and troop leaders have a chance to meet the camp director, see camp, and have questions answered. •F ee: $5 per girl; adults and children are free •B ring your camp registration or proof of registration to the event and receive a free water bottle. •R egister at www.gswise.org and click on Events and Camps. Click on Volunteer-Led Day Camp and then Camp Sneak Peek.
How to Register Registration will automatically open Monday, February 4, at 11:00 p.m. Online registrations are processed first and then paper registrations. •P rogram Activity Credits (PAC) earned through the Girl Scout Cookie Program Activity or Fall Nut Sale can reduce the cost for the girl who earned the PAC to attend
Online
Fees camp or an event. Write the camp/ event name on the PAC and mail in if registering online or attach to paper registration form. • Girls registering with an adult volunteer will guarantee registration. • Registration may close early if girl registrations begin to exceed adult volunteer coverage.
Secure
•G o to www.gswise.org and click Your Spo ta on Events and Camp. Click on Camp an t d Volunteer-Led Day Camp and then Register Online How to Register. Today! • Create one account per family so that camper’s parent/guardian receives confirmation information. • Pay full payment with a credit/debit card (Visa or MasterCard) or checking account. • Adults volunteering complete the Adult Day Camp Registration and online application and background check. Adults volunteering at day camp are also asked to become a registered member of the organization. • Complete any peewee/boy registrations. • Mail or bring used PACs to any council resource center. Write the name of your day camp on the PAC.
Paper • Complete the Registration and Health History forms or download forms. • Pay full payment with a credit/debit card (Visa or MasterCard) or checking account. • Adults volunteering complete the Adult Day Camp Registration and online application and background check. Adults volunteering at day camp are also asked to become a registered member of the organization. • Mail in or bring registration form and used PACs to any council resource center. Write the name of your day camp on the PAC.
All Girls Welcome All girls are welcome to attend day camp. If your girl is not a registered Girl Scout, include an additional $12 for membership dues with payment.
Confirmations Confirmations will be sent by your volunteer day camp director two weeks prior to your camp session. Packing list, information about specialty or theme days, and more are listed on your day camp’s web page. Confirmations include: • Pick-up cards and procedures • Unit assignment and bus stop information (if taking the bus) • Address and directions to camp
Refunds/Cancelations • Refunds, minus $25 nonrefundable processing fee, are available for cancelations received six weeks prior to the session start date. Within six weeks, refunds, minus $25, will only be issued for medical reasons, summer school, a death or critical illness in the immediate family, or if the family moves out of the area. • Cancelations must be made in writing.
•C amper (entering grades 1–7): Fee includes day camp t-shirt, patch, busing, and some meals/ snacks. - $100 per camper on or before May 5 - $125 per camper May 6 - July 1 - Registration closes July 1. No late registrations accepted. • PA/CIT (entering grades 8-12): No fee, includes day camp patch, busing, and some meals/snacks. - Girls pay overnight fee, if applicable. Register by July 1. • Overnights $15/night - Girls entering grade 6: Wednesday - Girls entering grade 7 (PAIT): Wednesday and Thursday - Girls entering grades 8-12 (PA/CIT): Sunday, Monday, Thursday. • Peewees (ages 3-5) and boys (ages 6-12): $15 per day, only on days the parent is volunteering
Financial Assistance Financial Assistance is available for registered members of Girl Scouts of Wisconsin Southeast to help families meet the cost of sending their girl to camp and events. Financial Assistance is funded by gifts to Girl Scouting and proceeds from the Girl Scout Cookie Program Activity. One resident camp, one day camp, and one event will be considered for Financial Assistance per girl. A Financial Assistance Form can be found on our website www.gswise.org and click on Forms. If registering online, mail completed form to the address listed within one week or mail with paper registration and $25 nonrefundable deposit.
Bus Transportation We reserve the right to cancel or change a bus stop if there are not enough bus riders. You will be notified at least two weeks prior to camp if a bus stop you registered for is canceled. Bus Stops • Addison Elementary School, Slinger Elementary, Hartford Rec Center
Girls with Additional Needs Let us know of any concerns you may have. Our goal is to provide a positive camp experience for all girls. Providing us with information about medications, special diets, and nighttime routines along with physical and mental limitations, will help us provide a positive camp experience for your girl. For specific questions or situations, please email or call the volunteer day camp director.
Girl Scouts of Wisconsin Southeast
Complete and Mail to:
2013 Volunteer Led DayCamp Registration
Girl Scouts of Wisconsin Southeast P.O. Box 14999 Milwaukee, WI 53214-0999
Register only one person per form. See camp information for specifics. Visit www.gswise.org for additional forms. Please check every category Camper’s name:___________________________________________________________________________________________________________________________________________________ Address:___________________________________________________________________________________________ City:_____________________________________________________ County:___________________________________________________________________________________________ State:__________________ Zip:______________________________ Phone: (________)______________________ Birthdate: __________________________________________________________ Troop # (if applicable):__________________ Grade in Fall 2013:___________ Troop Leader Name:________________________________________________________________________________ School: __________________________________________________ Note: Confirmation information will be sent to your e-mail address listed below. Please print clearly. E-mail address for confirmation:________________________________________________________________________________________________________________________________________ Buddy Request (Name) (Check day camp web page for availability.): ___________________________________________________________________________________________________ 1. Check Participation (grade in fall)
r Camper (grades 1-6) r PAIT (grade 7) r PA (grades 8-9) r CIT (grades 10-12)
r Peewee r M r T r W r Th r F r Boy r M r T r W r Th r F
2. Choose Day Camp(s) Kenosha and Racine Camps r Trefoil/ Dare to Imagine • July 15-19 r Windy Waters/Imagine Atlantis • July 29-Aug 2 rC ountry Cousins/Country Cousins Silly Circus • Aug 5-9 r Kenosha/ Once Upon a Day Camp • Aug 5-9 Washington and Waukesha County Camps
r Alpha Moraine • June 10-14 r Lakeland • June 10-14 r Deer Trails • June 17-21 r Rising Stars/Meadow Springs • June 17-21 r Prairie Hill • June 24-28 r Arrowhead • July 8-12 r Whispering Willows • July 15-19 r Glacier Hills • July 15-19 r River Valley • July 22-26 r Sun Lakes • July 22-26 r Sunny Trails • July 29-Aug 2 r Woodland Trails • July 29-Aug 2 r Indian Springs • Aug 5-9 r Enchanted Waters • Aug 5-9 r Northern Lights • Aug 12-16
3. C hoose Overnights (if applicable)
rS rM rT rW r TH
5. Choose FREE Camper T-shirt (Girls entering grades 1-7 only) Select One
6. Advanced Trading Post (optional) Additional T-shirt Price
YM (10-12) YL (14-16) AS AM AL AXL AXXL AXXXL
YM $ YL AS AM AL AXL AXXL AXXXL Progression Patch Adult Rain Poncho Youth Rain Poncho Bandana
7. R ace/Ethnicity (optional, check all that apply)
8. Camp Fees
Race r American Indian or Alaskan Native r Hawaiian or Pacific Islander r White (Caucasian) r African American or Black r Asian Ethnicity r Hispanic or Latino r Not Hispanic or Latino
4. Choose Transportation List Bus Stop: _________________
From
Camper fee: Overnight fee (if applicable): Trading Post fees: Donation amount:
$______________ $______________ $______________ $______________
Accept my tax-deductible gift to support camp.
GSUSA Membership Dues ($12): $______________ (If not currently registered)
Program Activity Credit (attach) PAC #____: Final Total:
– $______________ $______________
r Financial Assistance requested - a completed Volunteer Led Day Camp Financial Assistance form, found at www.gswise.org, and must be received with camp registration form.
Ride Bus Private To
QTY
10.00 10.00 10.00 10.00 10.00 10.00 12.00 12.00 2.25 3.25 3.25 4.00
To
From
S M T W TH F
I have read the camp information and agree that my camper and I will abide by the regulations and procedures stated therein, including those on refund, nonrefundable deposit, and health of camper. I understand that I am responsible for getting my camper to and from this camp or bus stop. I give my camper permission to ride the bus, if applicable. I give my camper permission to attend and participate in all phases of this session (except those noted on the Health History form), including off-site trips, if applicable. I give permission for photographs/video of my camper to be taken for GSUSA, GSWISE, and American Camp Association publicity and marketing purposes. If my camper is not already a registered Girl Scout, I give my permission for them to register as a member of the Girl Scouts of the USA.
Parent/guardian signature:___________________________________________ Date:__________________
Enclose full amount which already includes the $25 nonrefundable deposit or enclose a minimum of $25 if applying for financial assistance. Outstanding balances, including gift certificates and Program Activity Credits are due May 13. If you register online or pay by credit/debit card, outstanding balances will be automatically charged no later than May 16. Pay in full if registration is received after May 13. Any additional fees or outstanding balances will be automatically charged 7-10 days prior to camp. For all credit/debit card or check/e-check transactions, bank/credit card statements will show payments processed by Active Network. Check enclosed payable to GSWISE Charge r Visa r MasterCard Account # Card holder’s name (print)
Signature
Over for MANDATORY Health HISTORY Form
$ Exp. date
Complete and Mail to:
Girl Scouts of Wisconsin Southeast
Girl Scouts of Wisconsin Southeast P.O. Box 14999 Milwaukee, WI 53214-0999
2013 Health History
For Office Use Date:_____________________
Please print clearly and use blue or black ink.
Entered:_________________
Camper’s name:_____________________________________________________________________________________________________________________________________________ Session #1:________________________________________________________________________________________________ Date of session:__________________________________ Session #2:________________________________________________________________________________________________ Date of session:__________________________________ Session #3:________________________________________________________________________________________________ Date of session:__________________________________ Mother/guardian name: ________________________________ Phone during camp hours: (__________)_____________________ Phone #2: (__________)________________________ Father/guardian name: _________________________________ Phone during camp hours: (__________)_____________________ Phone #2: (__________)________________________ Camper is in custodial care of (check one): r Both r Mother r Father r Other__________________________________________________________________________________ Person(s) authorized to pick up child at camp/bus stop:____________________________________________________________________________________________________________ Emergency Contacts (besides parent/guardian) 1. Name: ______________________________________________________________________________ Relationship: ________________________________________________________ Phone during camp hours: (_____________)_____________________________________________Phone #2: (_____________)________________________________________________ 2. Name: ______________________________________________________________________________ Relationship: ________________________________________________________ Phone during camp hours: (_____________)_____________________________________________Phone #2: (_____________)________________________________________________ Medical History Family physician name:______________________________________________________________________________________ Phone #:_ (____________)___________________________ Are any medications taken on a regular basis? r Yes r No
If yes, does this need to be administered at camp? r Yes r No
If yes, explain:________________________________________________________________________________________________________________________________________________ Do you have any restrictions or special needs related to physical activity? r Yes r No If yes, explain:_______________________________________________________________ ____________________________________________________________________________________________________________________________________________________________
The following non-prescription medications are commonly stocked in the camp health center and used on an as needed basis to manage illness and injury. Cross out any of the following items the camper should NOT be given. • Antibiotic ointment (Neosporin) • Anti-itch cream or lotion • Athletes foot ointment or powder • Aloe or burn gel
• Tums • Ibuprofen (Advil, Motrin) • Acetaminophen (Tylenol) • Benadryl
Immunization Dates (M/D/Y) (Series Completed, Year of Booster) “Current” is not acceptable. Tetanus or DPT______________________________ Polio________________________________________ MMR________________________________________ Hepatitis B__________________________________ Varicella/HIB_________________________________ Since last health exam:
r Exposed to a contagious disease r Had a surgical operation r Had a serious illness Describe:____________________________________
• Eye drops • Rubbing alcohol • Hydrogen peroxide • Laxative
• Anti-diarrheal • Epi Pen
CHECK ALL THAT APPLY Illness
Allergies – include severity
Others or Special Needs
r Heart defect/disease
r Animals_____________________________
r Wears contacts/glasses
r Musculoskeletal disorders
r Insect stings_________________________
r Fainting
r Asthma
r Pollen_______________________________
r Ear problems/tubes
r Bleeding/Clotting disorder
r Latex_______________________________
r Hearing impairment
r Seizures
r Medicine/Drugs______________________
r Emotional behaviors
r Diabetes
r Nuts________________________________
r Other_____________________
r Milk_________________________________
r ADD/ADHD (circle one) r medicated not medicated
____________________________
r Food (specify)_______________________
r Sleep disturbances
____________________________
r Other (specify)______________________
r Menstrual cramps
____________________________
Type & Severity of Reaction___________
r Nosebleeds
____________________________
______________________________________
r Other_________________________
____________________________
______________________________________
________________________________
Please explain any items that you check. Include any useful information relative to any of these health conditions. ____________________________________________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________________________________________ I give my permission for my camper to receive necessary health care, prescribed medications, and emergency medical treatment. This health history is complete and accurate. I will not allow my camper to attend if they become exposed to any contagious disease, or if for any reason, I do not consider them to be in good physical condition. Upon arrival the camp health personnel have the right to refuse to admit anyone to the camp who does not meet the acceptable health conditions, e.g. temperature, contagious disease, etc. Parent/guardian signature:_______________________________________________________________________________________ Date:_______________________________________
Girl Scouts of Wisconsin Southeast
2013 Volunteer Led DayÂCamp Adult Registration
Complete and Mail to:
Girl Scouts of Wisconsin Southeast P.O. Box 14999 Milwaukee, WI 53214-0999
Only completed forms will be accepted. To be filled out by an adult.
Adult volunteer’s name: _________________________________________________________________________ Camp Name: ___________________________________________________________ Address:__________________________________________________________________________ City/State/Zip: ______________________________________________________________ Email Address: _______________________________________________ Home Phone: (_________)___________________________ Cell: (_________)___________________________ Birthdate: ____________________________________________ Occupation: _________________________________________________________________________________________ Are you a registered Adult Girl Scout for 2012-2013? r Yes r No If no, you can enclose the $12 GSUSA membership dues and support Girl Scouting by becoming a member. Background Check and References (Required) r Prior to submitting this form I have completed an online application and background check and submitted references at www.gswise.org. r I have already completed an online application and background check with the Girl Scouts Wisconsin Southeast within the last 3 years. M EDICAL HISTORY Name of family physician: __________________________________________________________ Phone number: (_____________)_________________________________________ A llergies r Animals r Hay Fever r Insect Stings r Plant r Pollen r Medicine/Drugs r Food r Nuts r Milk r Latex r Other Type and severity of reaction: _____________________________________________________________________________________________________________________________________ ILLNESSES r Bleeding/Clotting Disorders r Seizures r Asthma r Diabetes r Heart Defect/Disease r Musculoskeletal Disorder r Other If other, list special needs: ________________________________________________________________________________________________________________________________________ SPECIAL NEEDS r Wears Contacts/Glasses r ADHD or ADD r Hearing Defect/Disease r Hypertension r Other: ________________________________________________________________ IMMUNIZATIONS r Tetnus DPT: _________________________________ r HepB: _________________________________ (optional) MEDICATIONS r Yes r No If yes, does this need to be administered at camp? r Yes r No If yes, please explain: _____ ________________________________________________________________________________________________________________________________________ Do you have any restrictions or special needs to physical activity? r Yes r No If yes, please explain: __________________________________________________________________ Do you require a special diet or have any dietary restrictions? r Yes r No If yes, please explain: ______________________________________________________________________ CAMP SPECIFICS Name(s) and troop number(s) of camper(s) attending camp: _______________________________________________________________________________________________________ Name(s) of Pee Wee(s) and/or boys(s) attending camp: _______________________________________________________________________________ r M r T r W r Th r F I am Volunteering for: Day(s) r S r M r T r W r Th r F r unknown
Nights
r S r M r T r W r Th
Transportation: Bus Stop ______________________________________ Ride Bus to Camp: r M r T r W r Th r F Private Transportation: To Camp: r M r T r W r Th r F
From Camp:
From Camp:
r M r T r W r Th r F
r M r T r W r Th r F
EMERGENCY CONTACTS Name: ___________________________________________________________________________ Relationship: ________________________________________________________________ Phone during camp hours: (_________)______________________________________________ Phone #2: (_________)_________________________________________________________ Name: ___________________________________________________________________________ Relationship: ________________________________________________________________ Phone during camp hours: (_________)______________________________________________ Phone #2: (_________)_________________________________________________________ Have you ever volunteered at day camp? r Yes r No If so, when and in what capacity? _____________________________________________________________________________ AREAS OF INTEREST - please check all that apply (directors will assign on the basis of need, not just interest) r With my daughter r Not with my daughter r Boys unit r Peewee unit r Kitchen r Bus monitor r Shopper r Crafts r Nature r Equipment r Pre-camp preparation r Set up (day before camp) r Clean up (last day of camp) r Other: _____________________________________________________________________ CAMP FEES r $12 Girl Scout Membership for 2012-2013 (recommended) r $10 Camp T-shirt Size: r AS r AM r AL r AXL r AXXL r AXXXL r I would like a free camp patch r $ ___________ Donation (accept my tax deductible gift to support camp) (r For Trefoil only -adult horseback riding $30 ________) r Total enclosed: $ _____________ I have read the camp information and agree that I will abide by the regulations and procedures stated therein, including those on refund, non refundable deposit, and health. I understand that I am responsible for getting to and from this camp or bus stop. I give permission for photography/video of me to be taken for GSUSA, GSWISE, and the American Camp Association publicity and marketing purposes. If I am not already a registered Girl Scout, I give permission to register as a member of the Girl Scouts of the USA. I give permission to receive necessary health care and emergency medical treatment. The health history on this form is complete and accurate. I will not attend if I become exposed to any contagious disease, or if for any reason, I do not consider myself to be in good physical condition. Upon arrival the camp health personnel have the right to refuse to admit anyone to the camp who does not meet the acceptable health conditions e.g. temperature, contagious disease, etc.
Adult volunteer signature:_________________________________________________________________________________________________ Date:___________________________________