2014 YMCA of Austin Summer Camp by Phillip Lybrand

SAVE 30! $

— YMCA OF AUSTIN —

A SUMMER

TO EXPLORE

2014 SUMMER CAMP

CONTENTS WAYS TO REGISTER

WELCOME

THE Y SUMMER CAMP

SO MUCH

MORE CAMPS FILL UP FAST

CAMP OVERVIEW KINDER CAMP ages 4&5

5 6–7

CAMP DATES

CAMP FEES

LOCATIONS

PAYMENT DUE DATES FINANCIAL ASSISTANCE POLICY

›››5

WAYS TO REGISTER

›››

ONLINE AustinYMCA.org

REGISTRATION PACKET

9–12

CAMP DETAILS

THEME CAMP ages 5–12

14–15

SPORTS CAMP ages 8–12

16–17

ADVENTURE CAMP ages 11–14

18–19

IN PERSON Fill out the registration packet and hand it to us.

MAIL Fill out the registration packet and mail it to us.

YMCA OF AUSTIN Program Services 3208 Red River Suite #100 Austin, TX 78705

EMAIL Fill out the enclosed packet, scan it and email it to us. programservices@austinymca.org

FAX Fill out the enclosed packet, scan it and fax it to us. 512.478.8065

Summer Camp 2014 ∙ REGISTER ONLINE

» AustinYMCA.org

WELCOME TO SUMMER

THANK YOU FOR YOUR INTEREST IN YMCA OF AUSTIN SUMMER CAMP We provide a happy, healthy environment for children to learn and grow. Children have the opportunity to build self-confidence, independence, & creativity, and parents have peace of mind knowing their child is in a safe and enriching place.

WE CARE

• Experienced and caring adult staff • Staff and counselors who are genuinely interested in working with children • Low camper-to-staff ratios (15 to 1) • Character Values and Asset-Based Curriculum

Summer Camp 2014 ∙ REGISTER ONLINE

SAFETY COMES FIRST

• Day camps are licensed by TDFPS or TDH • Staff is First Aid and CPR certified • Staff is Basic Water Rescue qualified • Multiple criminal background checks have been performed on every staff member including fingerprint checks

» AustinYMCA.org

EVERYONE BELONGS AT THE Y FINANCIAL ASSISTANCE AVAILABLE • Individuals and families may apply for financial assistance for membership or programs such as child care and day camp. • Awards are based on a number of factors including total household income and number of dependents in the household. The process is confidential and application forms are available at each YMCA branch.

FUN FOR EVERY AGE

CAMP OVERVIEW

Recommended for campers who have yet to attend Kindergarten and need a slower pace with a little more quiet time, Kinder Camp is the place to start. Campers benefit from an afternoon quiet/nap period as well as lower camper-to-staff ratios: 12-to-1 during the camp day and 10-to-1 during swimming & field trips.

For those campers looking for the traditional day camp experience, Theme Camp is the way to go. Changing theme-related crafts, organized games, and character development activities help make each week a unique experience. Add in a weekly field trip and twice weekly dips in the pool and you have all the ingredients for a summer full of memories!

If your budding superstar is looking to increase his or her skills and learn about the values of teamwork and sportsmanship, then Sports Camp is your next stop. Daily drills and weekly competitions ensure skill development; while crafts, team building exercises, nutrition lessons, swimming, and community service events promote the development of the whole athlete.

If your camper has graduated from the day camp experience and is ready to move to the next level, then Adventure Camp should be this summer’s challenge. Get ready for a summer full of hiking, tubing, exploring, climbing, and more. Each week consists of three field trips and two days of swimming. A special week like extreme challenge involves inter-camp competition.

Summer Camp 2014 ∙ REGISTER ONLINE

» AustinYMCA.org

DATES / FEES / LOCATIONS WEEK

CAMP DATES

PAYMENT DUE

*Jun 2–6

May 23

Jun 9–13

May 30

Jun 16–20

Jun 6

Jun 23–27

Jun 13

Jun 30 –Jul 3

Jun 20

Jul 7–11

Jun 27

Jul 14–18

Jul 4

Jul 21–25

Jul 11

Jul 28–Aug 1

Jul 18

AAug 4–8

Jul 25

Aug 11–15

Aug 1

*Aug 18–22

Aug 8

*select locations only

REGISTRATION FEES DEPOSITS $30 per child $15 per child/ per week KINDER / THEME / SPORTS Camp Y members $160 week NonMembers $195 week JULY 4TH WEEK Y members $130 week NonMembers $155 week ADVENTURE CAMP Y members NonMembers JULY 4TH WEEK Y members NonMembers

$180 week $215 week $145 week $170 week

FINANCIAL ASSISTANCE POLICY YMCA of Austin programs and activities are designed to benefit persons of all backgrounds, and fees are based on the cost of providing each program. While participants are expected to pay their fair share, when financial assistance dollars are available, the YMCA will assist any individual or family that wants to participate but cannot afford the fee. Financial Assistance (FA) applicants are required to complete a Financial Assistance Packet, which includes a one-page FA application, acknowledgment of award responsibility, and provide proof of household income—tax return, two pay stubs or bank statements of all household earners. Since demand for assistance is great and funds are limited, the Y encourages parents to apply early. Only completed applications (included enrollment forms and FA packet) will be accepted.

KINDER CAMP

THEME CAMP

Northwest YMCA / CrossPointe Church 5703 McNeil Dr Austin, TX 78729

Hays YMCA 465 Buda Sportsplex Dr. Buda, TX 78610

Oak Hill United Methodist 7815 U.S. 290 Austin, TX 78736

Baranoff Elementary 12009 Buckingham Gate Rd Austin, TX 78748

Pease Elementary 1106 Rio Grande Austin, TX 78701

Cowan Elementary 2817 Kentish Dr Austin, TX 78748

Spicewood Elementary 11601 Olson Dr Austin, TX 78750

East Communities YMCA 5315 Ed Bluestein Blvd Austin, TX 78723

SPORTS CAMP

Fulmore Middle School 201 Mary St Austin, TX 78704

Winn Elementary 3500 Susquehanna Lane Austin, TX 78723

Laurel Mountain Elementary 10111 D-K Ranch Rd Austin, TX 78759

ADVENTURE CAMP

Concordia HS Pflugerville 1500 Royston Ln Round Rock, TX 78664

Dahlstrom Middle School 3600 Farm to Market 967 Buda, TX 78610

Northwest YMCA / CrossPointe Church 5703 McNeil Dr Austin, TX 78729

Golfsmith 11000 Middle Fiskville Rd Austin, TX 78753

Bailey Middle School 4020 Lost Oasis Hollow Austin, TX 78739

Mathews Elementary 906 West Lynn Street Austin, TX 78703

Carpenter Hill Elementary-Hays 4410 Ranch Road 967 Buda, TX 78610 Springs YMCA 27216 Ranch Road 12 Dripping Springs, TX 78620 North Central Theme TBA

North Adventure TBA

Summer Camp 2014 ∙ REGISTER ONLINE

» AustinYMCA.org

CAMP DETAILS SHARKS ‘N MINNOWS

SAFETY

This two-week theme provides Kinder and Theme campers with four swim lessons per week. Lessons are taught by YMCA swim instructors in small group settings. Remember to bring swimsuit, towel, and sunscreen everyday.

Safety always comes first at the YMCA of Austin, and it begins before the first day of camp. Staff are carefully chosen using in-person interviews, reference checks, and training attendance. The Y looks to hire experienced, caring, enthusiastic, and responsible staff for all positions.

FIELD TRIPS & BUSING Kinder, Theme, and Sports Camps take one field trip per week; Adventure Camp takes three field trips per week. Local school districts (Austin, Hays, or Round Rock) or charter bus companies provide transportation for all trips.

SWIMMING Weather permitting, all camps will enjoy two trips to the pool weekly. Most camps swim at YMCA of Austin interactive pools; some camps swim at city pools. Low ratios will exist for all swim trips and lifeguards will always be present in addition to camp staff.

T-SHIRTS While supplies last, the YMCA will provide one t-shirt per camper. Although not required, campers are encouraged to wear their Y camp t-shirt on field trip days.

E FRE MP C-ASHIRT! T

SPECIAL NEEDS Summer Camp is open to all children, and the YMCA will work with children of all abilities. Parents have a duty to disclose significant medical, physical, or behavioral needs at the time of enrollment. Due to the large-group format of camp, the Y is unable to provide one-on-one care except on an intermittent basis. Summer Camp 2014 ∙ REGISTER ONLINE

THE MISSION OF THE YMCA OF AUSTIN is to put Christian Principles into practice through programs that build healthy Spirit, Mind and Body for all.

» AustinYMCA.org

CREATIVITY STARTS HERE Kinder Camp is perfect for children who have not yet attended Kindergarten. Kinder Camp offers ageappropriate field trips, games, crafts, and books which emphasize a new theme each week. Campers will enjoy a field trip and two trips to the pool each camp week. This camp has a little more quiet time yet all the fun and activities of Theme Camp. Remember to bring a sleeping mat, blanket, and pillow daily for quiet time.

ABOUT

Boys & Girls ages 4 & 5* WEEKLY FEES (regular weeks) Y members $160 / NonMembers $195 JULY 4TH WEEK FEE Y members $130 / NonMembers $155 CAMP HOURS 7:30 am – 6:00 pm No half-day fees are available. Campers may be dropped off and picked up at anytime.

* no age exceptions

The program and activities were terrific. My daughter had a blast.

— Kinder Camp Parent

Summer Camp 2014 ∙ REGISTER ONLINE

» AustinYMCA.org

KINDER CAMP CALENDAR Jun 2–6

Jun 9–13

Jun 16–20

Jul 7–11

Jul 14 –18

Aug 4–8

Aug 11–15 Aug 18–22

week 0

week 1

week 2

week 3

week 4

week 5

week 6

week 7

week 8

week 9

week 10

week 11

Northwest CrossPointe

Hays YMCA

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Oak Hill UMC-South

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C C A

C C H

A E C

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H A E

B F J

D D D

F I B

I J F

J B I

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LOCATIONS

Jun 23–27 Jun 30– Jul 3

Jul 21– 25 Jul 28–Aug1

WEEKLY

THEMES A SUPERHEROES Put on your cape and mask and show us your super powers! Study your favorite legends and dress in your favorite gear, as we spend the week learning about all kinds of superheroes. We’ll talk about what makes a superhero SUPER and how YOU can be a hero too!

E WILD WEST Cowboys and cowgirls: grab your boots and hat, while we learn all the basics to being a true rodeo star. Sharpen your skills throwing horseshoes, twirling a lasso, and galloping with your stick horse around the ring. An unforgettable camp experience will have you hollering, “Yee-haw!”

I UNDER THE BIG TOP Put on your bow ties and top hats, because the YMCA three ring circus is coming to town. This week will be packed with carnival games and juggling, learning all about wild animals, and showing off our amazing talents at the end of the week. Welcome to the greatest show on earth!

B INNOVATION STATION Put on your thinking caps! We’ll use our inquiring minds, creative problem solving skills, and imaginations to experiment and manipulate anything we can get our hands on. Old, new, recycled, and mixed materials will be our medium for exploring, building, and creating!

F GETTIN’ AROUND TOWN Explore and discover all types of transportation that get us from home to school, across the country, and all over the world! Create your own plane, train, or car to zoom around camp like a speed racer. Beep beep!

J YOUNG ARTISTS Have you ever wanted to draw with your feet or run your toy cars through paint? This week we’ll learn about some of the basics, but also push the boundaries and try new ways to create masterpieces!

C SHARKS ‘N MINNOWS Beat the Texas heat! Visit the pool four days a week for 40-minute swim lessons. Whether you’re a first time swimmer or already comfortable in the water, YMCA swim instructors will help you overcome your doubts and develop lifelong water safety skills. D OLYMPIAD Calling all Y Olympians. This special week brings all Y campers together for an ultimate day of fun and games. Learn about your camp’s country, paint a flag, design costumes, and sing songs to represent your team and celebrate sports and culture! Summer Camp 2014 ∙ REGISTER ONLINE

G PIRATES AND PRINCESSES Who said boys and girls can’t be the best of friends?! Lessons and stories from popular books will inspire Y campers to work together. Embark on an amazing adventure full of enchanting stories and wild imaginations, as we build castles, ward off dragons, and hunt for treasure.

K ISLAND ADVENTURES * Ever wonder what it would be like to live on the beaches of Hawaii? We’ll cover all the basics: study the culture and traditions, make native jewelry, learn how to hula, build sandcastles, and end the week with a luau. Aloha!

* CrossPointe only

H DIGGING UP DINOS Step back into the prehistoric times and discover the world of dinosaurs! Dig up hidden bones, examine fossils, and hunt for eggs while we explore a time when these ancient creatures roamed the world.

» AustinYMCA.org

DISCOVERY STARTS HERE Theme Camp will offer kids new experiences mixed with old camp favorites each week. Campers thrive during various daily activities including organized games, arts and craft projects, exciting field trips, and swimming. Many activities will focus on the YMCA character values of Respect, Responsibility, Honesty, Caring, and Faith.

ABOUT

Boys & Girls ages 5 – 12* WEEKLY FEES (regular weeks) Y members $160 / NonMembers $195 JULY 4TH WEEK FEES Y members $130 / NonMembers $155 CAMP HOURS 7:30 am – 6:00 pm * no age exceptions

My kids came home happy and I felt confident in the staff. — Theme Camp Parent

Summer Camp 2014 ∙ REGISTER ONLINE

» AustinYMCA.org

THEME CAMP CALENDAR LOCATIONS

Baranoff Elem.-South Cowan Elem.-South East Communities YMCA Winn Elem.-East Pease Elem.-Central North Central-TBA* Spicewood Elem.-North Laurel Mtn. Elem.-North Concordia HS-Pflugerville Carpenter Hill Elem.-Buda Springs YMCA

Jun 2–6

Jun 9–13

Jun 16–20

Jul 7–11

Jul 14 –18

Aug 4–8

Aug 11–15 Aug 18–22

week 0

week 1

week 2

week 3

week 4

week 5

week 6

week 7

week 8

week 9

week 10

week 11

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G D D C D D I D A A B

B D D I D D D A G C D

D H H D H B D C D D D

D I G D E E C B D D A

I C C A B G E I E H H

C G A H A I H G H B G

F F F F F F F F F F F

H E B E C H K H I G L

A A I B I C G K B E C

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B E G G A A E

J* J*

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B D — — —

Jun 23–27 Jun 30– Jul 3

Jul 21– 25 Jul 28–Aug1

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I I

J* J*

*TBA - check website for updates - AustinYMCA.org

Y WEEKLY

THEMES A SUPERHEROES Join us as we turn Austin into a living comic! We’ll use our imaginations to stop crime in its tracks and save the world! Make Captain America, Wonderwoman, Spiderman, Superman, and Batman themed crafts! Costumes encouraged on special days! B ARTRAGEOUS If you love to express yourself through art, this is the right week for you. We will draw, paint, and sketch our way to becoming confident and passionate artists! C TEXAS PRIDE Want to learn a whole lot more about Texas and what makes our state unique? Create Texas themed crafts, read Texas themed books, and even enjoy a field trip authentic to Texas! D SHARKS ‘N MINNOWS Summer means it’s time to swim! Float, paddle, and kick your way to becoming a better swimmer with swim lessons from YMCA swim instructors! Four, 40-minute swim lessons, for experienced and non experienced swimmers alike, will ensure skill development and greater confidence in and around the water.

E MYSTERY ACADEMY Do you enjoy solving puzzles and learning how to explain things through science? As budding scientists, campers will practice using their brains to solve puzzles, do scientific experiments, and even visit a real science museum! F OLYMPIAD The Sochi Winter Olympics may be over but your future Olympian can join the fun at the Y. Learn and celebrate the traditions and customs of a new country and test your skills in an end of week YMCA style celebration. Games, food, and fun for everyone! G JUNGLES AND SAFARIS Sure you may know about the Texas Longhorn, but what about the animals of the rainforest, the jungle, or even the savanna? Let the YMCA take you on a journey of learning about animals from afar. H SPLISH SPLASH Texas summers can be hot, but with this camp, you can beat the heat. Come swim, splash, and slide your way into a cooler summer! Water games, relays, crafts, and more combine to produce a consistent summer favorite.

I TIME TRAVELER Let’s go back to the future! Big hair, bright colors, and grooveyness! Prepare to experience a different decade each day. Appreciate camp as a hippie, a pioneer, or maybe even a caveman! J AWESOME ADVENTURES* As the summer concludes, boredom is not an option! This camp will unlock the fun secrets Austin has to offer as we tour the city with a new field trip each day of camp!

11 locations for Awesome * Week Adventures are different

• Cowan South held at SW YMCA • North Central held at N. Austin YMCA • Laurel Mtn. held at NW YMCA/CrossPointe • Carpenter Hill held at Hays YMCA • Springs YMCA held at Spring YMCA • East YMCA held at East YMCA

K PIRATES AND BUCCANEERS* Ahoy matey! Join our crew of noble pirates as we bring the fun of open water discovery to summer camp. Pirate costumes and fictional books about pirates will give us a real taste of pirate life.

* select locations only L SPORTS SPECTACULAR* The Springs Family YMCA has great facilities! Tackle a new sport each day and work to improve skills in swimming, basketball, tennis, kickball, and even gymnastics!

* select locations only Summer Camp 2014 ∙ REGISTER ONLINE

» AustinYMCA.org

SUCCESS STARTS HERE YMCA Sports Camp is an ideal destination for every child who enjoys playing sports and being active. Y Sports Camp introduces and emphasizes the fundamentals of sports to each child. From skills to drills to the importance of teamwork, Sports Camp provides a fun and supportive environment for athletes of all skill levels.

ABOUT

Boys & Girls ages 8 – 12* WEEKLY FEES (regular weeks) Y members $160 / NonMembers $195 JULY 4TH WEEK FEES

Y members $130 / NonMembers $155 CAMP HOURS

7:30 am – 6:00 pm * no age exceptions Special Note: Locations and sports do require campers to be out-side during the camp day. YMCA staff is trained in the challenges of operating outside during the summer. Camps will take routine breaks inside or in the shade, and schedules are adjusted to limit exposure during the hottest part of the day. In addition, campers are encouraged to bring their own water bottle; extra water will also be provided by camp staff throughout the day.

My child enjoyed doing a variety of sports throughout the summer. The variety was fun! — Sports Camp Parent 12

Summer Camp 2014 ∙ REGISTER ONLINE

» AustinYMCA.org

SPORTS CAMP CALENDAR LOCATIONS

Jun 2–6

Jun 9–13

Jun 16–20

Jul 7–11

Jul 14 –18

Aug 4–8

Aug 11–15 Aug 18–22

week 0

week 1

week 2

week 3

week 4

week 5

week 6

week 7

week 8

week 9

week 10

week 11

E B

A E

G F

C D

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D C J

D A

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H H J

A D

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F G J

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Fulmore

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B A

GolfSmith

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Northwest CrossPointe

Jun 23–27 Jun 30– Jul 3

Jul 21– 25 Jul 28–Aug1

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WEEKLY

THEMES A BASKETBALL (Two, 1-week sessions) B SOCCER C INDOOR SOCCER D SWIMMING & WATER GAMES (Two, 1-week sessions) E FLAG FOOTBALL F VOLLEYBALL G BOWLING H KICKBALL I

BASEBALL*

*NW CrossPointe Only

J GOLFSMITH (11000 Middle Fiskville, 78753) Offered during weeks 5,6,&7 ONLY TIMES Monday–Friday 8:30am–12:30pm PRICE $200/week for Y members $250/week for NonMembers Campers receive golf instruction from PGA professional with equipment provided by Golfsmith. Campers receive gifts from Golfsmith, including t-shirt, golf balls, and tees.

Summer Camp 2014 ∙ REGISTER ONLINE

» AustinYMCA.org

EXCITEMENT STARTS HERE Designed for mature and older school-aged kids, Adventure Camp offers greater opportunity for specific skill development. Most of the day will focus on the weekly topic while also offering a healthy dose of swimming, arts and crafts, sports, and field trips. An extra emphasis will be placed on team building and leadership skills this summer.

ABOUT

Boys & Girls ages 11– 14* WEEKLY FEES (regular weeks) Y members $180 / NonMembers $215 JULY 4TH WEEK FEES Y members $145 / NonMembers $170 CAMP HOURS 7:30 am – 6:00 pm * no age exceptions

Wonderful staff. Did not have to worry at all.

— Adventure Camp Parent Summer Camp 2014 ∙ REGISTER ONLINE

» AustinYMCA.org

ADVENTURE CAMP CALENDAR Jun 2–6

Jun 9–13

Jun 16–20

Jul 7–11

Jul 14 –18

Aug 4–8

Aug 11–15 Aug 18–22

week 0

week 1

week 2

week 3

week 4

week 5

week 6

week 7

week 8

week 9

week 10

week 11

Dahlstrum Middle School-Hays

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Mathews Elementary-Central

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North-TBA

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B E G H

D A H K

H B F I

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F C I A

E H A E

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I F D C

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Bailey Middle School-South

A D B G

LOCATIONS

Jun 23–27 Jun 30– Jul 3

Jul 21– 25 Jul 28–Aug1

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WEEKLY

THEMES A ROCKS & ROPES Can you climb it? The rock walls and challenge courses of Central Texas are waiting to test you this summer. With strong effort, you’ll reach new heights of confidence, agility, and teamwork.

F CAVING Spelunking, we will go! Don’t be afraid of the dark – explore it. Grab your gear and investigate the mysteries held within the caves of Central Texas.

B RIVER RAFTIN It’s time to grab your inner tube and hit the rivers of Central Texas as we cool off in the summer heat. The ever-present watchful eyes of Y camp staff & lifeguards will always be nearby.

G INTO THE WILD – CAMPING Stars, s’mores, and campfire songs await us this week! Campers will learn general camping etiquette before putting their knowledge to the test with an end of the week overnight camp-out at the beautiful YMCA Camp Cypress on Onion Creek.

C GAME ON Bring on the games! Lace up the roller skates, grab your bowling shoes, and get ready for an arcade full of fun at camp! Throughout the week, campers will use their imaginations to invent new games while enjoying all of their Y favorites.

H ATX ADVENTURES It’s all about Austin this week for Y campers. Together, we’ll be exploring the sights and sounds of our own backyard with possible field trips to IMAX, sail boating on Lady Bird Lake, and more.

D BULLSEYE We’ll be on the move this week as we line up our sights and develop our skills as marksmen. Paintball and laser tag field trips help us find our targets. Catch us if you can! E CENTEX ADVENTURES Adventure awaits us this week as we explore the greatest attractions of Central Texas. Join us for action packed trips to places like Six Flags, Splashtown, and Austin’s Park.

Summer Camp 2014 ∙ REGISTER ONLINE

K HIT THE TRAIL* Head outside to experience the beautiful Texas Hill Country this summer. Campers will get a taste of the great outdoors while hiking picturesque trails and enjoying exercise, fresh air and fun! *north location only

I GET DRENCHED When temperatures soar, we’ll be keeping cool during this wild, wet, and water-filled week! Pack the swimsuits, goggles, and sunscreen as we prepare to play extreme water games. J EXTREME CHALLENGE Whether you’re a Camp Brazos Steer, Colorado Armadillo, Guadalupe Bobcat, or Rio Grande Rattler, this week will require all your wits, strength, and creativity. A week full of challenges and sportsmanship culminates in a YMCA style competition featuring four Adventure Camps and two Sports Camps.

» AustinYMCA.org

YMCA OF AUSTIN 2014 SUMMER DAY CAMP

Workforce CCS

REGISTRATION PACKET

Financial Assistance

REGISTRATION PACKET CHECKLIST

Camper information - pg. 1 of 4

Camper Information Authorization for Emergency Medical Care & Waivers (2 pages) Payment Method Authorization

To comply with State Licensing laws, ALL SECTIONS OF THIS FORM MUST BE COMPLETED before we can accept any child for care.

Session Enrollment form(s) Payment for Deposits & Registration Fee (fee waived in Feb. & Mar.)

*please print GENERAL CAMPER INFORMATION CHILD #1

CHILD #2

first & last name

date of birth boy

grade: 2014/15 school year

date of birth boy

girl

grade: 2014/15 school year girl

Please list any special needs that your child may have. Such as physical limitations, emotional or behavioral issues, allergies, existing illness, previous serious illness, injuries during the past 12 months, any medication prescribed for long-term continuous use, and any other information of which the staff should be aware of.

PARENT / GUARDIAN INFORMATION PRIMARY

SECONDARY

*Person listed as Primary Guardian will be the sole person authorized to request changes to information and/or cancellation of care. PRIMARY Parent/Guardian mother father Authorized to pick child up?

yes

Please check box if secondary parent is authorized to make changes to childcare account SECONDARY Parent/Guardian mother father Authorized to pick child up?

first & last name

city

home phone

first & last name

home address

yes

home address

state

cell phone

zip

work phone

city

ext.

home phone

cell phone

work phone

ext.

EMERGENCY CONTACT / AUTHORIZED PICK-UPS *Must list at least one emergency contact other than the parents listed above. LOCAL PERSON OTHER THAN THOSE LISTED ABOVE TO CONTACT IN CASE OF EMERGENCY IF PARENT/LEGAL GUARDIAN CANNOT BE REACHED: To be in compliance with EMERGENCY CONTACT #1

EMERGENCY CONTACT #2

first & last name

home address

city

home phone

home address

cell phone

state

zip

work phone

Online Registration Available » www.AustinYMCA.org

city

ext.

home phone

cell phone

state

zip

work phone

ext.

YMCA OF AUSTIN 2014 SUMMER DAY CAMP

REGISTRATION PACKET

child 1 name

child 2 name

Authorization for Emergency Medical Care - pg. 2 of 4 *please print GENERAL CAMPER INFORMATION To comply with State Licensing laws, a preferred physician and hospital must be listed. In the event that the parent/guardian cannot be reached to make arrangements for emergency medical attention, I hereby authorize the YMCA of Austin, Program Staff to take my child(ren) to: Dell Children’s Hospital 4900 Mueller Blvd. 78723

512.324.0000

St. David's NAMC

12221 Mopac Blvd. 78758

512.901.1000

Seton Northwest

512.324.6000

South Austin Hospital

901 West Ben Blvd. 78704

512.447.2211

11113 Research Blvd. 78759

Other

Seton Medical Ctr. (Hays) 6001 Kyle Pkwy. Kyle, 78640

512.504.5000

please provide name of hospital

physician name

address

phone

PARENTAL CONSENT

*Please provide your initials acknowledging each item below

CONSENT FOR TREATMENT I give consent for any and all necessary treatment when my child(ren) is in the care of his physician or hospital. AUTHORIZATION In case of sickness or accident, I hereby give my permission to the medical personnel selected by the YMCA to order and/ or perform any medical attention deemed necessary, if I am unable to be contacted. I accept financial responsibility if such treatment is necessary. I further understand that neither the YMCA nor its workers can be held responsible in the event of accident or accidental death. IMMUNIZATION My child's immunization record and/or records are on file at my child’s school. If not, I can provide a copy of my child’s immunization records upon registration. All required immunizations and/or tuberculosis tests are current.

initials initials

initials

name of school

address

phone

PARENT & PARTICIPATION STATEMENT OF AGREEMENT • I understand that I may not leave my child at the YMCA location unless there is a YMCA staff member present. • I understand that my child will not be allowed to leave the program with an unauthorized person or staff member. Only adults with valid photo ID’s and who are over the age of 18 can be authorized to pick up the child. • I understand that the YMCA is mandated by Texas Law to report any suspected cases of child abuse or neglect. • I understand that the YMCA staff may not baby-sit, transport, or care for children other than during YMCA program hours. • I understand that my child may be removed from a YMCA program for any of the following reasons: 1. Failure to pay program fees by designated deadlines 2. Inappropriate behavior of a child/parent that endangers anyone involved with the YMCA 3. Inappropriate behavior towards YMCA staff 4. Failure to observe any of the conditions listed in the seasonal Parent Handbook 5. Custodial issues which cannot be resolved by parents or legal guardians. • I authorize for my child(ren) to participate in the following activities while enrolled in YMCA Program 1. Swimming/Water Activities 2. View PG rated film 3. Participate in Camp Activities including Field Trips 4. Travel on YMCA arranged transportation 5. Participate in photos or videos for YMCA publications

PLEASE SIGN to indicate that you have recieved the YMCA of Austin’s Parent and Participant statement of agreement and agree to the terms listed above.

signature of parent/guardian

date

Online Registration Available » www.AustinYMCA.org

YMCA OF AUSTIN 2014 SUMMER DAY CAMP

REGISTRATION PACKET

child 1 name

child 2 name

Waivers & Consents - pg. 3 of 4

WAIVER / RELEASE / INDEMNIFICATION & HOLD HARMLESS AGREEMENT Waiver, Release, Indemnification and Hold Harmless Agreement I understand that YMCA activities have inherent risks and in consideration for membership at the YMCA and participation in YMCA programs I hereby assume all risks and hazards incident to my participation in all YMCA activities, due to the negligence of the YMCA or otherwise while in, about, or upon the premises of the YMCA and/or while using the premises or any facilities or equipment thereon or participating in any program affiliated with the YMCA, including volunteer service. I further waive, release, absolve, indemnify and agree to hold harmless the YMCA, the organizers, volunteers, supervisors, officers, directors, participants, coaches, referees, as well as, persons or parents transporting participants to and from activities from any claims or injury sustained during my use of the YMCA property or participation in programs. Large Group Format: I understand that, due to the large group format of our program, the YMCA is unable to provide one-on-one care for any child except on an intermittent basis. Such instances include: injuries, immediate disciplinary issues, and certain personal care needs customarily provided to other children. I UNDERSTAND THAT I WILL RECEIVE A COPY OF THE YMCA PARENT HANDBOOK ON OR BEFORE THE FIRST DAY OF MY CHILD’S ENROLLMENT. THIS INFORMATION IS ALSO AVAILABLE AT AustinYMCA.org. PLEASE SIGN to indicate that you have received, read and agree to the above waiver, release, idemnification, and hold harmless agreement.

signature of parent/guardian

date

DISCIPLINE AND BEHAVIOR POLICY AGREEMENT Behavior Policy Good behavior is important to everyone in daily life. Certain behaviors are expected from the children involved in the YMCA Summer Camp, and following rules promotes a good learning experience that is safe and secure. When a child ignores or disregards rules, everyone’s experience is diminished. A Behavior Contract is the first formal step to help solve rule violations. The Behavior Contract involves parents, child, and staff and it requires the participation of all parties. If your child’s behavior becomes an ongoing problem, then a Behavior Contract will be issued. A sample contract is available at the Summer Camp site. Failure to correct behavior may result in suspension or dismissal. Please note that not all of the steps of a Behavior Contract will be taken every time a child breaks a YMCA rule. Disciplinary action will be determined for each child based on the severity of the action. Violence or issues which compromise the safety of the YMCA staff or participants will not be tolerated and can result in immediate suspension or expulsion from the program.

signature of parent/guardian

date

FEES AND PAYMENT GUIDELINES REGISTRATION FEE – Any registration fee applied is Non-refundable / Non-Transferable $30 per child (waived in Feb. & Mar.) CAMP DEPOSIT – Camp deposits are Non-refundable / Non-Transferable A Camp Deposit of $15.00, per week, per child is required for all camp sessions. (Example: If you are registering for three camp sessions, a $45.00 deposit will be required to hold your spot for those sessions of camp.) The $15.00 deposit is applied to the weekly camp fee. However, in the case that you cancel those weeks of camp, all deposits of $15.00/week are non-refundable. CAMP FEES – If you are registering for multiple sessions, you must complete the Payment Method Authorization form authorizing payment for the balance of sessions. Automatic drafts will occur (10) ten days prior to the beginning of each session. All camps must be paid in advance or on the due date. Only paid participants are allowed to attend camp. Payments made from 7-5 calendar days before the desired session will pay an additional late fee of $30.00. Checks and EFT will only be accepted as a form of payment on or before payment due date. Money Orders, exact cash, and valid credit cards will be accepted at any time as a form of payment. Unpaid camp sessions will be canceled by the Wednesday before each session. If canceled due to non-payment, the camp spot and registration fee is forfeited and re-registration is not guaranteed. Please see the Camp Parent Handbook for more information regarding our fees and payment guidelines. The Camp Parent Handbook, Map to Sites, and Registration Confirmation will be emailed upon receipt of completed materials. MEMBERSHIP DISCOUNT – Once there is a change in membership, the Primary Member on the account must notify Program Services prior to the upcoming draft in order to have the discount towards the camp fee. Once Program Services is notified, the discounts will be applied towards future payments and fees. NSF PAYMENTS – A $30.00 fee is charged for all non-sufficient funds and declined credit card charges. Children will not be allowed to attend camp unless payment for camp session has been received and recorded by the Program Services Branch. CANCELLATIONS and TRANSFERS – After initial enrollment, no refunds or credits will be given for registration fee and camp deposit(s). All changes to a child’s enrollment or cancellations must be received by the Program Services Branch, by submitting the 2014 Summer Camp cancellation form. • 12 Calendar Days or more Before Camp Session: Cancellations and transfers accepted in writing and without additional charges. • 11 (two Thursdays before) - 5 (Wednesday before camp week) Calendar Days before Camp Session: Cancellation fee of $25 charged upon receipt of written notice. Transfer fee of $10 charged upon receipt of written notice. • On or After the Thursday Before Camp Session: No cancellations or transfers will be accepted. No credits will be awarded. No refunds will be given. You will be held responsible for the full amount of camp fees, regardless of whether or not your child attends camp. • Emergency Registration: An emergency registration is defined as any registration occurring Thursday through Friday before the desired camp session. The emergency registration will only be accepted up until 12pm on Friday and an additional $40.00 Emergency Registration fee will apply for all requests.

signature of parent/guardian

Online Registration Available » www.AustinYMCA.org

date

3 18

YMCA OF AUSTIN 2014 SUMMER DAY CAMP

REGISTRATION PACKET

child 1 name

child 2 name

Payment Method Authorization / Session Enrollment - pg. 4 of 4 AUTOMATIC PAYMENT PLAN The YMCA of Austin offers an automatic payment plan via our accounting software company called DAXKO. This plan provided you the opportunity to spread the payment of camp fees. Fees are automatically charged to Bank, Credit Union, or Credit Card Company. There’s no additional cost for this program. BANK / CREDIT / DEBIT DRAFT AGREEMENT 1. I understand that Daxko has been authorized as an agent on behalf of YMCA of Austin, Program Services Branch to initiate debit entries against my Checking/Savings Account or Credit/Debit Card. Also, I acknowledge that the origination of ACH (Automatic Clearing House) transactions to my account must comply with the provisions of United States Law. 2. I understand that Daxko, a U.S. corporation, will be processing electronic funds transfers. Debit to your account will be presented in your bank statements as “Daxko” and these funds will be electronically transferred to the YMCA of Austin, Program Services Branch and posted to your childcare account weekly. 3. The YMCA of Austin, Board of Directors and/or management may, at their discretion, adjust the rate plan applicable to childcare programs at any time. I understand that I will receive at least a 30 day notification prior to any such change. • When using the credit/debit card payment method: Should any debit not be honored by my credit card company for any reason, I understand that I am still responsible for the payment plus a $30.00 service charge applied by the YMCA. This is in addition to any service fee my credit card company may require. • When using the bank draft/EFT method: Should any debit not be honored by my bank/EFT account for any reason, I understand that I am still responsible for the payment, plus a service charge applied by a third-party debt collector called eCashFlow Systems. eCashFlow Systems may attempt to collect the outstanding balance up to three times. Each time they collect or are unable to collect, another $30.00 charge will be applied. This is in addition to any service fee. week #

draft date

May 23

May 30

Jun 6

Jun 13

Jun 20

Jun 27

Jul 4

Jul 11

Jul 18

Jul 25

Aug 1

Aug 8

OPTION 1: CREDIT / DEBIT CARD

OPTION 2: BANK DRAFT

Is this the primary contact for all billing concerns/questions?

yes

*PLEASE INCLUDE A VOIDED CHECK WITH THIS FORM (This needs 10 business days to

authorize before we could use this account. Please note that the EFT/Check account cannot be used as a form of payment after the payment due date.)

name of card / account holder

cell / work phone

name of card / account holder

credit / debit card number

routing / transit number

card billing address

zip code Authorization: I hereby authorize the YMCA of Austin to debit the above credit card/bank draft/EFT on the dates indicated for my 2014 Summer Day Camp payments. I understand that I am being enrolled in the automatic payment plan as described above and agree to any and all fees that may incur use of this service.

visa

discover

mastercard

amex

signature of parent / guardian

date

KEY:

child 1

child 2

Example: c1 child 1 enrollment

Please shade box for EACH child session

SESSION ENROLLMENT c2

Example: c1 child 2 enrollment

Example: c1 child 1&2 enrollment

Jun 2–6

Jun 9–13

Jun 16–20

Jul 7–11

Jul 14 –18

Aug 4–8

Aug 11–15 Aug 18–22

KINDER CAMP

week 0

week 1

week 2

week 3

week 4

week 5

week 6

week 7

week 8

week 9

week 10

Northwest Y / CrossPointe Church

—

Hays YMCA Oak Hill United Methodist - South THEME CAMP

week 0

Jun 23–27 Jun 30– Jul 3

Jul 21– 25 Jul 28–Aug1

week 1

week 2

week 3

week 4

week 5

week 6

week 7

week 8

week 9

week 10

week 11

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Baranoff Elementary - South

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Cowan Elementary - South

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East Communities YMCA

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Winn Elementary - East

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Pease Elementary - Central

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North Central - TBA

—

Spicewood Elementary - North

Laurel Mountain Elementary - North

— c1

c2 —

—

Carpenter Hill Elementary - Hays

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Springs YMCA

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SPORTS CAMP

week 0 —

Fulmore Middle School - Central c1

week 3

week 4

week 5

week 6

week 7

week 8

week 9

—

c2 —

week 2

—

week 1

—

Golfsmith - North

c2 —

Concordia HS - Pflugerville

Northwest Y / CrossPointe Church

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week 11 — — —

week 1

week 2

week 3

week 4

week 5

week 6

week 7

week 8

week 9

Dahlstrom Middle School - Hays

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Bailey Middle School - South

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Mathews Elementary - Central

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ADVENTURE CAMP

North Adventure - TBA

week 0

week 11

Online Registration Available » www.AustinYMCA.org

YMCA OF AUSTIN Program Services 3208 Red River Suite #100 Austin, TX 78705

Non-Profit Organization U.S. Postage PAID Austin, TX Permit No. 2182

CAMPS FILL UP FAST

A SUMMER

TO EXPLORE

2014 SUMMER CAMP

AustinYMCA.org

@AustinYMCA