2015 Cross Island YMCA Camp Brochure by New York City's YMCA

CROSS ISLAND YMCA Summer Camp 2015

WEâ&#x20AC;&#x2122;RE ready for a summer of growth and FUN! Dear Parents/Guardians, We welcome all of our returning and new campers to our 2015 Summer Camp Programs. We are excited to embark on another summer of fun and learning with you and your children. From sports and swimming to arts and culture, YMCA camps span a broad range of interests, while focusing on developing young minds and bodies. In 2014, the YMCA served over 10,000 campers in communities throughout New York City. We are proud that in Queens the Cross Island YMCA will be able to engage your child in a summer of new friendships, skills and exploration. Thank you for choosing our Y summer camp. We look forward to getting to know your child! Sincerely, Cross Island YMCA

In 1885, the YMCA helped to invent summer camp to provide children with positive and fun experiences that build confidence and new friendships. YMCA camp staff have served as positive role models for generations of campers and helped build future leaders. The centerpiece of YMCA camps are activities that excite and engage your child, giving them a summer filled with fun and adventure. Whether learning a new sport, discovering arts and culture or exploring the best of New York City, YMCA Summer Camps offer an opportunity to build wonderful lifelong memories and a feeling of community that will last beyond the summer. “She loves camp and doesn’t want to leave at the end of the day. I feel good knowing she is safe and happy while I am at work” - YMCA Day Camp Parent

Each of our camps is accredited by the American Camping Association (ACA) and our staff go through rigorous training to ensure the safety and positive experience of each child.

PROGRAMS

OUR CAMP LOCATIONS

Our YMCA camps have something unique to offer for every age group from our Kinder Camp Programs to Teen Camp. Our goal is to meet your child’s developmental needs and provide a foundation for continued learning during the summer months.

The Cross Island YMCA Summer Day Camp operates out of PS 33 at 91-37 222nd Street, Queens VIllage. The Early Childhood Camp runs out of the Cross Island YMCA.

Alongside sports, swimming and arts programs the YMCA offers academic enrichment that is infused throughout the camp day. These programs include summer reading, journal writing and science activities. Each session you will be given a schedule of activities so you can follow your child’s course of learning and adventure over the summer.

Our Summer Sleepaway Camp is for boys and girls ages 6-16 from all over the world and is located outside NYC in Huguenot, NY. There are two villages, McAlister (ages 6–12) and Talcott (ages 12–15), that are located on 1,150 acres of forests and lakes.

718-551-9336 mturenne@ymcanyc.org 718-551-9309 lsingh@ymcanyc.org 718-551-9334 hharper@ymcanyc.org 718-551-9316 ssandiford@ymcanyc.org

DATES & HOURS OF OPERATION Cross Island YMCA Summer Day Camp is an eight-week program that runs from June 29th - August 21st. No camp Friday, July 3rd. Camp hours are from 9:00 am - 4:00 pm. Extended Day hours are from: 7:00 am - 9:00 am 4:00 pm - 6:00 pm

DAY CAMP OPEN HOUSES • • • •

Saturday, Feb 28: 10 am - 3 pm Saturday, April 25: 10 am - 3 pm Saturday, May 16: 10 am - 3 pm Saturday, June 13: 12 pm - 4 pm

REGISTRATION MADE EASY •

Submit $100 deposit per session you would like your child to attend. This will hold your child’s spot for the designated sessions of camp.

•

Take advantage of the 10% Early Bird discount by registering by May 16.

•

Submit your child’s medical form completed with parent information and signature as well as the doctor’s information, signature and stamp as soon as possible. It’s a good idea to keep extra copies of the medical form for your records.

•

Submit 2 passport size photos of your child along with registration forms. Please write your child’s first and last name on the back of each photo.

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The YMCA accepts all major credit cards and debit cards, cash and money orders.

•

Checks will be accepted until June 14, 2015.

FINANCIAL ASSISTANCE

The YMCA of Greater New York awards financial assistance to campers based on a parent or family’s annual income. The financial aid applications must be submitted by May 30, 2015.

DAY CAMP DISCOUNTS •

10% Early Bird Discount for those who register before the end of the day on Saturday, May 16th.

•

10% Sibling discount is available for all siblings of the first child registered at full price.

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Discounts cannot be combined and are available only on the cost of camps per session, not on extended day or transportation fees.

VOUCHERS

We accept TWU Local 100, and 1199 SEIU vouchers. You must have your confirmation letter with you at the time of registration.

REFUNDS AND CREDITS

If your child cannot attend camp for a period of time paid, you may submit a request for credit along with documentation to the Camp Director. Credits can be used for camp or other programs throughout the year. Any refund requests will be submitted to the Camp Director and will be granted under the discretion of the Youth and Family Director. All requests should be made prior to the start of the session.

PARENT ORIENTATION (Ages 5.9-17)

Parent/Guardian orientation meetings are mandatory. The 1-hour meetings will be held on the following dates and times: Saturday, April 25 12pm; 2pm Saturday, May 16 12pm; 2pm Friday, June 5 7pm Saturday, June 13 12:30pm; 2:30pm Early Childhood Camp (Ages 2-5.8) Parent Orientation dates listed under Early Childhood Camp details.

CAMP GEAR

Each camper will receive 2 tee shirts and a camp bag. Swim caps will be provided during the camper’s first day of swim. Camp tee shirts must be worn every day. Additional shirts can be purchased for $10 each or 3 for $25. Swim gear must consist of a towel, swim-suit, change of clothing, water shoes and a plastic bag for wet swim gear.

Transportation

Transportation to and from the Cross Island YMCA at PS 33 is available only to campers in Youth & Teen or Specialty Camps (not Early Childhood Camp) who attend regular hours (9am–4pm). We do not offer transportation for our extended hours campers. The registration deadline for transportation service is Friday, May 29. The Cross Island YMCA offers transportation within the following communities:

Arverne Bayside Bellerose Cambria Heights Douglaston Elmont Far Rockaway Floral Park Franklin Square Fresh Meadows Glen Oaks

Hollis Jamaica Jamaica Estates Laurelton Little Neck New Hyde Park Ozone Park Queens Village Richmond Hill Rochdale Rosedale

St. Albans Springfield Gardens Valley Stream

EARLY CHILDHOOD CAMP

CROSS ISLAND TEEN CAMP

Ages 2 – 5.8

Ages 13-15

Sunita Batra at 718-551-9313; sbatra@ymcanyc.org

Teen Camp is for 13-15 year olds currently enrolled in high schools. Teen Camp motivates teens through hands on programming that fosters development of educational and career goals. Along with sports, arts and cultural programs teens will have the opportunity to participate in college and career readiness programs. Field trips will allow teens to explore some of New York City’s key landmarks and cultural institutions.

Early Childhood Camp provides our youngest campers with hands-on, experiential, fun activities intentionally planned to support each child’s social, physical and cognitive skill development. Activities include swimming (3 years & up), outdoor play, music and movement, and interactive science, language and literacy activities. Staff members experienced in engaging with preschoolers understand the importance of rich adult-child interactions and focus on building supportive, nurturing relationships with every camper. Early Childhood campers will enjoy campsite-based collaborations with child-friendly organizations.

Early Chilhood Camp Orientation Dates: Thursday, June 4 6-7pm; Saturday, June 13 4-5pm; Wednesday, June 17 6-7pm Check the next page (Ages 2-5.8) for prices

CROSS ISLAND DAY CAMP Ages 5.9-12 Traditional Day Campers will engage in activities that will enhance their social and emotional skills, help keep their academics on track, keep them physically active and challenge them to learn new things every day. They will have the opportunity to meet new friends and take exciting trips throughout New York City. Campers will participate in a wide range of sports, instructional swimming, arts and crafts, and weekly themed days such as Crazy Hat Day. They will engage in environmental science and more. Traditional day campers will be divided into age groups with children no more than 1-2 years apart in age. Day camp activities are designed to help children retain and build upon the academic skills they have developed during the school year. Research has shown that children can lose a half grade of learning over the summer months. The YMCA offers programs such as Book of the Week which gives children the opportunity to read a book as a camp group and participate in related discussion. Journaling helps children to retain writing skills through writing exercises that connect with their camp experiences. Field trips are selected to maximize educational enrichment and include trips to local museums and science centers.

*Cost per 2 week session: Member: $470 Non-Member: $480

LISA BETH GERSTMAN CAMP FOR CHILDREN WITH SPECIAL NEEDS

Ages 6 – 14 This camp is made possible through the generous support of the Lisa Beth Gerstman Foundation. Its donation has offset the expenses of equipment, transportation and staffing required to serve children with special needs. All children will receive wheelchair accessible transportation, one-on-one swimming instruction, adaptive physical activities and equipment. A nurse is also present both onsite and on field trips outside of the Y for children who require special care like catheterization and/or medication administration. Session A July 6 - July 24 Session B July 27 - August 14 Jean Dattner at 718-551-9325, jdattner@ymcanyc.org Dianne DiPeri at 718-551-9319, ddiperi@ymcanyc.org

*Cost per 3 week session: Member: $800 Non-Member: $800

INCLUSION CAMP Ages 5.9-14 A special summer experience awaits those enrolled in the inclusion explorer camp. This camp brings an inclusive recreational experience to children with disabilities. This unique camp gives children with special needs the same experience as other campers. Children with disabilities and their peers who are typically developing come together to participate in recreational activities such as swimming, arts and crafts, educational activities, reading, physical fitness and more. Camp counselors will serve as shadows—one counselor to every 2 campers.

*Cost per 2 week session: Member: $760 Non-Member: $770

PERFORMANCE ARTS CAMP

SOCCER CAMP

Ages 5.9-12

Performance Arts Camp participants experience a wonderful summer of dance, drama, music & art. Campers will learn the basics of choreography from lyrical to hip-hop. In addition, campers will learn the fundamentals of acting, character study, improvisation exercises, and even try script writing. Create, Play, have Fun! Each camp showcases their new skills and performs for their families at the end of the session.

Soccer Camp participants will develop soccer skills, improve stamina, strength and endurance in a fun environment with trained coaches. Each camper will be taught the fundamentals such as ball control, passing, dribbling, tapping, shooting and goalkeeping skills. All ability levels are welcome. *Cost per 2 week session: Member: $500 Non-Member: $510

*Cost per 2 week session: Member: $500 Non-Member: $510

S.T.E.A.M. (SCIENCE, TECHNOLOGY, ENGINEERING, ARTS, MATH) CAMP Ages 5.9-12 The S.T.E.A.M. Camp (Science, Technology, Engineering, Arts and Math) is an interactive and creative learning experience that includes Arts and Technology combined with traditional camp activities that children associate with summer fun. S.T.E.A.M. campâ&#x20AC;&#x2122;s curriculum emphasizes creativity and learning in a fun environment. Campers will experience art, math and science activities. This project based camp will give campers hands-on experience with Science, Technology, Engineering, Arts and Math. *Cost per 2 week session: Member: $500 Non-Member: $510

TEEN SPORTS CAMP Ages 13-15 Our progressive curriculum enhances various sports skills and fundamentals. Campers will learn the different rules of each game while practicing their techniques in mini games. In addition, they will learn about team work, sportsmanship, and motivating each other to succeed. The camp will also focus on teaching fitness and healthy lifestyles. *Cost per 2 week session: Member: $500 Non-Member: $510

TEAM SPORTS CAMP

BASKETBALL CAMP

Ages 5.9-12

Our Team Sports Camp is designed to enhance various sports skills and fundamentals in groups according to age. Campers will learn basic fundamentals and rules for Baseball, Basketball, Soccer and Flag Football. Each day of the week our staff will focus on one of the four sports. Our goal is to expose the children to a variety of sports. In addition, they will learn about teamwork, good sportsmanship and motivating each other to succeed. Camp staff have background in coaching sports.

Players will perfect their dribbling, passing, shooting, defense, and offense skills according to their level of expertise. Academics, team work, and life skills will be incorporated throughout the sessions in order to enhance each camper as a whole. Classes are based on appropriate age and level of play. All ability levels are welcomed. Offensive and defensive skills and team concepts develop the most complete basketball player possible.

*Cost per 2 week session: Member: $500 Non-Member: $510

GYMNASTICS CAMP

TENNIS CAMP

Ages 5.9-12

Our Gymnastics Camp emphasize Individual skill development in a safe, fun and supportive environment. Dance, conditioning, stretching and performance tips will focus on fun for gymnasts of every level. Gymnasts will have an opportunity to showcase their new skills in an exhibition at the end of each session.

The Tennis Camp offers drills and activities carefully designed for different developmental levels so each camper will have a successful learning experience. The camp will focus on positioning, court layout and rules and regulations. The campers will also learn about the basic forehand and back hand strokes and compete in both singles and doubles activities. Campers must bring a tennis racket.

*Cost per 2 week session: Member: $500 Non-Member: $510

Early Childhood Camp Ages 2- 5.8 Please CHILD & ADOLESCENT HEALTH EXAMINATION FORM Print Clearly

NYC DEPARTMENT OF HEALTH & MENTAL HYGIENE

—

DEPARTMENT OF EDUCATION

Press Hard

STUDENT ID NUMBER OSIS

TO BE COMPLETED BY PARENT OR GUARDIAN Child’s Last Name

First Name

� Female � Male

Date of Birth (Month/Day/Year ) __ __ / ___ ___ / ___ ___ ___ ___

Hispanic/Latino? Race (Check ALL that apply) � American Indian � Asian � Black � White � Yes � No � Native Hawaiian/Pacific Islander � Other ____________________________

Child’s Address City/Borough

State

Zip Code

District __ __ Phone Numbers Number __ __ __ Home _____________________

School/Center/Camp Name

Health insurance � Yes � Parent/Guardian Last Name (including Medicaid)? � No � Foster Parent

� Uncomplicated

� Premature: ________ weeks gestation

� Complicated by Allergies

_______________________________ � None

� Epi pen prescribed

� Drugs (list) � Foods (list)

Cell ______________________

First Name

Work ______________________

TO BE COMPLETED BY HEALTH CARE PROVIDER Birth history (age 0-6 yrs)

If “yes” to any item, please explain (attach addendum, if needed)

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 Persistent If persistent, check all current medication(s): � Inhaled corticosteriod � Other controller � Quick relief med � Oral steroid � None � � � � �

Attention Deficit Hyperactivity Disorder Chronic or recurrent otitis media Congenital or acquired heart disorder Developmental/learning problem Diabetes (attach MAF)

� � � � �

Orthopedic injury/disability Seizure disorder Speech, hearing, or visual impairment Tuberculosis (latent infection or disease) Other (specify) ___________________

Medications (attach MAF if in-school medication needed) � None � Yes (list below)

Dietary Restrictions � None � Yes (list below)

� Other (list)

Explain all checked items above or on addendum

PHYSICAL EXAMINATION

General Appearance:

Height ____________________ cm

( ___ ___ %ile)

Weight ____________________ kg

( ___ ___ %ile)

____________________ kg/m2

BMI

Sex

Middle Name

( ___ ___ %ile)

Head Circumference (age ≤2 yrs) ______________ cm ( ___ ___ %ile) Blood Pressure (age ≥3 yrs)

Nl Abnl

� � HEENT � � Lymph nodes � � Dental � � Lungs � � Neck � � Cardiovascular Describe abnormalities:

� � � � � �

Nl Abnl

Abdomen Genitourinary Extremities

Nl Abnl

Skin Neurological Back/spine

� � � � � �

� � Psychosocial Development � � Language � � Behavioral

_________ / __________

DEVELOPMENTAL (age 0-6 yrs)

� Within normal limits

SCREENING TESTS

Date Done

If delay suspected, specify below

Blood Lead Level (BLL)

� Cognitive (e.g., play skills) ____________________________

(required at age 1 yr and 2 yrs and for those at risk)

__ __ / ___ ___ / ___ ___

_________ µg/dL

__ __ / ___ ___ / ___ ___

_________ µg/dL

__ __ / ___ ___ / ___ ___

� At risk (do BLL) � Not at risk

__ __ / ___ ___ / ___ ___

� Normal � Abnormal

Lead Risk Assessment � Communication/Language _________________________

(annually, age 6 mo-6 yrs)

� Social/Emotional __________________________________

Hearing � Pure tone audiometry � OAE

� Adaptive/Self-Help ________________________________ � Motor ___________________________________________ IMMUNIZATIONS – DATES

Date Done

Results

Tuberculosis

PPD/Mantoux placed

__ __ / ___ ___ / ___ ___

Induration ______mm

PPD/Mantoux read

__ __ / ___ ___ / ___ ___

� Neg

� Pos

Interferon Test

__ __ / ___ ___ / ___ ___

� Neg

� Pos

Chest x-ray (if PPD or Interferon positive)

__ __ / ___ ___ / ___ ___

—— Head Start Only —— Hemoglobin or Hematocrit (age 9–12 mo)

__________ g/dL __________ %

__ __ / ___ ___ / ___ ___

CIR Number of Child

Results

Only required for students entering intermediate/middle/junior or high school who have not previously attended any NYC public or private school

Vision (required for new school entrants __ __ / ___ ___ / ___ ___ and children age 4–7 yrs) � with glasses

� Nl � Abnl

� Not Indicated

Acuity Right ___ / ___ Left ___ / ___ Strabismus � No � Yes

Influenza

__ __ / ___ ___ / ___ ___

MMR

__ __ / ___ ___ / ___ ___

Rotavirus

__ __ / ___ ___ / ___ ___

Varicella

__ __ / ___ ___ / ___ ___

DTP/DTaP/DT

__ __ / ___ ___ / ___ ___

Tdap

Hep A

__ __ / ___ ___ / ___ ___

Hep B

__ __ / ___ ___ / ___ ___

Hib

__ __ / ___ ___ / ___ ___

Meningococcal

__ __ / ___ ___ / ___ ___

PCV

__ __ / ___ ___ / ___ ___

HPV

__ __ / ___ ___ / ___ ___

Polio

__ __ / ___ ___ / ___ ___

Other, specify: ____________

__ __ / ___ ___ / ___ ___ ;

_______________

__ __ / ___ ___ / ___ ___

RECOMMENDATIONS

� Full physical activity

ASSESSMENT

� Full diet

� Restrictions (specify) ___________________________________________________________________________ Follow-up Needed Referral(s): � Other

� No

� None

� Yes, for _________________________ Appt. date:

� Early Intervention

� Special Education

� Dental

__ __ __ __ __

� Vision

_____________________________________________________________

__ __ __ __ __

_____________________________________________________________

__ __ __ __ __

__ __ / ___ ___ / ___ ___ Provider License No. and State

Facility Name

National Provider Identifier (NPI)

Telephone

( __ __ __ ) ___ ___ ___ – ___ ___ ___ ___

CH-205 (5/08)

DOHMH PROVIDER ONLY I.D.

Date

City Fax

ICD-9 Code

_____________________________________________________________

Health Care Provider Name and Degree (print)

Address

� Diagnoses/Problems (list)

__ __ / ___ ___ / ___ ___

________________________________________________________________________

Health Care Provider Signature

� Well Child (V20.2)

State

TYPE OF EXAM:

NAE Current

NAE Prior Year(s)

Comments Zip

Date Reviewed:

( __ __ __ ) ___ ___ ___ – ___ ___ ___ ___

Copies: White School/Child Care/Early Intervention/Camp, Canary Health Care Provider, Pink Parent/Guardian

I.D. NUMBER __ __ / ___ ___ / ___ ___

REVIEWER:

early childhood camp Sessions and Fees CAMP OFFERINGS (Ages 2-5.8)

CHILD’S NAME: _________________________________________________________________________________________AGE:__________________________ CAMP SESSIONS Session Session 1 Session 2 Session 3 Session 4

Start Date June 29, 2015 July 13, 2015 July 27, 2015 August 10, 2015

End Date July 10, 2015 July 24, 2015 August 7, 2015 August 21, 2015

Payment Due Date June 19, 2015 July 3, 2015 July 17, 2015 July 31, 2015

*CIRCLE ALL PRICES THAT APPLY TO YOU - CAMP FEES PER SESSION (every two weeks)

CAMP

AGES

TODDLER

2 - 3.4

DAYS

3 - 4.5

SESSION 3

SESSION 4

FULL | HALF M: $540 | $290 NM: $555 |$300

FULL | HALF FULL | HALF M: $400 | $215 M: $400 | $215 NM: $410 | $225 NM: $410 | $225

FULL | HALF FULL | HALF 5 M: $475 | $255 M: $525 | $280 (Mon-Fri) NM: $480 | $260 NM: $535 | $290

FULL | HALF FULL | HALF M: $525 | $280 M: $525 | $280 NM: $535 | $290 NM: $535 | $290

FULL | HALF FULL | HALF M: $380 | $205 M: $380 | $205 NM: $390 | $215 NM: $390 | $215

3 DAYS

EARLY CHILDHOOD

SESSION 2

PRESCHOOL

SESSION 1

5 M: $475 (Mon-Fri) NM: $480

M: $525 NM: $535

5 AM: $105 (Mon-Fri) PM: $105

AM: $115 PM: $115

AM: $85 PM: $85

Totals

-Discount

Grand Total

Extended Hours

4.5 - 5.8

3 DAYS

Summer day camp Sessions and Fees CAMP OFFERINGS (Ages 5.9-15) CHILD’S NAME: _________________________________________________________________________________________AGE:__________________________ CAMP SESSIONS Session Session 1 Session 2 Session 3 Session 4

Start Date June 29, 2015 July 13, 2015 July 27, 2015 August 10, 2015

End Date July 10, 2015 July 24, 2015 August 7, 2015 August 21, 2015

Payment Due Date June 19, 2015 July 3, 2015 July 17, 2015 July 31, 2015

*CIRCLE ALL PRICES THAT APPLY TO YOU - CAMP FEES PER SESSION (every two weeks)

CAMP

AGES

SESSION 1

SESSION 2

SESSION 3

SESSION 4

DAY CAMP

5.9 - 8 & 9 -12

M: $425 NM: $435

M: $470 NM: $480

BASKETBALL CAMP

5.9 - 8 & 9 -12

M: $450 NM: $460

M: $500 NM: $510

GYMNASTICS CAMP

5.9 - 8 & 9 -12

M: $450 NM: $460

M: $500 NM: $510

PERFORMING ARTS CAMP

5.9 - 8 & 9 -12

M: $450 NM: $460

M: $500 NM: $510

S.T.E.A.M. CAMP

5.9 - 8 & 9 -12

M: $450 NM: $460

M: $500 NM: $510

SOCCER CAMP

5.9 - 8 & 9 -12

M: $450 NM: $460

M: $500 NM: $510

TEAM SPORTS CAMP

5.9 - 8 & 9 -12

M: $450 NM: $460

M: $500 NM: $510

TENNIS CAMP

5.9 - 8 & 9 -12

M: $450 NM: $460

M: $500 NM: $510

TEEN CAMP

13 - 15

M: $425 NM: $435

M: $470 NM: $480

TEEN SPORTS CAMP

13 - 15

M: $450 NM: $460

M: $500 NM: $510

INCLUSION CAMP

5.9 - 8, 9 -12 &13 -14

M: $685 NM: $695

M: $760 NM: $770

SESSION A July 6 - July 24 ALL: $800

SESSION B July 27 - Aug14 ALL: $800

LISA BETH GERSTMAN CAMP

6 - 14

Extended Hours

5.9+

AM: $105 PM: $105

AM: $115 PM: $115

Transportation

5.9+

AM: $145 PM: $145

AM: $160 PM: $160

Totals

-Discount

Grand Total

Summer Day Camp Ages 5.9-15 HEALTH RECORD FOR CHILDREN IN DAY CAMPS & AFTERSCHOOL & YOUTH CENTERS (This side to be filled in by parent before presentation to physician) NAME OF PROGRAM / CHILD'S LAST NAME

FIRST NAME

M❑

BIRTHDATE

Home Address:

Phone:

Parent or Guardian:

Phone:

Place of Employment: Father (Guardian)

Phone:

Mother (Guardian)

F❑

SEX

Phone:

In case of emergency, notify:

Phone:

If Parent, Guardian are not available in an emergency, notify: 1.

Phone:

or 2.

Phone:

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: ) HEALTH HISTORY: (Check box if child has had afflictions, give appropriate dates) Allergies

❑ ❑ ❑ ❑

Rheumatic Fever Seizures Diabetes Asthma

❑ Chicken Pox

❑ ❑ ❑ ❑

Hay Fever Poison Ivy, etc. Insect Stings Penicillin

❑ Other Drugs ❑ Food

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 Dr. Appliance worn (glasses, contacts, etc.) Medication taken Suggestion from Parent/Guardian CONSENT FOR EMERGENCY MEDICAL TREATMENT 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

Tel.#

Department of Health and Mental Hygiene — The City of New York — Bureau of Food Safety and Community Sanitation DCR 7 (Rev. 2/04)

Summer Day Camp Ages 5.9-15 PHYSICAL EXAMINATION (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. IMMUNIZATION HISTORY – This is a record of dates of basic immunization and most recent booster doses. DTaP, DTP, DT, Td Date __________ Date __________ Date __________ Date __________ Date __________ Polio Date __________ Date __________ Date __________ Date __________ Date __________ MMR Date __________ Date __________ Date __________ Hemophilus Influenzae type b (Hib) Date __________ Date __________ Date __________ Date __________ Hepatitis B Date __________ Date __________ Date __________ Date __________ Varicella Date __________ Date __________ Pneumococcal Conjugate (PCV) Date __________ Date __________ Date __________ Date __________ Date __________ Other _____________ Date __________ Other _________ Date __________ Other _________ Date __________ MEDICAL EXAMINATION – To be filled out by licensed physician. Examination is acceptable when performed no more than 12 months prior to arrival at camp. Code: S = Satisfactory X = Not Satisfactory (Explain) 0 = Not Examined General Appearance Genitalia Height Weight Blood Pressure Posture & Spine Nose Teeth Abdomen Hernia Feet Hgb. Test (Date) Urinalysis (Date) Eyes Vision w/Glasses Extremities Ears Hearing Neurological Findings Describe Abnormal Findings and/or Handicapping Conditions

Throat - Tonsils Lungs Skin Heart

Allergy: (Please specify) Recommendations and restrictions while in camp: Special Diet Special Medicine (dose, route of administration, when should it be administered) Is parent/guardian sending special medicine? Activity Restrictions Swimming Diving 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. M.D. EXAMINING PHYSICIAN (SIGNATURE)

PHYSICIAN'S NAME (PLEASE PRINT)

Telephone

Address

Date of Examination ZIP CODE DCR 7 (Rev. 2/04)

Registration Form (all Ages)

A SUMMER OF FUN

CROSS ISLAND YMCA

SLEEPAWAY CAMPS The New York YMCA Camp is located 86 miles outside of NYC on 1,150 forested acres. We are a safe, inclusive and diverse camp community in which children can develop friendships, lifelong skills and cherished memories. Programs offered at New York YMCA Camp are Summer Sleepaway Camp, Specialized Summer Sports Camps (Gymnastics, Rhythmic Gymnastics & Power Tumbling, Volleyball, and Judo), Day Camp for Hudson Valley residents, Outdoor Education, customizable Retreat Groups, and Special Retreat Weekends (Women’s Wellness Weekend, Family Camp). For more information on any of these programs please call 877-30-YCAMP or visit our website at www.nyycamp.org.

family Camp Summer 2015 | September 4 - 7

Winter 2015 | February 13 - 16

Strengthen family bonds and have fun at our all-inclusive Summer or Winter Family Camps. Enjoy a weekend with sports, crafts, and special themed activities. In the summer, have fun in the sun on our beautiful beaches where families can swim, tube, and water-ski. When winter gives us snow, XC-skiing, snow-shoeing, and snow-tubing are always family favorites.

cross island ymca summer Sleepaway Camp Have an unforgettable summer at New York’s YMCA Camp! Our Summer Sleepaway Camp is for youth ages 6-16 from all over the world and is located outside NYC in Huguenot, NY. There is a Counselor In Training (CIT) program for 16 year olds, as well as two villages, McAlister (ages 6-12) and Talcott (ages 12-15), that are located on 1,150 acres of forests and lakes. Just a sample of activities that we offer are swimming lessons, a wide variety of sports, arts and crafts, outdoor living skills, media program, canoeing, Wibit, and our ropes courses. We also offer specialty programs that include water skiing, horseback riding, and rafting trips for a small additional fee.

Session 1 Session 2 Session 3 Session 4 Session 5

June 28 – July 3 July 5 - 17 July 19 - July 31 August 2 – 7 August 9 - 21

Tier 1 1 Week 2 Weeks $869 $1599

Tier 2 1 Week 2 Weeks $769 $1399

Tier 3 1 Week 2 Weeks $699 $1199

Why three prices? New York YMCA Camp realizes that families have differing abilities to pay, so we offer a voluntary 3-tier pricing program. This is strictly an honor system; select the fee you feel is appropriate to what you can pay. The program is voluntary, and in no way influences the experience children receive. Tier 1 – Is the actual cost of camp for a child to participate Tier 2 – Is our partially subsidized fee for temporary or minor financial need Tier 3 – Is our heavily subsidized fee for those in need of more financial assistance *We offer need-based financial assistance.

NATIONAL GYMNASTICS TRAINING CAMp

Session 1 Session 2

Girls ages 7 - 17

July 5 - 10 July 12 - 17

We offer world class training for dedicated and determined gymnasts from around the world. Our focus is to support each gymnast to develop new skills and improve existing ones. Every gymnast has the opportunity to train closely with our world class coaches. Our camp includes 16,000 sq feet of training space, 6 vault stations, 12 beam stations, 4 sets of competition bars, 2 full floor exercises, certified athletic trainers, and medical staff available 24/7, and more. Team rates are available.

Tier 1 Tier 2 Tier 3 $899

$799

$699

Team Camp 1 week 2 week $799 $1598

WORLD VOLLEYBALL TRAINING CENTER Ages 10 - 18

We offer progressive training techniques for all skill levels, position specific training, and video training with personal feedback. We also offer plyometric and weight training opportunities for qualified campers. The Volleyball Select program is for advanced players looking to experience training on the collegiate level.

Session 1 Session 2 Session 3 Team Mini Camp 1 Team Mini Camp 2

July 19 – 24 July 26 - 31 August 2 – 7 July 19 - 22 July 26 - 29

Our camp includes 6 indoor courts with all new sport court, 5 outdoor grass courts, a training room, certified athletic trainers, and medical attention available 24/7. We offer team packages for full week and half week rates.

Tier 1 $849

Tier 2 $799

Tier 3 $749

Team Mini Camp $395

Team Weekly Camp $799

RHYTHMIC GYMNASTICS & POWER TUMBLING Ages 7 - 17 | June 28 – July 3 RGPT Camp includes cardio conditioning and fitness, choreography, beginning and advanced element training, equipment and body mastery, and routine and creative dance development. Our philosophy is to develop the athlete on every level-technically, physically, artistically, and emotionally – and to create a fun, safe, and memorable summer experience.

Our camp includes 2 Rhythmic Gymnastics floors, stall and ballet bars, power tumbling and DMT equipment, full rod floor with run-up and regulation landing area, two Euro DMT with competition run and landing area, trainers and medical staff onsite 24/7. Camp Rate: $599

INTERNATIONAL JUDO CAMP For players of all ages starting at age 6 | August 9 – August 15 We offer world class training for athletes from around the world. During daily practice and evening Randori, our coaches evaluate skills to develop an individualized, training program for every camper. Our focus is to support each child and adult to learn new skills and to perfect their existing ones. Our camp includes Olympic quality Tami mats, 2 inch Swain flexi-roll mats, weightlifting and cardiovascular training equipment, trainers and medical staff on site 24/7. Apply before July 1st:

$649

Apply after July 1st:

$699

nyycamp.org

160 Big Pond Rd.

2015 Sleepaway Camp Summer Showcase Dates April 12th April 26th May 31st June 7th Join us for a tour. Sign up at nyycamp.org

OUTDOOR ADVENTURE TRIPS

Ages 10 - 15

We offer one or two-week adventure trips where campers experience safe, outdoor activities including mountain biking, hiking, camping, canoeing, whitewater rafting, kayaking, surfing, tubing, high-team adventure and so much more.

Trip Delaware River Adventure Empire State Adventures Southeast Adventures Introductory Adventures Great Lakes Adventures

Ages 12-15 12-15 12-15 10-12 12-15

Date June 28 - July 3 July 5 -17 July 19 - July 31 August 2 - 7 August 9 - 21

Fee $719 $1829 $1889 $719 $1889

RETREAT CENTER

Year Round, Upstate New York The Greenkill Retreat Center at the New York YMCA Camp is open year-round with options for day trips, overnights, or multiple-night stays. From activity choices and breakout sessions to lodging, recreation, team building, and meals, we work closely with each group to design a retreat that meets group goals.

OUTDOOR EDUCATION CENTER

September to June, Upstate New York The Greenkill Outdoor Education Center at the New York YMCA Camp provides safe and educational programs for students through a holistic approach that tailors each trip to a school’s specific needs. Educational programs range from social and emotional development to recreation, to experiential environmental education. Our professional staff focuses on the needs of students and encourages learning in the natural environment.

WOMEN’S WELLNESS WEEKENDS Spring 2015 | May 15 – 17

Fall 2015 | October 16 - 18

Immerse yourself in nature at one or both of our women’s-only retreat weekends. Activities include arts and crafts, guided hikes throughout our picturesque property, health and wellness sessions, yoga, and more.

Huguenot, NY

877-30-YCAMP

YMCANYC.ORG/CAMP TO LEARN MORE!

* Does not apply to sleepaway Camp programs VISIT

Pick up a scholarship application at the Brach or download an application online at ymcanyc.org.

financial assistance available*

10% off each additional sibling. Discounts cannot be combined.

Sibling Discounts*

10% discount for participants who are registered by May 16, 2015 and have paid in full.

Early Bird Discounts*

DAY CAMP Promotional Offers!

238-10 Hillside Ave. Bellerose, NY 11426 T 718-551-9300 F 718-468-9568 www.ymcanyc.org/crossisland Facebook.com/CrossIslandYMCA

CROSS ISLAND YMCA YMCA of GREATER NEW YORK

Non-Profit Organization U.S. Postage PAID Jamaica, NY Permit No. 671