CAMP WINONA 898 Camp Winona Rd DeLeon Springs, FL 32130...

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Camper’s Name ___________________________________________________ Birthday ______/_______/_______ Age_____ Mailing Address___________________________________________________ ___________________________________________________ Gender Male Female AUTHORIZED ADULTS TO PICK UP CAMPER Name Relationship Phone # Phone # Email Is this your child’s first time at Camp Winona? YES NO Most recent year? ____________________ What school does your camper attend? ________________________________________________________________________ Did someone refer you? NO YES Who can we thank? ______________________________________________ Does your camper have any cabin mate requests?_____________________________________________________________ Any learning behaviors we should know about? NO YES Special dietary needs? NO YES 898 Camp Winona Rd DeLeon Springs, FL 32130 386.985.4544 www.CampWinona.org *If there are more people authorized to pick your child up, please list them on the health history form. CAMP SESSION(S) AMOUNT: $________________ Additional Fees Camp Store Account: $________________ High Ropes (age 10+)$30 each: $________________ Paintball (age 10+)$75 each: $________________ Weekend Stayover$155 each: $________________ Tax Deductible Donation to help send kids to Camp: $________________ **TOTAL BALANCE:** $________________ If registering before March 1st, save $50! Use the code EARLYBIRD if registering online $50 deposit for each session is required to reserve your spot. Balance must be paid in full no later than 2 weeks prior to session start date. Registrations less than two weeks before Camp require full payment. Fees are non-refundable and non-transferable. Payment and Registration Info Please refer to the next page for the schedule and check the sessions your camper is attending. Member Rate Community Rate Traditional Week $560 $610 Mini Camp $200 $250 Teen $560 $610 Leader in Training $1,250 $1,300 Counselor in Training $1,250 $1,300 CVC $750 $750 CAMP WINONA Summer Camp 2020 Registration

Transcript of CAMP WINONA 898 Camp Winona Rd DeLeon Springs, FL 32130...

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Camper’s Name ___________________________________________________ Birthday ______/_______/_______ Age_____

Mailing Address___________________________________________________

___________________________________________________ Gender Male Female

AUTHORIZED ADULTS TO PICK UP CAMPER

Name Relationship Phone # Phone # Email

Is this your child’s first time at Camp Winona? YES NO Most recent year? ____________________

What school does your camper attend? ________________________________________________________________________

Did someone refer you? NO YES Who can we thank? ______________________________________________

Does your camper have any cabin mate requests?_____________________________________________________________

Any learning behaviors we should know about? NO YES Special dietary needs? NO YES

898 Camp Winona Rd

DeLeon Springs, FL 32130

386.985.4544

www.CampWinona.org

*If there are more people authorized to pick your child up, please list them on the health history form.

CAMP SESSION(S) AMOUNT: $________________

Additional Fees

Camp Store Account:

$________________

High Ropes (age 10+)—$30 each:

$________________

Paintball (age 10+)—$75 each:

$________________

Weekend Stayover—$155 each:

$________________

Tax Deductible Donation

to help send kids to Camp:

$________________

**TOTAL BALANCE:**

$________________

If registering before March 1st, save $50! Use the code EARLYBIRD if registering online

$50 deposit for each session is required to reserve your spot. Balance must be paid in full no later than 2 weeks prior to session start date.

Registrations less than two weeks before Camp require full payment. Fees are non-refundable and non-transferable.

Payment and Registration Info Please refer to the next page for the schedule and check the sessions your camper is attending.

Member Rate Community Rate

Traditional Week $560 $610

Mini Camp $200 $250

Teen $560 $610

Leader in Training $1,250 $1,300

Counselor in Training $1,250 $1,300

CVC $750 $750

CAMP WINONA

Summer Camp 2020

Registration

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TRADITIONAL

2020 Summer Camp Schedule

TEEN & LEADERSHIP

Teen (ages 13-16)

June 14—19 Week 3

LIT—Leader in Training (ages 15-16)

June 7—19 Weeks 2,3

CVC Camp (High Schoolers)

July 11—17

One Week Camp (ages 6-15)

May 31—June 5 Week 1

June 7—12 Week 2

June 14—19 Week 3

June 21—26 Week 4

June 28—July 3 Week 5

July 5—10 Week 6

Mini Camp (ages 6-8)

June 7-9 (Boys) Week 2

June 10-12 (Girls) Week 2

CIT—Counselor in Training (age 17)

May 31—June 19 Weeks 1,2,3

CONTACT US For questions about registering for camp, financial assistance or camp forms,

please contact us at Camp!

Phone: 386-985-4544

Email: [email protected]

Visit us at: www.campwinona.org

FINANCIAL ASSISTANCE

We believe that everyone should have the opportunity to attend Camp and

we will do our best to help get your child to Camp, no matter your financial

ability. If you are interested in a scholarship to send your child to Camp,

please fill out the Financial Assistance Request form found on our website or

at your local Y. Please note that all add ons are not eligible for scholarship.

ADD ONS

High Ropes (ages 10+) Week 1-6

Paintball (ages 10+) Week 1-6

Weekend Stayover

(End of session, Friday

through Sunday)

Week 1-5

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898 Camp Winona Rd

DeLeon Springs, FL 32130

386.985.4544

www.CampWinona.org

YMCA Camp Winona Summer Camp 2020

Camper’s Name _______________________________________________________________ Birthday ______/_______/_______

FLORIDA MINOR RELEASE AND WAIVER OF LEGAL LIABILITY THIS IS YOUR RELEASE AND WAIVER OF LIABILITY (the “Release”). You individually and on behalf on your minor child, release the Volusia Flagler Family

YMCA, Inc. (“YMCA”), its officers, directors, board members, employees, volunteers, agents, independent contractors, other participants, and/or others acting

on its behalf (collectively, “YMCA”). You agree that this Release is effective immediately.

Read this form completely and carefully. You are agreeing to let your minor child engage in a potentially dangerous activity. You are agreeing that, even if

the YMCA uses reasonable care in providing this activity, there is a chance that your child may be seriously injured or killed by participating in this activity

because there are certain dangers inherent in the activity which cannot be avoided or eliminated. By signing this form you are giving up your child’s right and your right to recover from the YMCA in a lawsuit for any personal injury, including death, to your child or any property damage that results from the

risks that are a natural part of the activity. You have the right to refuse to sign this form, and the YMCA has the right to refuse to let your child participate if

this form is not signed.

I HAVE READ THE ABOVE WAIVER, RELEASE, AND INDEMNIFICATION AGREEMENT:

SIGNATURE OF PARENT / GUARDIAN DATE

CONDITIONS OF YOUTH DEVELOPMENT PROGRAM PARTICIPATION While the YMCA will make every attempt to provide reasonable accommodations for mentally and physically challenged children, the YMCA will not accept

children that are (1) of danger to themselves, (2) of danger to others, or (3) a disruption to the normal activities making it unreasonably difficult for other

children to enjoy YMCA programs. Any of the above reasons will be grounds for dismissal from YMCA programs. The YMCA strongly recommends that you

discuss with YMCA staff any special conditions or circumstances involving your child. The YMCA requests that the undersigned do this PRIOR to registration

so that the YMCA can advise you as to whether we can make reasonable accommodation for your child.

The undersigned understands that the YMCA is NOT responsible for personal property lost or stolen while members and/or program participants are using

YMCA facilities or on YMCA premises.

I give my permission to the Volusia Flagler Family YMCA to use, without limitation or obligation, photographs, film footage or tape recordings that may in-

clude mine and or my family member’s image(s), or voice(s) for purposes of promoting or interpreting YMCA programs. In the event of an emergency and my emergency contact person cannot be reached, the undersigned hereby gives his or her permission to the physician

selected by the YMCA to hospitalize, secure proper treatment for, and to order injections, anesthesia or surgery for the individual named on this application.

As the undersigned, I understand that no accident or medical insurance is provided with this activity.

As the undersigned, I give my permission for my child to be transported by the bus service secured by the YMCA for related programs activities.

I understand the deposit and registration fee is non-refundable except for verified medical reasons.

I accept the Conditions of Youth Development Program Participation set forth above and, being in sympathy with the Mission of the YMCA, hereby apply to

participate.

SIGNATURE OF PARENT / GUARDIAN DATE

PAINTBALL & HIGH ROPES PROGRAM INFORMATION AND RELEASE OF LIABILITY FORM PLEASE READ AND SIGN FOR ANY 10+ CHILD ADDING PAINTBALL OR HIGH ROPES

The YMCA Camp Winona Paintball & High Ropes Programs involve a variety of activities may include games, group initiative problems and other potentially

strenuous activities. The level of participation in these activities at all times are up to the individual’s choice. Yet there is a risk which must be assumed by

each participant that he/she may suffer emotional/physical injury.

I understand that parts of the YMCA Camp Winona Paintball & High Ropes Program may be physically and emotionally demanding. I affirm that my child is

in good health and that my child does not have any limiting physical conditions, disabilities or handicaps that might endanger him/her or other participants.

I recognize the inherent risk of injury or disability in YMCA Camp Winona Paintball and High Ropes activities. I understand that each participant must assume

the risk of physical and emotional injury that could result from any of these activities. I hereby release YMCA Camp Winona, the Volusia Flager Family YMCA,

its agents, employees and instructors from any liability what-so-ever from any injury or disability to my child resulting from my child’s participation in the YMCA Camp Winona Paintball and High Ropes Programs.

I have read and understand all of the above participant information and release of liability form and consent to his/her participation in the YMCA Camp

Winona Paintball and/or High Ropes Programs.

SIGNATURE OF PARENT / GUARDIAN DATE

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CAMPER CODE OF CONDUCT

Camp is meant to be a fun place to be for EVERYONE. The best way to ensure this mission is to make sure that all

campers follow the camp policies. These rules are meant to keep each camper safe and happy.

PLEASE REVIEW THE FOLLOWING CONDUCT CODE WITH YOUR CHILD AND ASK HIM/HER TO SIGN IT.

To stay safe, have fun, and ensure a good experience for all other campers, I will…. Always follow directions of YMCA Camp Winona Staff

Stay with your counselor or activity group at all times

Respect other campers and their belongings at all times (This includes not physically or verbally hurting

other people)

Respect your environment by refraining from littering and abusing equipment/furnishings

Shoes must be worn at all times. Exceptions will be approved by the counselor

No camper is allowed to have or use any form of tobacco product, controlled substance, illegal sub-

stance, alcoholic substance

Electronic items (such as phones and tablets) are not allowed at Camp; any found will be confiscated

until check out.

No camper is allowed in any cabin or bathhouse except his or her own

After lights out, campers must remain in their cabin unless using the bathroom or seeing the nurse. The

counselor must be informed

All campers must participate in their scheduled activities. If ill, inform cabin counselor, who will direct

the camper to the nurse

No pillow fights or towel flicking (rat tails)

Demonstrate the four core values at all times; caring, honesty, respect, and responsibility

Treat others how I would want to be treated

Maintain a positive attitude

SHOULD YOU CHOOSE TO VIOLATE THIS CODE OF CONDUCT, THE FOLLOWING ARE THE CONSEQUENCES:

1. Camp Staff will first verbally warn campers for breaking these policies

2. If behavior or action persists, camper will not participate in that given activity

3. If behavior still persists, camper will be sent to the camp office with the Camp Executive Director and

parents will be notified at this time

4. Camper will be put on a 24 hour contract. If behavior or actions do not improve child will be sent home

at parents’ expense

5. The camp director will discuss all decisions thoroughly with the parent before any child is sent home

6. The camp director reserves the right to send home any camper if it is decided that it is in the best in-

terest of the YMCA Camp Winona program and campers. Immediate dismissal of a camper may result

from severe infractions

I AGREE TO FOLLOW THESE POLICIES AND ACCEPT THE CONSEQUENCES IF I DO NOT.

PARTICIPANT’S SIGNATURE DATE

I HAVE REVIEWED THESE POLICIES AND CONSEQUENCES WITH MY CHILD.

PARENT/GUARDIAN’S SIGNATURE DATE

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LETTER FROM CAMPER This is a letter from you, the camper, to your counselors so that they know something about you before you arrive!

Today’s Date:

Full Name: Nickname:

Age: Gender: Boy Girl School Grade Next Year:

What would you like to do/get out of camp this year? _________________

What do you want to learn?

What worries/concerns do you have about camp?

What do you like to do for fun?

What are your likes?

What are your dislikes?

Is there anything else you want your counselors to know about you?

Finish this statement:

This year, I think camp is going to be ___________!

Sincerely,

_________________________________________________________

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PARENT’S CONFIDENTIAL QUESTIONNAIRE

The following information is confidential and will only be shared with relevant staff to ensure your child acclimates to camp and

has a safe, meaningful, and fun camp experience. Your child will not see this form at camp.

If printed on same paper, please have child finish his/hers first.

CAMPER NAME PREFERRED NAME

BIRTH DATE AGE AT CAMP MALE FEMALE

1ST PARENT/GUARDIAN NAME RELATIONSHIP TO CAMPER

RESIDES WITH CHILD Yes No ACTIVE IN CHILD’S LIFE Yes No

2ND PARENT/GUARDIAN NAME __________RELATIONSHIP TO CAMPER

RESIDES WITH CHILD Yes No ACTIVE IN CHILD’S LIFE Yes No

OTHER ADULTS ACTIVE IN CHILD’S LIFE

NUMBER OF BROTHERS AGES NUMBER OF SISTERS AGES

OVERNIGHT EXPERIENCE; Has your child stayed overnight anywhere but home? Yes No

DETAILS ________________________________________________________________________________________

PLEASE DESCRIBE ANY IMPORTANT DETAILS ABOUT YOUR CHILD THAT WILL HELP HIS/HER COUNSELORS PROVIDE THE BEST

SUPPORT POSSIBLE

___________________________________________________________________________________________________________________

CAMPER’S INTERESTS, TALENTS, AND HOBBIES _________

EXPECTATION: What do you expect your child to gain from Camp?

ACTIVITES: What does your child want to do most at Camp?

BEHAVIORS/HEALTH ISSUES: Please describe anything the counselor should be aware of (i.e. bedwetting, aggression, etc)

MAJOR EVENTS/ACCOMPLISHMENTS: Please detail any highs or lows in the last year that have affected your child

_________________________________________

PERSONALITY TRAITS: Please mark all that apply to your child

ADVENTUROUS BOSSY CONFIDENT DEPENDABLE ENCOURAGING

FAIR FEARLESS FINICKY HELPFUL IMAGINATIVE

IMPULSIVE INDEPENDENT LAZY METICULOUS OPTIMISTIC

QUARRELSOME QUICK LEARNER RELIABLE SARCASTIC TRUSTING

ARE THERE ANY OTHER ISSUES, CONCERNS, FEARS OR QUIRKS WE SHOULD KNOW ABOUT

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Health History Form

YMCA Camp Winona

This form must be filled out completely, signed by the camper’s parent/guardian, and returned with requested documentation to the camp office TWO weeks prior to your camper’s session.

Email the completed form to [email protected]

Camper’s Name ______________________________________________ Birthday ______/_______/_______ Age_____

Home Address ___________________________________________________ Grade in Fall 2020 __________________

__________________________________________________ Gender Male Female

CAMPER MEDICAL INFORMATION

Name of Family Physician ___________________________________________ Phone # ___________________________

Name of Family Dentist _____________________________________________ Phone # ___________________________

Name of Family Orthodontist _______________________________________ Phone # ___________________________

MEDICAL INSURANCE INFORMATION

Camper is covered by family medical/hospital insurance Yes No

If yes, please include a copy of your insurance card (both sides)

Insurance Company__________________________________________ Phone Number ____________________________

Subscriber____________________________________________________ Policy Number _____________________________

CONTACT INFORMATION IN CASE OF ILLNESS OR INJURY

Camper Lives With __________________________ Relationship To Camper ___________________________________

Home Address (if different from above)___________________________________________________________________

First Guardian’s Name & Email____________________________________________________________________________

First Guardian’s Phone # __________________________________ Alternate Phone # ____________________________

Second Guardian’s Name & Email ________________________________________________________________________

Second Guardian’s Phone # ________________________________ Alternate Phone # __________________________

Emergency Contact Name __________________________________ Relation to Camper_________________________

Emergency Contact Phone # _______________________________ Alternate Phone # __________________________

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GENERAL HEALTH HISTORY Please check if any of the below apply.

Recent injury, illness, or infectious

Ever been hospitalized

Chronic or recurring illness/condition

Ever had surgery

Ever had seizures

Skin conditions

Diabetes

Asthma/Wheezing/Shortness of Breath

Headaches

Fainting/Dizziness

Passed out/chest pain during exercise

Back/joint problems

Regular diarrhea/constipation

Frequent ear infections

Heart defect/disease

Blood disorder (hepatitis, HIV, clotting)

Nosebleeds

Hypertension

Mononucleosis

Chicken Pox

Measles/German Measles

Mumps

Sleepwalking or night terrors

History of bedwetting

Wakes in night to use restroom

History of being afraid of the dark

History of noise while sleeping (snores,

talks, etc)

Menstruation problems

Glasses/Contact lenses

Braces, retainers, or other dental items

Ever had professional help for behavioral

or emotional difficulties

Mental health hospitalization

Eating disorders

Depression

Attention Deficit Hyperactivity Disorder

Anxiety

Tourette’s Syndrome

Autism Spectrum Disorder

Behavior Disorder

Obsessive Compulsive Disorder

Schizophrenia

Bipolar Disorder

Pervasive Development Disorder

Oppositional Defiant Disorder

Learning Disability

Traveled outside the country in the past

12 months _________________________________

Have any restrictions to activities (what

cannot be done/adaptations/limitations

necessary)

Significant life event that continues to af-

fect Camper’s life (abuse, death, family changes, etc)?

Additional concerns Camp should be

aware of (behavior, physical, emotional

health, etc)

Please explain all checked items or anything we have forgotten to ask_________________________

___________________________________________________________________________________________________

___________________________________________________________________________________________________

___________________________________________________________________________________________________

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IMMUNIZATION HISTORY:

_______ I hereby verify that my child is current on all immunizations required for school.

You must include a current copy of immunization records from your health care professional

OR fill out the information below.

_______ If your camper has not been fully immunized, please sign the following statement:

I understand and accept the risks to my child from not being fully immunized.

___________________________________________________________________________________________

Signature of Parent/Guardian Date

ALLERGIES Please check if any of the below apply. If checked, please state if the allergy

is mild, moderate, or severe AND if the allergy is contact or airborne.

Animal____________________

Insect Stings

Medicine__________________

Penicillin

Environmental (Pollen,

trees, mold, etc)

Peanut/Tree Nut

Food ______________________

Other _____________________

Severity of reaction and action plan for your camper __________________________________________

__________________________________________________________________________________________________

Immunization

Dose 1

Month/Year Dose 2

Month/Year Dose 3

Month/Year Dose 4

Month/Year Dose 5

Month/Year Booster

Month/Year

Diptheria, tetanus, pertussis (DtaP or TdaP)

Mumps, measles, rubella

(MMR)

Polio (IPV)

Haemophilus influenza Type B

(HIB)

Pneumoccal (PCV)

Hepatitis B

Hepatitis A

Varicella

(chicken pox)

Meningococcal meningitis (MCV4)

Tuberculosis (TB) Test Date: Negative Positive

DIET & NUTRITION Please check if any of the below apply.

Vegetarian

Vegan

Lactose Intolerant

Gluten Intolerant

Other ____________________

___________________________

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MEDICATIONS Please list ALL medications (including over-the-counter and non-prescription)

that are taken routinely by the camper. Please bring enough medication to last for the whole

week. ALL medication must be in its original packaging that identifies prescribing physician (if

prescribed), the name of the medication, dosage, and frequency.

This camper does not take any medication

This camper takes routine medication (including vitamins) as follows:

Medication Dosage Times Taken Reasons for taking

The following medications may be stocked in our Health Center and are dispensed

by our Health Administrators on an as needed basis.

Please cross out any medications which your camper SHOULD NOT be given.

Acetaminophen (Tylenol)

Aloe Vera lotion or spray

Antibiotic cream

Antihistamine/allergy medicine

Bismuth subsalicylate for diarrhea (Pepto-

Bismol, Kaopectate)

Calamine lotion

Cough drops

Dextromethorphan cough syrup (Robitussen DM)

Diphenhydramine antihistamine/allergy medicine (Benadryl)

Epsom Salt

Guaifenesin cough syrup (Robitussen)

Hydrocortisone Cream

Hydrogen Peroxide

Ibuprofen (Advil, Motrin)

Lice shampoo or cream (Nix or Eliminate)

Laxatives for constipation

Phenylephrine decongestant (Sudafed PE)

Pseudoephedrine decongestant (Sudafed)

Rubbing Alcohol

Sore throat spray

Sterile eye drops

Tums

OTHER ____________________________

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PARENT/GUARDIAN AUTHORIZATION FOR HEALTH CARE This health history is correct and accurately reflects the health status of (camper to whom it

pertains) ____________________________________________________. S/he has permission to participate

in all camp activities except as noted by me and/or an examining physician. I give permission to the

physician selected by the camp to order x-rays, routine test, and treatment related to the health of my

child for both routine health care and in emergency situations. If I cannot be reached in an emergen-

cy, I give my permission to the physician to hospitalize, secure proper treatment for, and order injec-

tion, anesthesia, or surgery for this child. I understand the information on this form will be shared on

a “need to know” basis with camp staff. I give permission to photocopy this form. In addition, the camp has permission to obtain a copy of my child’s health records from providers who treat my child and these providers may talk with the program’s staff about my child’s health status.

____________________________________________________________________________________________________________

Parent/Guardian Signature Date

If for religious or other reasons, you cannot sign this, contact the camp for a legal waiver which must be signed for attendance.

FOR CAMP USE ONLY

Is all the information current? YES NO

Does the camper have medications? YES NO

Does the camper have allergies? YES NO

Any signs/symptoms of illness/injury upon arrival? YES NO

Head checked and cleared? YES NO

AUTHORIZED PICK UP LIST (In addition to Parents/Guardians on 1st page)

Name ______________________________________________Relationship:__________________________________________

Phone # ____________________________________________Alternate Phone # ____________________________________

Name ______________________________________________Relationship:__________________________________________

Phone # ____________________________________________Alternate Phone # ____________________________________

Name ______________________________________________Relationship:__________________________________________

Phone # ____________________________________________Alternate Phone # ____________________________________

Name ______________________________________________Relationship:__________________________________________

Phone # ____________________________________________Alternate Phone # ____________________________________

Name ______________________________________________Relationship:__________________________________________

Phone # ____________________________________________Alternate Phone # ____________________________________

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Recommendations for Licensed Medical Personnel

FORM 2

Developed and reviewed by: American Camp Association,

American Academy of Pediatrics Council on School Health, &

Association of Camp Nurses

Mail this form to the address below by (date)

The following non-prescription medications are commonly stocked in camp

Health Centers and are used on an as needed basis to manage illness and

injury. Medical personnel: Cross out those items the camper should

not be given.

Diet, Nutrition: Eats a regular diet. Has a medically prescribed meal plan or dietary restrictions:(describe below)

The camper is undergoing treatment at this time for the following conditions: (describe below) None.

Medication: No daily medications. Will take the following prescribed medication(s) while at camp: (name, dose, frequency—describe below)

Other treatments/therapies to be continued at camp: (describe below) None needed.

Do you feel that the camper will require limitations or restrictions to activity while at camp? No Yes

If you answered “Yes” to the question above, what do you recommend? (describe below—attach additional information if needed)

“I have reviewed the CAMPER HEALTH HISTORY FORM (FORM 1), and have discussed the camp program with the camper’s parent(s)/guardian(s). It is my

opinion that the camper is physically and emotionally fit to participate in an active camp program (except as noted above.)Name of licensed provider (please print): _____________________________________________________Signature: _________________________________Title: _________________

Office Address_____________________________________________________________________________________________________________________________________________Street City State Zip Code

Telephone: (________)_____________________ Date:_______________________

Copyright 2014 by American Camping Association, Inc. Rev. 1/14 LEE/EAW

To Parent(s)/Guardian(s): Complete this section and give this form (FORM 2) and a copy of your

completed CAMPER HEALTH HISTORY FORM (FORM 1) to your child’s health-care provider for review.

Dates will attend camp: from ______________to_____________

Month/Day/Year Month/Day/Year

Camper Name: _____________________________________________________________________________________

First Middle Last

Male Female Birth Date __________________ Age on arrival at camp ________________ Month/Day/Year

Camper home address: ______________________________________________________________________________

____________________________________________________________________________________________________

City State Zip Code

Custodial parent(s)/guardian(s) phone: (_______)________________________ (_______)_________________________Parent(s)/guardian(s) stop here. Rest of form to be completed by medical personnel.

Physical exam done today: Yes No (If “No,” date of last physical: ____________________)

Month/Day/YearACA accreditation standards specify physical exam within the last 24 months.

Medical Personnel: Please review the CAMPER HEALTH HISTORY FORM

(FORM 1) and complete all remaining sections of this form (FORM 2).

Attach additional information if needed.

Weight: _______ lbs Height: _____ft_____in Blood Pressure_______/_______

Allergies: No Known Allergies To foods (list):

To medications: (list):

To the environment (insect stings, hay fever, etc.– list):

Other allergies: (list):

Describe previous reactions:

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Acetaminophen (Tylenol)Ibuprofen (Advil, Motrin)Phenylephrine (Sudafed PE)

Pseudoephedrine (Sudafed)

Chlorpheneramine maleate

Guaifenesin

Dextromethorphan

Diphenhydramine (Benadryl)

Generic cough drops

Chloraseptic (Sore throat spray)

Lice shampoo or scabies cream

(Nix or Elimite)

Calamine lotion

Bismuth subsalicylate (Pepto-Bismol)

Laxatives for constipation (Ex-Lax)

Hydrocortisone 1% cream

Topical antibiotic cream

Calamine lotion

Aloe

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2020 PARENT PACKET

We are very excited that you have decided to send your child to spend

time with us this summer. We know that your child is the most pre-

cious thing in your life, and we promise to do our absolute best to en-

sure an amazing, safe experience for your camper, unlike any other.

We have been providing character development programs for over

100 years. It is our goal with this packet, that

most of your questions will be addressed.

Please contact us if you have any other ques-

tions.

Welcome to the Camp Winona Family!

Alex Kinney

Executive Director

2. Who We Are

3. Daily Camp Schedule

4. Preparing For Camp

5. Check In & Out Procedures

6. Homesickness & Camp Store

Going through this packet with

your camper will help alleviate any

anxiety and homesickness that

they (and you!) might be feeling!

What You Will Find In This Packet — And How It Helps!

Phone #: 386.985.4544

Email: [email protected]

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Who Is Caring For Your Child?

We know it can be difficult sending your child off to people you do not know

personally. However, you can sleep easy! Our counselors and staff at Camp are

not only capable, but are also very excited to work with your child this summer.

Camp Winona is accredited by the prestigious American Camping Association

and follows over 300 standards in safety, health and program quality.

During the hiring process, we do expansive background

checks to ensure your child’s safety. All counselors we hire are over the age of 18 and go through a very exten-

sive training program. Besides preparing them to work

with children, we also certify them in all the various pro-

gram areas that Camp Winona has to offer. We lifeguard

train all of our staff, so your children are safe at our lake waterfront. Our staff are

all CPR/First Aid trained, and we have a Registered Nurse on site.

Still Unsure? Come Check Us Out!

Join us at a Sunday Open House! We will have staff available to answer all your

questions and it gives you the opportunity to see the Camp facilities. Another

great opportunity is to sign up for Family Camp over Memorial Day before

Camp officially begins; you’ll get to have the fun of Camp with your child and meet the staff that will be working with your campers this summer.

Open Houses: 2:00-3:30pm Sunday, January 26

Sunday, February 23

Sunday, March 29

Sunday, April 26

Family Camp: May 22-25

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Typical Camp Schedule

Every day is a little different at

Camp, depending on what type

of Camp your child is signed up

for. However, the schedule to

the right will give you a good

idea of what it might look like.

Overnight campers will have the

opportunity to sign up for pro-

grams that they would like to fo-

cus on and learn it on a deeper

level, such as; archery, outdoor

living skills, riflery, athletics, sail-

ing, dance, and more! Start talk-

ing to your child about what they

might want to sign up for!

7:30 am Rise and Shine

8:15 am Flag Raising

8:30 am Breakfast

9:15 am Camp Activities—Focus

12:30 pm Lunch

1:15 pm Rest Period

2:30 pm Camp Activities—Cabin

3:30 pm Snack & Rest

4:00 pm Waterfront Activities

5:45 pm Flag Lowering

6:00 pm Dinner

6:45 pm Free Time

7:15 pm Vespers

7:30 pm All Camp Activity

9:00 pm Showers

9:30 pm Cabin Chats

10:00 pm Lights Out

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Preparing For Camp

There are a few things that need

to be done before you arrive at

Camp Winona. If you go to our

website under the “Resources,” you will find the forms you need.

To Do Checklist

Complete and turn in the

Health History Form

Turn in a copy of a Physical

done in the last 12 months

Pay your camp balance

Go through this packet with

them

Pack! We recommend writing

your name on all the items.

Get excited!

Packing List Water Bottle

Small backpack/fanny pack

High SPF Sunscreen & Bug Spray

2 Pair Close Toed Shoes (that can

get muddy/wet)

Flip flops (for bathhouse/beach only)

Hat & Sunglasses

Swimsuits & Towels

Daily Socks/Underwear

6-8 Shirts & Shorts

1-2 Pants

Light Jacket/Rain Gear

Long sleeve shirt/pants (required for

paintball)

Pajamas

Toiletries in Carrying Container

Bath Towel

Sleeping Bag or Twin Sheet/Blanket

Pillow

Flashlight

Pre-addressed & stamped envelopes

Do NOT bring the following:

Phones, or any electronics, inappropri-

ate clothing (if you can not wear it to

school, do not wear it at Camp), per-

sonal sports equipment, drugs, alcohol,

expensive items, food, knives, fireworks

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Your child’s safety is our number one priority, which is why we take check in and check out very seriously. You MUST sign your child in before you depart. Every per-

son, including the person that dropped them off, is REQUIRED to be listed on the

authorized pick up list AND show a driver’s license to pick your child up.

Check In & Check Out

Check In—Sunday, 2-3pm

Do not arrive early, as our staff are pre-

paring. Activities begin promptly at

3:30pm, so please do not arrive late.

Upon arrival, you will be directed to the

Becky Building for:

Cabin Assignment

Health & Head Check

Paperwork, if not submitted

Camp Store Account

Pay balance if needed

Then you will take your camper to their

cabin. You’ll get to help them settle in, meet their counselors, sign your camper

in, and then say your “see you laters!”

Check Out—Friday, 5-6pm

Please come directly to the Becky

Building for check out. You’ll sign your camper out and pick up any meds and

a weekly report. All the campers will

then arrive to the Becky Building for a

short ceremony at 5:30pm. Once the

ceremony is finished, you can:

Chat with your child’s counselors and friends

Visit the Camp Store

Check Lost and Found

Go to the cabin to collect your

campers belongings and depart!

Weekend Stayover

If your child is staying over the

weekend after their session, but

leaving before the next session,

check out will be on SUNDAY at

11am at the Main Office

Mini Camp Boys Session

Check in—Sunday, 2-3pm

Check out—Tues, 5-6pm (Main Office)

Mini Camp Girls Session

Check in—Wed, 2-3pm (Main Office)

Check out—Friday, 5-6pm

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Homesickness

Read this packet with them. It will

help them know what to expect and

build excitement.

Hide your anxiety. As a parent, your

child will look to you on how to act

about this new experience. Talk

about how you wish you could go!

The more conversations you have

with them, the better they will feel.

Limit screen time. Many kids don’t know life without screens. We rec-

ommend limiting screen time prior to

Camp to help them prepare to be

“unplugged!”

Do NOT tell them you’ll pick them up early or call to check in. This

prepares them to be homesick and

less likely to keep a positive attitude

or try new things.

Tell them about your first time

away from home. This lets them

know that it’s normal to miss home. And that even if they get sad, they’ll get through it!

Tell them you love them and send

them letters.

Camp Store While daily nutritious snacks are provided, campers will have the opportunity to buy

additional snacks and drinks, as well as merchandise like shirts, hats, stuffed ani-

mals, and more! Do not give your child cash to use; you will deposit money into an

account at Camp Check In. We will have the store open during Check Out to spend

any leftover money, or to grab additional swag!

There are no refunds. Any leftover amount will be donated to our Annual Campaign

to help send Kids to Camp.

We get it. Going to Camp for the first time or staying overnight away from home

can be tough and bring a lot of anxiety for any child or parent. We have some

helpful tips to prepare you both for a beneficial and rewarding experience.