Christine de CHANAUD - Séjours HOME ABROAD

INFORMATIONS GENERALES SEJOUR EN SUMMER CAMP DISCOVERY
(AVEC ACCOMPAGNATEUR)
« PARENTS PACK » - IMPORTANT à retourner avant le 14 mai
Nous vous adressons par courrier électronique le « parents pack » du camp de votre enfant
(si vous n’arrivez pas à l’ouvrir, appelez nous ou téléchargez-le sur notre site internet : www.sejourshomeabroad.com - rubrique « Autres formulaires »).
Il s’agit des informations générales sur le camp, accompagnées de documents à remplir et à nous
retourner au plus tard pour le mercredi 3 juin 2009 : date de la réunion d’information à laquelle vousmêmes et vos enfants êtes conviés : dans les locaux du MUSEE EN HERBE - 18h30 à 20h00
- 21, rue Herold 75001 PARIS - Métro : Sentier ou Chatelet les Halles –
(attention : il n’est pas facile de se garer dans le quartier…)
La « Health Form » ou Formulaire médical, est à faire compléter obligatoirement par un médecin
(tampon faisant foi). Merci de nous régler également le solde du séjour dés réception de la facture
(sauf si paiement par carte bancaire donnée à l’inscription et prélevée automatiquement).
Amandine reste à votre entière disposition pour la compréhension et le remplissage des documents
en anglais.
POUR LE VOYAGE (Organisé par l’Agence en groupe accompagné) :
Vous trouverez dans les documents joints notre convocation aéroport.
Parents, nous vous retrouverons à l’aéroport à l’embarquement de votre enfant. Au retour, il vous
appartient de venir le chercher en ayant bien noté les coordonnées de son vol.
Prévoir de donner au voyageur l’adresse complète de sa destination ce jour là (dans les
documents du camp).
ASSURANCES INDIVIDUELLES
Nous vous rappelons que chaque enfant partant à l’étranger doit être couvert pour :
- santé / responsabilité civile / assistance rapatriement, valable aux USA et pendant toute la durée
du séjour.
Pour ce faire, voici les diverses possibilités existantes :
- assurance Carte Bancaire (Visa Premier / Mastercard Gold et autres cartes haut de gamme). Merci
de vérifier auprès de votre banque que ces risques sont bien couverts pour votre enfant.
- assurance personnelle familiale : par extension, vos contrats familiaux vous permettent peut-être
de bénéficier de tout ou partie des couvertures ci-dessus pour votre enfant. Il vous appartient de le
vérifier.
- souscription d’une assurance auprès de ACS : vous trouverez sur notre site internet dans la
rubrique infos Pratiques / s’assurer un lien vous permettant de souscrire directement auprès de la
Compagnie.
Dans tous les cas, vous devrez nous remettre avant le départ le numéro d’urgence à appeler en cas
de problème, avec les références à indiquer.
ASSURANCES ANNULATION
En option. Ce risque sera couvert par les paiements effectués par certaines cartes bancaires (vérifier
auprès de votre banque). Sinon, pour vous couvrir contre une annulation séjour ou voyage, vous
pouvez opter pour l’assurance de Europ assistance (risque annulation simple, ou annulation séjour et
Séjours HOME ABROAD
59 avenue de Saint Cloud – 78000 VERSAILLES – Tél. (0)1.39.50.77.70 – Fax. (0)1.39.50.75.01
Email : [email protected] Site INTERNET : www..sejours-homeabroad.com
SARL au capital de 8 000 € - Licence Agence de Voyage : Numéro : LI.078.05.0001
Garantie financière BNP PARIBAS PARIS – Garantie RCP HISCOX France
1
voyage inclus dans la multirisque). Nous tenons à votre disposition –sur simple demande par mail ou
téléphone- une documentation, avec en dernière page un formulaire d’inscription à remplir et à nous
retourner avec un chèque correspondant à la prime, à l’ordre de Home Abroad). Cette assurance doit
être souscrite impérativement 40 jours avant la date de départ.
ACTIVITES AU CAMP
Vous trouverez dans le tableau ci-joint la liste des activités à choisir pour chaque camp. Vous devez
nous le retourner rempli et signé au plus vite, de façon à ce que nous puissions pré-inscrire votre
enfant aux options choisies, le cas échéant. Les places en rafting à FAIRVIEW LAKE sont limitées !
TRADING POST / ARGENT DE POCHE
Toujours dans le tableau ci-joint, vous devez indiquer une somme en dollars US qui sera créditée au
compte de votre enfant à la boutique du camp (ou Trading Post). Il y trouvera des T-shirts, snacks,
souvenirs etc…les camps recommandent un crédit de 50 $ par session de deux semaines. Attention,
certains camps se réservent le droit de garder l’argent de poche non utilisé à la fin du séjour (voir la
politique du camp dans le « parents pack »).
Vous pourrez également remettre à notre accompagnateur le jour du départ une somme libre en
dollars US, dans une enveloppe à son nom, pour les attentes aéroports ou les éventuelles sorties
organisées par le camp. Le montant est ben sûr libre.
COMMUNICATIONS AVEC VOTRE ENFANT
Pas d’accès au téléphone pour les campeurs, sauf en cas de problème majeur (voir la politique du
camp dans le « parents pack »).
Le lendemain de leur arrivée et une fois par semaine, notre accompagnateur nous enverra un e-mail,
sur lequel chaque enfant pourra mettre un mot pour ses parents. Nous vous le transmettrons : merci
de nous donner vos adresses mail si ce n’est pas déjà fait. De votre côté, vous pourrez écrire des
lettres et e-mails à votre enfant, mais certains camps retiennent une somme par lettre distribuée sur le
compte du Trading Post (trop d’abus dans le passé, les distances au camp sont immenses et il y a
parfois plus de 300 enfants)
LISTE ADAPTEE DES VETEMENTS ET EQUIPEMENTS DIVERS POUR UN SUMMER CAMP
*vêtements :
-sous-vêtements
-tenue chaude
-chaussettes
-shorts
-jeans ou pantalons
-T-shirts, sweat-shirt
-maillot de bain (nous conseillons 2)
-pyjamas
-vêtements de pluie
-blouson épais (pour les soirées froides)
-baskets (solides, les terrains pouvant être rocailleux. Nous conseillons une deuxième paire, si elles
sont mouillées)
*linge de toilette :
-serviettes (deux de toilette et une de plage) et un gant
-trousse de toilette complète
Séjours HOME ABROAD
59 avenue de Saint Cloud – 78000 VERSAILLES – Tél. (0)1.39.50.77.70 – Fax. (0)1.39.50.75.01
Email : [email protected] Site INTERNET : www..sejours-homeabroad.com
SARL au capital de 8 000 € - Licence Agence de Voyage : Numéro : LI.078.05.0001
Garantie financière BNP PARIBAS PARIS – Garantie RCP HISCOX France
2
*équipement :
-de préférence un sac/valise à roulettes, et un sac à dos moyen (à garder dans l’avion, avec le
« minimum vital » nécessaire, utile si perte de bagages, et aussi pour des randonnées éventuelles)
-duvet léger et petit oreiller si possible
-« sac à viande » (draps cousus)
-lampe de poche + piles de rechange
-sac pour le linge sale
*il serait bien d’avoir :
-de quoi écrire
-appareil photo avec flash si possible, plus des pellicules ; mieux, un jetable
-un bon livre
-une peluche préférée
-raquette de tennis, si option choisie
NB : pas de chewing-gums !
Nous conseillons de marquer tout vêtement et équipement auquel vous tenez.
Eviter tout appareil coûteux et tentant (Ipod, téléphone portable, etc…)
FORMALITES DOUANIERES
- Un passeport individuel « électronique » ou « biométrique » (passeport à puce), ou :
- un passeport individuel à lecture optique valable au moins 3 mois après la date de retour
suffit, s’il a été émis avant le 26/10/05 (Si émis après le 26/10/05 et non biométrique, il
faudra un visa ou un passeport biométrique : nous consulter).
ATTENTION : Depuis le 12 janvier dernier la procédure américaine a changé. Vous devez
impérativement obtenir l’autorisation électronique ESTA, en vous rendant sur le site
https://esta.cbp.dhs.gov au plus tard 72 heures avant le départ, afin d’enregistrer le voyage et
d’imprimer l’autorisation de séjour, qui sera à mettre dans le passeport de votre enfant le jour du
départ. Ce formulaire s’obtient en quelques minutes.
L’adresse américaine à donner pour le séjour de votre enfant est :
‐
Camp CONRAD WEISER : 201 Cushion Peak Road ‐ WERNERSVILLE – PA (Pennsylvania) 19565 ‐
Camp RALPH MASON : 23 Birch Ridge Road – HARDWICK – NJ (New Jersey) 07825 ‐
Camp FAIRVIEW LAKE : 1035 Fairview Lake Road ‐ NEWTON ‐ NJ (New Jersey) 07860 ‐
Camp YMCA MAINE : 305 Winthrop Center Rd ‐ WINTHROP – ME (Maine) 04364 NUMERO D’URGENCE
En dehors des horaires de bureau, nous laisserons sur le répondeur du 01 39 50 77 70 un n° de
portable de permanence, pour toute urgence médicale ou avion.
Nous souhaitons un excellent séjour de « découverte » SUMMER CAMP à votre enfant !
Amandine BADOUR Christine de CHANAUD Inge du CHEYRON Aurélien LAFERRERE Caroline RIPOLL
Séjours HOME ABROAD
59 avenue de Saint Cloud – 78000 VERSAILLES – Tél. (0)1.39.50.77.70 – Fax. (0)1.39.50.75.01
Email : [email protected] Site INTERNET : www..sejours-homeabroad.com
SARL au capital de 8 000 € - Licence Agence de Voyage : Numéro : LI.078.05.0001
Garantie financière BNP PARIBAS PARIS – Garantie RCP HISCOX France
3
MANUEL DE SURVIE POUR UN JEUNE FRANÇAIS EN SUMMER CAMP AMERICAIN
(et pour ses parents…)
Cabin : ma cabine où je dors, mais aussi le groupe auquel
j’appartiens. Je suis avec des jeunes de mon âge et ma cabine a
un nom spécial – plusieurs cabines font un village
Counselor : moniteur
Staff : tous les moniteurs
Program Staff : les moniteurs en charge d’une activité
French group Leader : Mon accompagnateur français (si j’en ai
un dans mon camp)
Lifeguard : maître nageur
Cabin Counselor : mon moniteur de cabine
Cabin mate : copain de cabine
bunkbed : lits superposés
Linen / bedding : linge de lit – draps
trunks : malles
Cabin clean-up : nettoyage des cabines
Activities : les activités auxquelles je peux participer :
Archery : tir à l’arc – riflery : tir à la carabine – arts and crafts : artisanat
Beads : enfilage de erles - Wood ou leather working : travail du bois ou du cuir - Sailing :
voile – Boating : bateau (à rames) - Backpacking : randonnée - Horsebackriding :
équitation - Trailriding : randonnée à cheval - bikeriding : vélo – mountainbike : VTT –
teamsports : sports d’équipe - Soccer : notre foot à nous – softball : baseball avec des
règles assouplies et une balle moins dure – lacrosse : un sport ressemblant au hockey
sur gazon – Ropes course : parcours aventure dans les arbres – high ropes : en altitude
– low ropes : plus bas, pour les plus jeunes - outdoor living skills : apprendre à survivre
dans la nature - Cheer leading : pour les filles, « pom pom girls » - Drama : théâtre Wrestling : lutte – fencing : escrime – whitewater rafting : rafting en eaux vives….
Activity period : tranche horaire pour une activité
Majors : activités principales Minors : activités secondaires
Waterfront : plan d’eau, lac le plus souvent
Swimtest : test de natation
skills : technique
Buddy watch : mon binôme, pour vérifier qu’il est bien à côté de
moi, à la piscine par exemple
Flag raising : cérémonie de lever du drapeau, pendant laquelle
les jeunes américains chantent l’hymne national : moi je reste
silencieux et respectueux
Chapel service, Bible study : moments de recueillement religieux
(pas dans tous les camps). Là je respecte aussi.
Color war – olympics : Jeux de groupes en équipe, olympiades
Talent night : soirée cabaret
Scavenger hunt : chasse au
trésor
Community / project service : bénévolat, projet
Date : la fille qu’on choisit comme cavalière pour les « dances » et
autres « parties » Campfire : feu de camp
Vespers : veillées
Bunk mail : le système par lequel je peux recevoir des mails de
l’extérieur (s’il existe dans mon camp)
Trading Post / Canteen : la boutique du camp, ouverte à
certaines heures, et où je peux acheter (avec l’argent
déposé par mes parents au départ) des choses utiles, des snacks
et des souvenirs du camp
Et quelques phrases utiles :
« I don’t feel too well » : je ne me sens pas bien
« can I go see the nurse ? » ; je peux aller à l’infirmerie ?
“ I’m homesick” : j’ai le cafard - j’en parle à ton counselor, il est là pour t’aider !
« this is great ! I love it » :c’est génial, j’adore
“ I’m in ….. grade” : ” je suis en … classe”
Cp=5th grade
6eme=6th
5ème=7th
4ème=8th
3eme=9th
2nde=10th
2009 PARENT HANDBOOK
Everything You Need to Know About Sending Your Child to Camp.
Welcome to
YMCA Camp Ralph S. Mason
YMCA Camp Mason has welcomed youth and families of all nationalities, backgrounds, and faiths since 1900. We offer a
variety of programs focused on building character and deve
developing leadership skills through
rough a shared community
camping experience. The mission-based
based programs of YMCA Camp Mason afford personal growth opportunities to
people of all ages.
Located on 650 acres adjoining the Delaware Water Gap National Recreation Area, an extensive, well-maintained
well
facility
blends with more than 100 years of tradition to provide an exceptional camping experience. Generations of men and
women from all walks of life have spent their summers at Camp Mason.
Camp Mason provides a traditional residential summer camp experience for children 7-16 years of age. Campers learn
important life skills and values while residing in small cabin groups, gaining a better understanding of themselves while
living and working cooperatively in a diverse community.
Camp Mason also prepares teens for responsible citizenship, service, and leadership roles through specialized programs.
Our Leadership Treks and Counselor-in-Training
Training programs help young adults to become conscientious members of the
camp community with an eye toward joinin
joining the staff in the future. The Senior Guide program gives older campers the
opportunity to share their mastery as they assist program specialists in their areas.
Our Mission:
“Through the transforming experience of outdoor camping – rich in bonding friendships, physical activity, and fun –
YMCA Camp Mason will lead youth, families, and community to an awareness of our core traditions: environmental
stewardship, spirituality, and respect for our fellow man.”
Our History:
Camp Mason’s story begins in 1900 when the Trenton/Mercer County YMCA organized its first season of residential
summer camp at Camp Washington,, near Washington’s Crossing, NJ
NJ. Several years later the camp moved to Marshall
Island (also known as Eagle Island) in the Delaware River and changed its name to Camp James J. Wilson. An epic flood
inundated the island in 1955 and the camp was moved to its current location in Hardwick
Hardwick, NJ.. Another name change
accompanied the move: Camp Wilson became Central New Jersey YMCA Camps.
At this time the camp organized itself as an independent YMCA association, serving children from across the tri-state
tri
area. In the 1970's
0's the camp's name was changed again to Camp Ralph S. Mason to honor the man who was
instrumental in relocating and rebuilding the camp after the flood. Mr. Mason was a
camper and staff member who grew up to serve as President of the Board of
Trustees for 34 years; his two sons,, Rip and Tom, remain involved with the camp to
this day.
Each year Camp Mason hosts approximately 800 campers in its summer resident
camping program,, as well as over 10,000 at its Outdoor Center. With 394 beds
available in winterized cabins and lodges, the Mason Outdoor Center welcomes offseason participants come from over 120 different schools, groups and organizations
that use our facility for environmental education, outdoor education, recreation,
retreats, and group getaways.
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Staff:
YMCA Camp Mason employs approximately 100 seasonal staff during the summer. International staff members are
hired for a number of positions, but most are domestic college-age students. All staff members participate in a weeklong training program prior to working with campers. In addition to counselors, the camp hires teaching specialists for
activities such as swimming, the arts, and our extensive adventure programs. Support staff work in the office, kitchen,
and at maintenance. Thoughtful hiring, training, and shared experience create a summer staff at Camp Mason that is
energized, dedicated, and focused on providing an exceptional camping experience to your child.
Camp Mason is committed to creating a safe environment for our campers. We adhere to stringent hiring procedures
when selecting staff. We currently partner with Praesidium (www.praesidiuminc.org), a consultant company consisting
of experts in the field of risk reduction and policy assessment related to hiring and supervising employees working
primarily with children. They review our standards annually, making sure that best hiring practices are maintained.
All staff members sign our Code of Conduct as part of the hiring process, which details our abuse prevention policies
and general conduct expectations. We would be happy to send you a copy of this document or to address any
questions you might have about our hiring policies and procedures. Please direct any requests or questions to the camp
office.
Facilities:
Camp Mason features extensive program facilities including two
recreation lodges, an arts center, playing fields, boating and
canoeing facilities, two ponds, basketball/volleyball courts, a
skateboard park, heated swimming pool, high and low ropes
courses, archery and riflery ranges, and miles of hiking trails.
Cabins are simple and comfortable. Each duplex building is home
to two cabin groups. Junior cabins hold 8 campers and two staff
members. Senior cabins hold 10 campers and two staff members. Each cabin has electricity and full dormitory-style
bathrooms. Campers and staff sleep in sturdy bunk beds in the main cabin area. Our dining hall seats 250 in family-style
comfort. Food is served buffet-style by our experienced food service staff. The kitchen is equipped to deliver healthy
meals in sufficient quantity year-round. Camp Mason recycles its food service and office waste.
YMCA Camp Mason is accredited by the American Camp Association (www.acacamps.org). The camp complies and is
licensed with all state and local health authorities and is inspected annually by the local health department.
Daily Schedule:
Resident summer campers follow a daily schedule that is designed to provide both structure for skills-based learning
and free-time activity choices. A sample of the daily schedule is can be found on our website (www.campmason.org).
Campers begin their day at 7:30AM. Breakfast is served shortly thereafter. Cabin cleanup follows breakfast, after which
is morning cabin activity, a time when each cabin group participates in an activity they’ve planned together early in the
week. A brief free-time follows morning cabin activity. The camp store is open during this time. Lunch is served at
midday and is followed by siesta, a rest period. Campers often spend this time reading, playing cards, or writing home.
The afternoon is devoted to individual interests. There are three activity periods each day. Campers select their
activities twice, on the first and second Sundays of the session, for a total of six activity options over the course of 2
weeks. Campers may change an activity after a short time, though they are encouraged to give careful thought to their
choices. Afternoon open activities are next. Open activity areas include the courts, the pool, boating & canoeing, arts &
crafts, the climbing wall, and the athletic field. Dinner follows open activities.
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Evenings consist of an all-camp, village, or age-group activity, such as a campfire, talent show, or carnival. Evening
activities are followed by cabin chat, an opportunity for individual cabin groups to reflect on the day’s events and
discuss a topic of interest. Cabin chats are directed by the counselors. Bedtime varies for age groups, but ranges from
9:00 – 10:00PM.
Weekend schedules are slightly different. Each weekend is themed and consists of cabin and group activities. Past
theme weekends have included Wild West, Medieval, Olympics, and Outer Space. On Sunday the entire camp gathers
for chapel, a non-denominational meeting that is planned and presented by villages, in turn. Chapel often includes
readings from inspirational sources, music or a skit, and a brief message based on one of the four core values.
Camp Activities:
Our core activity offerings are listed below. Others added, depending on the talents and abilities of our staff.
Land Sports:
Target Sports:
Aquatics:
Creative Arts:
Adventure:
Trips:
Other:
Baseball, Basketball, Disc Golf, Fencing, Flag Football, Mountain Biking, Street Hockey, Rugby,
Skateboarding, Soccer, Ultimate Frisbee, Volleyball
Archery, Riflery
Swimming, Canoeing, Kayaking, Boating, Fishing
Arts & Crafts, Painting, Drawing, Photography,
Jewelry Making, Ceramics, Music, Dance, Drama,
Newspaper, Pottery
Climbing Wall, High/Low Ropes, Rock Climbing
Daily optional Hiking, Climbing, and Paddling trips in
the Delaware Water Gap.
Nature, Pond Exploration, Gardening, Farming
Registration Information:
The following documents must be completed in order for us to admit your child into camp. We unfortunately cannot
make any exceptions to this policy. Copies of these documents are available in PDF format on our website.
-
-
-
Medical Form with Copy of Insurance Card Attached: Making a copy of both sides of your insurance card before you
get here will significantly shorten your wait on Opening Day. Double-check that your medical form is complete and
signed by a physician. Many pediatricians are able to print records of their patients’ physicals in the office – these
documents can be accepted in place of our medical form, provided they document the same information.
Camper Information Form: This confidential document will be shared with your child’s counselor before they arrive
at camp. Our staff members use this information to ensure that your child has a safe, meaningful, and enjoyable
camping experience. It is our primary means of documenting and communicating your expectations regarding your
child’s experience at camp.
Program Release Form: This document provides permission for your child to participate – or not to participate – in
the following activities: rock climbing, skateboard park, archery, riflery, boating + canoeing, off-site trips.
Copies of these forms must be mailed or faxed to us prior to your arrival at camp. Keep the originals and bring them
with you for backup, if necessary. The medical form is required by law in the state of New Jersey. Your child’s doctor
should include records of all immunizations, instructions for administering prescription medications, and the results of a
physical examination conducted within the last twelve months. The YMCA does not offer accident or insurance to
individual campers.
Refunds and Cancellations:
Registration deposits are refundable by written request before May 1. Registration deposits are not refundable after
this date. Tuition fees are not refundable after May 1 except in the case of verified academic or medical restriction.
Please notify the camp if you must cancel your registration. No refunds are available for children sent home from camp
for behavioral reasons.
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Cabin-Mate Requests:
The camp makes every attempt to honor cabin
cabin-mate
mate requests, but cannot guarantee placement in every instance. Make
your requests early for best consideration. The camp reserves the right to change village and cabin assignments at any
time.
Medical Costs:
The camp retains Sparta Medical Associates of Blairstown, NJ as a medical consultant and uses Newton Memorial
Hospital in Newton, NJ for emergency treatment
treatment.. The camp will attempt to contact parents prior to making any
necessary appointments for off-site
site treatment. Sparta Medical Associates will bill you directly for co-payments. The
camp will bill you for any uncovered medical expenses. A detailed invoice will be provided for the purpose of claim
processing. Emergency trips to a dentist, optician or orthodontist will be handled in the same manner as a visit to our
doctor.
We recommend that you review your family’s health insurance rules and activate any applicable vacation or travel
stipulations prior to sending
ending your child to camp
camp. Make sure we know who your primary care physician is and how to
reach them. If your HMO insists that your child be seen by a specific doctor you will need to make the appointment and
take him/her yourself.
Financial Aid:
Financial assistance toward the cost of tuition is available. Contact the office to request an application. If applying, your
financial aid application must accompany your registration.
What to Bring:
The following is a list of suggested items to pack for a two
two-week stay at camp. Your child may bring additional items
such as a fishing pole, baseball glove, football, lacrosse stick, deck of cards, etc.. The camp is not responsible for lost or
stolen items.
Packing List
14 Pair Underwear & Socks
14 Shirts/T-Shirts
3-5 Pair Jeans or Pants (5 if in Ranch)
2-3 Sweatshirts
1 Jacket (can substitute sweatshirt)
6-8 Pair Shorts
Pajamas (or preferred sleepwear)
1 Raincoat or Poncho
1 Pair Able-to-Get-Wet Shoes/Sandals
2 Pair Sneakers/Athletic Shoes
1 Pair Closed- Toe Comfortable Boots/Light
Light Boots
2 Bath Towels + Washcloth
Laundry Bag (camper’s name on outside)
Sleeping Bag (required)
Sheets & Blankets (optional)
Pillow & Pillow Case
Letter Writing Supplies
Toiletries
Sunscreen
Insect Repellent (no aerosols)
Flip-flops (for the shower)
Water Bottle (required)
2 Swimsuits
2 Beach Towels
Flashlight (extra batteries)
Cap/Hat
- Please label ALL of your child’s
ch
belongings with their full name.
- The camp is not responsible for
lost, stolen, or unlabeled items.
Personal belongings are best
packed in a sturdy suitcase,
duffel bag, or trunk.
The camp cannot provide secure
storage for ANY expensive or
irreplaceable personal
person items.
Do Not Bring
- Weapons of any kind
- Candy or gum
- Cell phone or pager
- MP3 players (iPod, Zune, etc.)
- Matches or lighters
- Cash or credit cards
- Expensive jjewelry
- Video cameras
- Tobacco products of any kind
- Illegal drugs or paraphernalia
- Excessive amounts of food or drink
- Fireworks
A Note on Electronic Devices:
Please note the camp does not allow music players (iPod, Zune, etc.), cell phones, laptop computers,
video cameras, or portable DVD players to be brought to camp.
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Arrival
Plan to arrive to drop-off your child at camp between 2:00 – 4:00 PM on
opening day. A staff member will greet you at the gate. Follow their
instructions and proceed to the office. Once you have completed your
business there, proceed to the health screening at the dining hall. Visit the
trading post next, and then proceed to your child’s cabin. A counselor will
greet you in the village and help your child move in. It is best not linger at
this point; prolonged farewells may cause distress. All families are asked to
leave by 4:00 PM. Counselors hold the cabin group until everyone arrives
before starting tours and swim assessments. Please call if you are going to be
late so we can let them know, as well as be available to greet you at the
office when you arrive.
Departure
Plan to arrive to pick-up your child from camp at 9:00 – 11:00 AM on closing day. A staff member will greet you at the
gate. Follow their instructions and proceed to your child’s cabin. Your child’s counselor will greet you and help to load
your vehicle. The village leader will sign your child out. Stop by the trading post to claim any money left in your child’s
account. Funds left in trading post accounts are added to our campership fund for tuition assistance. Visit the camp
nurse if there are medications that need to be retrieved.
Ranch Camp Parents: There is a rodeo at the Upper Barn on closing day. It begins at 9:30 AM and lasts about an hour.
You may proceed directly to the Upper Barn to meet your child. At the conclusion of the rodeo you may go to Spruce
lodge to sign out your camper and retrieve your child’s belongings. For parents that have children in both camp
programs, we suggest picking up the resident camper first, taking them with you to enjoy the rodeo, and departing from
there.
Stay-over Weekend
There are two stay-over weekends that occur between sessions 1A and 1B (July 11-12), and 2A and 2B (August 8-9).
Four-week campers may stay-over for an additional fee which covers a day trip to Knoebel’s Family Amusement Park
accompanied by staff members. Parents may also choose to take their children away from camp over these weekends.
The camper registration form contains a space to mark whether or not your child will be staying-over. The camp will
assume your child is not staying-over if that space is left blank. Last minute additions to the stay-over weekend and
Knoebel’s trip are not possible. There is NO mid-season stay-over weekend. This is our change-over weekend. The camp
is CLOSED between sessions 1 and 2 (July 25-26).
Visiting:
Parents may visit campers on the Sunday of each stay-over weekend with prior arrangement. Contact the office with the
details if you plan to visit your child. Your child may be picked-up between 9-9:30 AM and must be returned to camp by
4:00 PM at the latest. Please be sure to sign your camper out at the office before departing. Go to the office upon
returning, as well. Note that Sunday is opening day for many families – there will be lines and traffic starting around
1:00 PM and lasting to about 3:00 PM that day. Plan your return accordingly.
Homesickness:
Homesickness is a normal and healthy response to being away from home; parents of younger children and first time
campers should expect it. Our staff members are well-trained in techniques that help campers develop coping skills for
overcoming the challenges of separation from home and family. These skills often lead to more confidence and
independence, a key outcome of the camping experience. If the first letter from your child is a little down-hearted,
don’t be alarmed. Send a reassuring response encouraging them to stick with it. Resist the temptation to include
phrases that would lead them to believe you or other family members (including pets) are missing them or that your
child is missing out on important things at home. If the problem becomes serious we’ll give you a call: we want to
involve you in developing useful strategies for your child’s success. Remember that what was a crisis on day two might
be forgotten by day four.
5
Keep
eep your letters positive and supportive when you write - let your child know how proud you are
ar that they are facing
this challenge. Allow some time for their letters to get home. And finally, feel free to call the camp director at any time
if you still have concerns. In our experience, putting children on the phone with parents seriously compounds
homesickness issues and typically makes the situation more difficult; however our staff is always willing to speak with
you regarding your child’s experience. As will be men
mentioned
tioned below, it is our experience that the least helpful thing you
can do is send your child to camp with a cell phone. Give them the chance to learn and grow on their own – it’s what
summer camp is all about!
Our Telephone Policy
Here at Camp Mason we work to develop strong, independent young people who can function
nction on their own as part of
our community. Our staff members are ready to assist campers in dealing successfully with any challenges that arise
during their stay with us. Cell phone
one usage by campers is counter
counter-productive
productive to this process.
process It bypasses the
development of confidence in a community setting, removes the opportunity to resolve conflicts,
conflicts and undermines our
ability to provide guidance
ance within a given situation. Please - don’t
on’t send your child to camp with a cell phone. Give them
the chance to succeed on their own. If you must get an important message to your camper, we will pass
pa it along. The
camp office is open from 9:00 AM to 5:00 PM every weekday, and the Camp Directorr carries an emergency pager
outside of business hours. That number is contained on the first page of this document, as well as in the after-hours
after
answering service message.
OUR OFFICIAL CELL PHONE POLICY: Cell phone use by campers is prohibited. We wi
willll confiscate
any cell phone in a camper’s possession and return it at the end of the session. Thank you for
helping us to provide your child with the opportunity to be a confident, independent member of
our community.
Communicating with the Camp Director or Your Child’s Counselor:
The camp director is available through the camp office or by pager in case of emergency. Parents are encouraged to call
with any questions or concerns. Your child’s counselor or village leader is also available to speak with you as needed.
Communicating With Your Camper
Letters: We encourage campers
rs to write home once every two weeks. You can help by encouraging your camper to
write frequently. Yourr chances of receiving mail will be increased if you pack pre-addressed,
addressed, stamped envelopes
e
or
postcards. Mail is delivered every afternoon except Sunday. Send mail to your camper at:
YMCA Camp Mason
23 Birch Ridge Rd.
Hardwick, NJ 07825
ATTN: Your Camper, Village
Village, Cabin
FAX: You may send a FAX to your child if you wish. Our FAX number is 908-362-5767. Please limit your FAX to a single
page. A busy signal in the morning is normal - we suggest you FAX the night before. Campers cannot send letters via
FAX. FAX are delivered with camper mail.
Packages: Campers enjoy receiving packag
packages from home. Please keep consumable
sumable treats to a minimum.
minimum All packages are
opened in the presence of a staff member
member. It is expected that treats will be shared with the group. Packages should be
addressed in the same way as letters. Packages
ackages are delivered with camper mail.
Email: Campers do not have access to outgoing email, though we do accept incoming email for campers. Please keep
messages brief - wee will only print one pa
page.. Please do not forward messages. We cannot print in color
col or deliver
graphics. Anything with an attached
tached file will be deleted
deleted. Watch our website for a new email service being offered in
2009!
6
Health Services
Our Health Services staff includes an RN or other advanced medical
dical personnel on-site
on
at all times.
The camp doctor’s office is ten minutes away. In case of emergency, we use Newton Hospital,
which is twenty minutes from camp. When your child arrives at camp, he or she is required to
check-in at the dining hall for a health check. We are required by law to screen
scr
all incoming
campers for contagious illnes
illnesses or conditions. The nurse will check your child’s Health Form and
ask you for any necessary clarification. This is a good opportunity for you to meet the health care
staff and discuss special concerns or situations.
Remember to bring your child’s medication with you on opening day. D
Do
o not pack it in their bags. All medication must
be turned in to the nurses upon arrival. This includes prescriptions, over the
he counter medications, and vitamins. All
A
prescription medication must be brought to the nurse in the original container, from the pharmacy, with the child’s
name and the proper administration
tration directions on the label. Your child’s health form must include your doctor's written
instructions for administering the necessary
ecessary medications. Our medical staff can administer over-the-counter
over
products
with a parent’s permission and instructions. Medications for your child not following these requirements cannot be
accepted or administered.
Laundry
There are no provisions for
or doing laundry for two week campers, so please be sure to send a sufficient supply of
clothing. Campers staying for four weeks will have their laundry done near the middle of their stay, so a two week
supply of clothes is required. Please make sure tha
thatt all clothes are well labeled, and that the camper has a sturdy, cloth
laundry bag with their
eir name written on the outside.
Lost and Found
We cannot urge you strongly enough to mark or tag all of your child’s belongings. We try to identify and return all
al loose
items at the end of the session. Any item without a name that is not claimed is donated to the Red Cross or the
Salvation Army. Please be sure to check the lost and found area by the trading post when you come to pick up your
camper.
Trading Post
Items available in the Trading Post include snacks, juice, clothing, stamps, postcards, small toys, batteries, stationary,
minor necessities, toiletries and personal items. We suggest depositing $50 in your child’s account for each two weeks
they’re at camp. Unspent money
ney in your camper’s account will be refunded on the last day of camp. Any unspent
money left in Trading Post accounts after closing day will be placed in the camp’s scholarship fund.
Horseback Riding Lessons
Horseback riding lessons are available to campers in grades 44-9, as space permits.
There is an additional fee of $70/week and pre-registration is required. Your
registration form has a sign-up
up area for this option. The program includes five days
of general lessons and trail riding. Most children in this program are beginner to
intermediate riders and are placed in groups accordingly. Though there is ample
opportunity to move up in skillll level, a child who has extensive horsemanship
experience will likely find this option too basic
basic. We cannot offer refunds for this
program if your child changes their mind about participating. We suggest that you
talk it over and sign them up for one wee
week of lessons rather than two or more. If
the Riding Director
or decides that a child is not capable of handling a horse, then we
will inform you right away. In this instance a full refund will be issued. All campers
who ride must wear hard soled shoes or boot
boots that have at least a 1/2 inch heel.
They also must wear long pants. A safety
ty helmet will be provided by the camp
camp.
7
Ranch Camp
Ranch Camp is a horsemanship program open to all campers in grades 6-9. Pre-registration is required. Tuition is
slightly higher than residential camp. Ranch Camp is an intensive horsemanship experience, not just a daily ride. Ranch
campers will spend several hours a day at the barn learning the many facets of horse ownership - grooming, saddling,
equine health care, feeding, mucking stalls, care of equipment, breeds, conformation, and of course, riding. The
amount of time spent at the barn does limit the time available for other activities, though Ranch campers still have
many opportunities to get involved in other camp programs.
All Ranch campers must bring proper riding clothes. This includes a pair of sturdy, hard-soled shoes/boots with at least
a 1/2 inch heel, and plenty of loose fitting long pants. A pair of work gloves is also recommended. All riders must wear
a safety helmet while mounted. Camp provides these, but if your child may bring their own if they choose. The helmet
must have an SEI/ASTM approval rating and be labeled as such inside.
Waiting List:
When a session or program fills, subsequent applicants are placed on a waiting list according to the date we receive
their application. The first person on the waiting list is given the opportunity to complete enrollment when a space
becomes available. This list moves at a different rate each year. It is therefore difficult to advise as to the likelihood that
an applicant on the waiting list will secure a specific place at camp. Flexibility on choice of session or program increases
the chances of acceptance.
Donation Opportunities:
As a charitable organization, YMCA Camp Mason is dependent on contributions to maintain the quality of our programs
and facilities. Gifts to YMCA Camp Mason help provide tuition assistance, fund programs, improve facilities, support
staff development, and assist in creating other exceptional leadership opportunities for staff and campers. Please
contact our office for more information about how you can support the mission of YMCA Camp Mason.
YMCA Camp Mason Professional Staff:
Dave DeLuca
Marcus Forster
Judy Trigg
April Szekula
Alison Fisk
Don Jennings
Alissa Duffy
Laurie DeLuca
Marjorie Dickison
Tim McKeever
CEO/Executive Director
Associate Executive Director of Camping Operations
Associate Executive Director of Business Operations
Registrar
Outdoor Center Director
Summer Camp Director
Adventure Bound Director
Development Director
Food Service Director
Facility Director
[email protected]
[email protected]
[email protected]
[email protected]
[email protected]
[email protected]
[email protected]
[email protected]
YMCA Camp Mason Board of Trustees:
OFFICERS:
President
Vice President
Treasurer
Auditor
Secretary
Thomas Mason
Martin Birkenthal
Michael Schwartz
John Katsock
Barbara Cooper
MEMBERS:
Emily Vickers
James Jennings
David Bath
Joseph Thompson
8
Mark Thielmann
Donna Marcks Line
Daniel Robinson
Kent Weber
Christian Knigge
Edward Vander Berg
Jeffrey Hall
Driving Directions to Camp Mason
Camp Mason is located north of the Delaware Water Gap, in rural Warren County. It is about 1.5 hours from the George
Washington Bridge, and 2 hours from North Philadelphia, traffic expected.
To reach Camp Mason, take the most direct route to Interstate 80, near the New Jersey/Pennsylvania border. From the
New York area, take I-280, I-287 or the GSP to I-80. From the shore, take the GSP to I-287 or I280 to I-80. From
Trenton/east Philadelphia routes 31 or 206 north to I-80. From west Philadelphia, or Bucks County rt. 611 N or the N.E.
extension to 78/22, east to rt. 33 then North to I-80 East.
From Interstate 80 West-Bound (NYC & New Jersey)
- Take Exit 12: Blairstown/Hope. Proceed north off the ramp on 521 towards Blairstown. Follow 521 to the junction of Rt. 94.
-
Turn left. The Forge restaurant is on the corner.
Proceed ¼ mile to Sunoco and Valero gas stations on left. Turn right, opposite gas stations, and then another right onto Main St.
Follow "From Blairstown" directions below.
From Interstate 80 East-Bound (Pennsylvania and Delaware Water Gap)
- Take Exit 4C: Blairstown/Rte 94N.
-
Follow Rte. 94N to Blairstown (approx. 7 miles).
Pass A&P center and go through one traffic light. At Valero gas station (on right) turn left and then right onto Main Street.
Follow "From Blairstown" directions below
From Blairstown
- At the old mill with stone arches (waterfalls and park behind) bear left and go up short, steep hill.
-
At top of hill, bear left at split, and proceed towards Millbrook, on Millbrook Rd. (multi-camp signs on corner)
Stay on Millbrook Rd. for about 3 miles. Past Princeton Camp, watch for Birch Ridge Rd. on the right. A sign is on a tree.
-
Pass one house. Camp Mason sign and driveway are on the left. Proceed to the end of driveway to the office.
TRADING POST AND OPTIONAL ACTIVITIES 2009 RALPH MASON TRADING POST (about 30$/week) ACTIVITIES : $ HORSERIDING (5h/semaine) TOTAL 65 $/week $ Attention, merci de bien lire les parents packs ci‐joint, effectivement certains camp remboursent le solde après séjour et d autres non. Les activités sont sous réserve de disponibilité du camp. CAMPER : ………………………………………………….. ……………………………………………………..
LAST NAME FIRST NAME I undersigned ……………………………………. …………………………………… hereby authorize camp to debit my credit card : LAST NAME VISA/MASTERCARD N° _ _ _ _ _ _ _ _ For the amount of ……………………………$ FIRST NAME _ _ _ _ _ _ _ _ I authorize / do not authorize my child to overdraw his account exp __/__ SECURITY CODE ___ Date : __/__/__ Signature of card holder: FOR OFFICE USE ONLY:
YEAR:
YMCA CAMP RALPH S. MASON
SESSION:
CAMPER INFORMATION FORM
PARENTS/GUARDIANS: PLEASE TAKE A FEW MOMENTS TO COMPLETE THIS CONFIDENTIAL FORM. IT WILL BE SHARED WITH YOUR CHILD’S COUNSELOR
BEFORE THEY ARRIVE AT CAMP. OUR STAFF MEMBERS USE THIS INFORMATION TO ENSURE THAT YOUR CHILD HAS A SAFE, MEANINGFUL, AND ENJOYABLE
CAMPING EXPERIENCE.
CAMPER NAME:
MALE
FEMALE
ATTENDING SESSION (CIRCLE ONE):
DATE OF BIRTH:
STARTER 1
CURRENT GRADE:
STARTER 2
1A
1B
2A
2B
SIBLINGS
AGE
PARENT/GUARDIAN 1:
HOME PHONE:
LIT
CIT
ATTENDED MASON?
OCCUPATION:
DAY/WORK/CELL PHONE:
PARENT/GUARDIAN 2:
HOME PHONE:
ADVENTURE BOUND
OCCUPATION:
DAY/WORK/CELL PHONE:
HAS YOUR CHILD BEEN TO CAMP BEFORE? IF YES, HOW WAS HIS/HER EXPERIENCE?
YOUR CHILD’S CAMP EXPERIENCE IS VERY IMPORTANT TO US. PLEASE USE THIS SPACE TO DESCRIBE ANY SIGNIFICANT DETAILS ABOUT YOUR CHILD THAT
WILL HELP HIS/HER COUNSELOR SUPPORT THEM WHILE THEY’RE AT CAMP:
WHAT ARE YOUR CHILD’S INTERESTS, TALENTS, AND HOBBIES?
WHAT ACTIVITIES DOES YOUR CHILD EXPECT TO DO AT CAMP?
PLEASE TURN OVER
HOW WELL DOES YOUR CHILD SWIM (CIRCLE ONE)?
NON-SWIMMER
BEGINNER
INTERMEDIATE
ADVANCED
WHAT DO YOU EXPECT YOUR CHILD TO GAIN FROM HIS/HER EXPERIENCE AT CAMP?
DESCRIBE ANY BEHAVIORAL ISSUES THAT YOUR CHILD’S COUNSELOR SHOULD BE AWARE OF. EXAMPLES INCLUDE: NIGHTMARES, BED-WETTING,
SLEEPWALKING, OR AGGRESSIVE BEHAVIOR. PLEASE ALSO LIST ANY MEDICATIONS YOUR CHILD TAKES THAT MAY AFFECT HIS/HER BEHAVIOR OR MOOD:
PLEASE DESCRIBE ANY MAJOR EVENTS OR ACCOMPLISHMENTS IN YOUR CHILD’S LIFE DURING THE PAST YEAR. EXAMPLES INCLUDE: NEW SIBLINGS, A
DEATH IN THE FAMILY, SEPARATION OR DIVORCE, EMPLOYMENT OR RESIDENCE CHANGES, ACADEMIC CHALLENGES, SPORTING ACHIEVEMENTS:
ADDITIONAL COMMENTS:
THANK YOU FOR YOUR TIME. WE’RE LOOKING FORWARD TO WELCOMING YOUR CHILD TO CAMP!
SIGNATURE OF CUSTODIAL PARENT/GUARDIAN
DATE
REVISED 10/2008
Dates will attend camp: from ______________to_____________
HISTORY FORM 1
Camper Name: _____________________________________________________________
Month/Day/Year
First
Male
Developed and reviewed by: American Camp Association,
American Academy of Pediatrics Council on School Health, &
Association of Camp Nurses
Female
Month/Day/Year
Middle
Birth Date ____________
Last
Age on arrival at camp: ________
Month/Day/Year
1)
Complete pages 1, 2 and 3 of this form (FORM 1) and make a copy.
2)
Send the original, signed FORM 1 to camp by the requested date.
3)
Complete the top of FORM 2 (CAMPER HEALTH-CARE RECOMMENDATIONS) and provide the
copy of FORM 1 with FORM 2 to your child’s health-care provider for review and completion.
4)
After it has been completed and signed by your child’s health-care provider, return FORM 2 to
camp by the requested date.
First
To Parent(s)/Guardian(s): Please follow the instructions below. Attach additional information if needed.
Mail this form to the address below by _______ (date)
Camper Home Address: ______________________________________________________________________________________________________
Street Address
City
State
Zip Code
Parent/guardian with legal custody to be contacted in case of illness or injury:
Relationship
Name: ____________________________ to Camper: ________________Preferred Phones: (______) ________________(______)_________________
(If different from above)
Street Address
City
State
Middle
Email: _______________________
Home Address: _____________________________________________________________________________________________________________
Zip Code
Second parent/guardian or other emergency contact:
Relationship
Name: ____________________________ to Camper: ________________Preferred Phones: (______) ________________(______)_________________
Email: _______________________
Additional contact in event parent(s)/guardian(s) can not be reached:
Relationship
Name(s): __________________________ to Camper: ________________ Preferred Phones: (______) ________________(______)_________________
Allergies:
No known allergies.
Restrictions:
Food
Medicine
The environment (insect stings, hay fever, etc.)
Other
(Please describe below what the camper is allergic to and the reaction seen.)
This camper eats a regular diet.
This camper eats a regular vegetarian diet.
This camper has special food needs. (Please describe below.)
I have reviewed the program and activities of the camp and feel the camper can participate without restrictions.
I have reviewed the program and activities of the camp and feel the camper can participate with the following restrictions or
adaptations. (Please describe below.)
Medical Insurance Information:
This camper is covered by family medical/hospital insurance
Yes
No
Include a copy of your insurance card if appropriate; copy both sides of the card so information is readable.
Insurance Company______________________________
Policy Number___________________________
Subscriber_____________________________________
Insurance Company Phone Number (______) ___________________
Parent/Guardian Authorization for Health Care:
This health history is correct and accurately reflects the health status of the camper to whom it pertains. The person described 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 tests,
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 emergency, I give my
permission to the physician to hospitalize, secure proper treatment for, and order injection, 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 record from providers who treat my child and these providers may talk with the program’s staff about my child’s health status.
Signature of Custodial
Parent/Guardian __________________________________________________________________Date:
Relationship
to Camper: _______________________
If for religious or other reasons you cannot sign this, contact the camp for a legal waiver which must be signed for attendance.
Page 1/4
Last
Diet, Nutrition:
This camper is allergic to:
Camper Name ______________________________________________________________________ (For Camp Use) Cabin or Group____________________ (For Camp Use) Session Code(s): ________________
CAMPER HEALTH
CAMPER HEALTH HISTORY FORM 1
Camper Name: ________________________________________________
Developed and reviewed by: American Camp Association, American Academy of Pediatrics Council on
School Health, & Association of Camp Nurses
Birth Date: ____________
First
Middle
Last
Month/Day/Year
Immunization History: Provide the month and year for each immunization. Starred ( ) immunizations must be current. Copies of immunization forms
from health-care providers or state or local government are acceptable; please attach to this form.
Immunization
Dose 1
Month/Year
Dose 2
Month/Year
Dose 3
Month/Year
Dose 4
Month/Year
Dose 5
Month/Year
Most Recent Dose
Month/Year
Diptheria, tetanus, pertussis
(DTaP) or (TdaP)
Tetanus booster
(dT) or (TdaP)
Mumps, measles, rubella
(MMR)
Polio
(IPV)
Haemophilus influenzae type B
(HIB)
Pneumococcal
(PCV)
Hepatitis B
Hepatitis A
Varicella
Had chicken pox
(chicken pox) Date:
Meningococcal meningitis
(MCV4)
Tuberculosis (TB) test
Date:
Negative
Positive
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 Custodial
Parent/Guardian: ______________________________________________________________Date:
Medication:
Relationship
to Camper: __________________________
This camper will not take any daily medications while attending camp.
This camper will take the following daily medication(s) while at camp:
"Medication" is any substance a person takes to maintain and/or improve their health. This includes vitamins & natural remedies. Please review camp
instructions about required packaging/containers. Many states require original pharmacy containers with labels which show the camper’s
name and how the medication should be given. Provide enough of each medication to last the entire time the camper will be at camp.
Name of medication Date started
Reason for taking it
When it is given
Amount or dose given
How it is given
Breakfast
Lunch
Dinner
Bedtime
Other time:_____________
Breakfast
Lunch
Dinner
Bedtime
Other time:_____________
Breakfast
Lunch
Dinner
Bedtime
Other time:_____________
The following non-prescription medications may be stocked in the camp Health Center and are used on an as needed basis to manage illness and injury.
Cross out those the camper should not be given.
Acetaminophen (Tylenol)
Phenylephrine decongestant (Sudafed PE)
Antihistamine/allergy medicine
Diphenhydramine antihistamine/allergy medicine (Benadryl)
Sore throat spray
Lice shampoo or cream (Nix or Elimite)
Calamine lotion
Laxatives for constipation (Ex-Lax)
Copyright 2008 by American Camping Association, Inc.
Ibuprofen (Advil, Motrin)
Pseudoephedrine decongestant (Sudafed)
Guaifenesin cough syrup (Robitussin)
Dextromethorphan cough syrup (Robitussin DM)
Generic cough drops
Antibiotic cream
Aloe
Bismuth subsalicylate for diarrhea (Kaopectate, Pepto-Bismol)
Page 2/4
Rev. 1/2007 LEE/EAW
CAMPER HEALTH HISTORY FORM 1
Camper Name: ________________________________________________
Developed and reviewed by: American Camp Association, American Academy of Pediatrics Council on
School Health, & Association of Camp Nurses
Birth Date: ____________
First
Middle
Last
Month/Day/Year
General Health History: Check "Yes" or "No" for each statement. Explain “Yes” answers below.
Has/does the camper:
1. Ever been hospitalized? ………………………….
Yes
No
11. Had fainting or dizziness? .....................................................
Yes
No
2. Ever had surgery? .............................. ………….
Yes
No
12. Passed out/had chest pain during exercise? ….…………….
Yes
No
3. Have recurrent/chronic illnesses? .......……….…
Yes
No
13. Had mononucleosis ("mono") during the past 12 months?...
Yes
No
4. Had a recent infectious disease? ....... ………….
Yes
No
14. If female, have problems with periods/menstruation?.……..
Yes
No
5. Had a recent injury? ........................... ………….
Yes
No
15. Have problems with falling asleep/sleepwalking? ...............
Yes
No
6. Had asthma/wheezing/shortness of breath?......
Yes
No
16. Ever had back/joint problems?…….………...……………......
Yes
No
7. Have diabetes? .................................. ………….
Yes
No
17. Have a history of bedwetting?………………….……………...
Yes
No
8. Had seizures? ....................................................
Yes
No
18. Have problems with diarrhea/constipation?………………....
Yes
No
9. Had headaches? ………………………………….
Yes
No
19. Have any skin problems?……………………..........................
Yes
No
10. Wear glasses, contacts, or protective eyewear?
Yes
No
20. Traveled outside the country in the past 9 months?..............
Yes
No
Please explain “Yes” answers in the space below, noting the number of the questions. For travel outside the country, please name countries visited
and dates of travel.
Mental, Emotional, and Social Health: Check "Yes" or "No" for each statement.
Has the camper:
1. Ever been treated for attention deficit disorder (ADD) or attention deficit/hyperactivity disorder (AD/HD)? ………………………........
Yes
No
2. Ever been treated for emotional or behavioral difficulties or an eating disorder?…….............................................................................
Yes
No
3. During the past 12 months, seen a professional to address mental/emotional health concerns?……….………………………………….
Yes
No
4. Had a significant life event that continues to affect the camper’s life?......................................................................................................
(History of abuse, death of a loved one, family change, adoption, foster care, new sibling, survived a disaster, others)
Yes
No
Please explain “Yes” answers in the space below, noting the number of the questions. The camp may contact you for additional information.
Health-Care Providers:
Name of camper’s primary doctor(s): ____________________________________________________ Phone: (________) _______________________
Name of dentist(s):___________________________________________________________________ Phone: (________) _______________________
Name of orthodontist(s):_______________________________________________________________ Phone: (________) _______________________
What Have We Forgotten to Ask? Please provide in the space below any additional information about the camper’s health that you think important or
that may affect the camper’s ability to fully participate in the camp program. Attach additional information if needed.
Parents/Guardians: STOP here. The rest of this is form is completed when the camper arrives at camp. Keep a copy for your records.
Copyright 2008 by American Camping Association, Inc.
Page 3/4
Rev. 1/2007 LEE/EAW
CAMPER HEALTH HISTORY FORM 1
Camper Name: ________________________________________________
Developed and reviewed by: American Camp Association, American Academy of Pediatrics Council on
School Health, & Association of Camp Nurses
Birth Date: ____________
First
Middle
Last
Month/Day/Year
Individual Health Record (For Camp Use Only)
Initial Screening
Date/Time: _________
Initials: ____________
Screening has been conducted according to camp protocol and significant findings noted as follows:
A. Any signs/symptoms of illness or injury upon arrival?........................
No
Yes as noted below
B. History of exposure to communicable disease?..................................
No
Yes as noted below
C. Additions or corrections to information on this health history?............
No
Yes as noted below
D. Medication given to health-care staff?..................................................
E. Any signs/symptoms of head lice?......................................................
No
No
Yes as noted below
Yes as noted below
Provider notes: (date/time/initial all entries) _____________________________________________________________________________
____________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________
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Exit Note: Check one of the following:
Left camp this day with no reported illness or injury symptoms.
Left camp this day with the following problem/concern:
_____________________________________
________________________________________________________________________________________________________________
This person was told about the problem and instructed about follow-up as noted above: __________________________________________
Date/Time: ___________
Copyright 2008 by American Camping Association, Inc.
Page 4/4
Initials: __________
Rev. 1/2007 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.
Developed and reviewed by: American Camp Association,
American Academy of Pediatrics Council on School Health, &
Association of Camp Nurses
Dates will attend camp: from ______________to_____________
Month/Day/Year
Month/Day/Year
Camper Name: _____________________________________________________________
First
Middle
Female
Birth Date ____________
Mail this form to the address below by _______ (date)
Last
Age on arrival at camp ________
Month/Day/Year
First
Male
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.
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.
Eats a regular diet.
Yes
No
(If “No,” date of last physical: ___________)
Month/Day/Year
ACA accreditation standards specify physical exam within last 24 months.
Weight: _______ lbs
Allergies:
Height: _____ft_____in
Blood Pressure_______/_______
No Known Allergies
To foods (list):
To medications: (list):
To the environment (insect stings, hay fever, etc.– list):
Other allergies: (list):
Describe previous reactions:
Last
Diet, Nutrition:
Physical exam done today:
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)
Medication:
No daily medications.
Middle
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
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.
None.
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
Telephone: (________)_____________________
Copyright 2008 by American Camping Association, Inc.
State
Zip Code
Date:_______________________
Rev. 2/07 LEE/EAW
Camper Name ______________________________________________________________________ (For Camp Use) Cabin or Group____________________ (For Camp Use) Session Code(s): ________________
CAMPER HEALTH-CARE RECOMMENDATIONS
by LICENSED MEDICAL PERSONNEL FORM 2
Program Permission and Release Waiver
YMCA Camp Ralph S. Mason
Camper(s) Name:_____________________________________________________________
I GIVE My PERMISSION FOR MY CHILD T
TO
O ENGAGE IN THE FOLLOWING ACTIVITES (please check all
that apply):
limbing
Rock Climbing
Skate Park
Riflery
Archery
Boating and Canoeing
Off-Site
Site Adventure Trips
YMCA Camp Ralph S. Mason does and will make every possible effort to insure the complete
safety of all of our campers and staff at all times. However, we ask that certain activities are
acknowledged to involve inherent risk. YMCA Camp Mason conducts its programs with the best interests
of its participants in mind. YMCA Camp Mason pledges to provide the following: (i) well maintained
equipment and activity areas; (ii) necessary and industry recognized safety g
gear
ear for all campers at all
times; (iii) mature and experienced supervision at all permitted activity times; and (iv) reasonable and
universally recognized safety rules and procedures, thereby making all activities as safe as possible.
However, these programs
ams do have inherent risks and although safety procedures have been established
to minimize these risks not all risks and hazards can be eliminated due to the nature of the activities
offered.
Living in the natural environment can be unpredictable. Some o
off the possible risks include contact with
wildlife, falling, cuts, burns, bruises, sprains, fractures, falling trees, falls during climbing, falling rocks
during climbing, tipping over a canoe, falling into the water, drowning, near drowning, hypothermia,
unpredictable weather conditions. All of these risks may result in injuries to the participant. I understand
that Camp Mason’s intent is not to frighten me but wants me to be fully informed of all the risks. I
understand that the risks listed above are not complete and that there are other risks that exist.
The potential of contracting Lyme Disease increases in rural settings such as Camp Mason. We encourage
all participants to check themselves regularly for ticks and to be educated on the signs and symptoms
sympto
of
Lyme Disease, which may occur days or months after an encounter with a tick.
My signature below indicates that I fully understand the nature of the program at YMCA Camp Mason and
I freely wish to participate. I know of no legal, physical or health rreason
eason why myself and/or my child
cannot fully participate in the program that I am registering for. I agree to assume responsibility for the
inherent risks identified herein and to those risks that are not specifically identified. I understand that it is
myy responsibility to participate in a safe manner, doing my best to follow the safety instructions provided
to me by the Camp Mason staff. I agree not to do anything that jeopardizes me or other members of my
group. I (and my parents/guardians if a am a min
minor)
or) assume and accept full responsibility for me and for
injury, death and loss of personal property and expenses suffered by me as a result of those inherent
risks and dangers identified herein, and those not specifically identified, as a result of my negligence
neg
or
the negligence of others participating in the activity.
My signature authorizes the management and staff of YMCA Camp Mason to act for me according to their
best judgment in the event of a medical emergency and/or routine medical care. By my signature
s
I
hereby waive, release and hold harmless the YMCA, its management, volunteers, agents, and staff from
any and all liability for any injuries, death or illness sustained and/or incurred while at Camp and /or while
Program Permission and Release Waiver
YMCA Camp Ralph S. Mason
using any facilities of, or participating in any of the activities of YMCA Camp Mason. I grant permission
for emergency medical treatment and/or routine medical care by the YMCA camp staff, a rescue squad,
private physician and/or hospital or emergency health care facility staff, under the same circumstances as
above, if needed. Any such action will be taken in the best interest of my child and will be reported to
me as soon as possible. My signature waives and/or releases YMCA Camp Mason from any and all
liability and/or financial responsibility for any medical expenses incurred.
I agree to waive and release all future claims, demands or causes of action which the undersigned and/or
such participant might have by reason of any loss, damage, expenses, injury or death arising out of or in
any way connected with such person’s participation in such program. I further agree to indemnify and
hold harmless YMCA Camp Mason, their agents, officers, directors, employees and volunteers from and
against any such claim, demands or causes of action.
By signing below, I acknowledge that it is understood that YMCA Camp Mason is a non-profit
corporation, organized exclusively for charitable and educational purposes, and as such, is immune from
liability for the negligence of its agents, servants or employees under N.J.S.A. 2A:53A-7.
I give YMCA Camp Mason permission to use any photographs taken of myself and/or my child while
participating in programs at Camp Mason. No identifying information will be associated with the image.
Signature:_____________________________________________
Date:_____________________
Parent/Guardian/Participant
If the participant is under 18 I am signing as the parent/guardian to reflect my
understanding and acceptance of the risks involved in attending programs at YMCA
Camp Mason.
YMCA Camp Ralph S. Mason
23 Birch Ridge Road
Hardwick, NJ 07825
(908) 362-8217
www.campmason.org