“I Survived...Day Camp”

“I Survived...Day Camp”
Osceola Day Camp
Girls will get a chance to hike,do crafts, learn history, leather working, songs, flag etiquette,
team-building, low-ropes*, archery*,and just have a LOT of fun! *age and training restrictions
apply.
When:
Monday, July 27, – Friday, July 31, 2015
Where:
Mon., Tues., Thurs., Fri. - Mary Ann Beebe Center, Harvard Illinois
Wednesday – St. John's Lutheran Church for a fun Service Project
Time:
8:00 A.M. – 5:15 P.M. All Week
Cost:
$125.00 registered Girl Scouts BEFORE JUNE 1. “Cookie Dough”/“S’More Dough”
may be used.
$140.00 new Girl Scouts (includes $15 Girl Scouts of the USA registration fee, valid
through September 2015)
$100.00 Cadette/Senior/Ambassador Girl Scout Volunteers
Cost includes patch, T-shirt, crafts, snacks, and four lunches.
BRING LUNCH ON WEDNESDAY.
Make check payable to GSNI Osceola Service Unit Day Camp – NO REFUNDS
***Late Registration accepted until June 15. (Please add $25 Late Fee)***
Overnight:
Open to all girls entering grade 4 and up on a first come basis – limited space.
Date: Thursday, July 30, 2015 – Bring overnight gear Thurs. Morning
Location: Mary Ann Beebe Center, Harvard, IL
$10.00 additional fee for overnight - includes two meals and snacks.
Transportation: Bus will be provided.
Pick up & Drop off Location
St. John's Lutheran Church
300 Jefferson St., Algonquin
Pick up
8:00 A.M, SHARP
Return
5:15 P.M.
PLEASE ARRIVE 15 MINUTES EARLY TO BOARD BUS!
The busses leave promptly at 8:00 A.M. every day except Wednesday, TBA
Please be advised, in fairness to all campers, the busses will not wait for late arrivals.
About Insurance at Day Camp…All Registered Girl Scouts (both girls and adults) attending day camp are covered by the
limited accident insurance provided by their Girl Scouts of the USA membership dues. Non-member adults wishing to be
covered by this insurance may register.
Girl Scouts of Northern Illinois
Registration Closes: June 1, 2015
Registration Information: Enrollment is limited and will be on a first-come, first-served basis.
Registration begins March 11, 2015 and closes June 1, 2015
All registrations must be postmarked on or before the closing date.
1. Complete both sides of the registration form, filling in ALL of the blanks.
2. Mail form and payment to:
Jenny Tackett-Irwin, 6 Kelsey Ct., Algonquin, IL 60102 (Bin also available on front porch for drop off)
3. Payment in full is due at the time of registration, unless applying for financial assistance. “Cookie Dough” or “S’More
Dough” may be used for girl registrations.
Financial Assistance: Financial assistance is available for a portion of the girls’ fees.
1. To apply for financial assistance call 847-741-5521 as soon as possible. A simple form will be mailed to you
and must be completed and returned to the Girl Scout Center no later than June 1st.
2. Anyone applying for financial assistance must still fill out and return the registration form, along with “Cookie
Dough” or “S’More Dough” and the amount you will be able to pay, to the name above by the close of
registration.
3. Financial assistance will be forwarded to the day camp directly. Parents will receive a letter indicating the
amount of assistance awarded. Any balance not covered by financial assistance must be paid in full before the
start of camp. If further financial assistance is needed, it is the parent’s responsibility to call 847-741-5521 to
request additional assistance.
Refund Procedure: NO REFUNDS —NO confirmation of registration will be sent.
Required C/S/A Volunteer Training:
Sunday, July 12, 1-3 p.m., Lynn Konzen’s Home, 750 Pickwick Ct, Algonquin
Required Parent Volunteer Training:
Sunday, July 19, 1-3 p.m., Megan Petronella’s Home, 1235 Greenridge, Algonquin
Parents/Guardians:
Day camp is a volunteer-based program—there is no paid staff at camp. Safety guidelines require a 1:6 ratio of adults to
children for the safe operation of our day camp. Adults are encouraged to volunteer in order for their camper to attend. If you
cannot commit to volunteering at camp, we will also need volunteers for camp setup on Sunday, 7/26 and take down on
Friday, 7/31. Please complete the attached application with your preferences.
Volunteer services include both a toddlers’ unit and a boys’ unit. Drinks, snacks, lunch and crafts will be provided at the cost
of $10 Tots and $15 Boys per day.
We are not a peanut-free or any other allergen-free camp!
Questions?
Name:
Megan Petronella
Phone:
630.667.8875
Email:
megan@petronellas.com
OR
Name:
Gina Wynn
Phone:
847.687.3988
Email:
ginawynn60@gmail.com
Day camp offers girls of all ages the opportunity to discover the fun, friendship and power of girls together. Girls will be able to enjoy the outof-doors, while learning basic camping and outdoor skills.
Would you like to make a difference in a young girl’s life? Day camp offers you that opportunity. Service unit day camp is powered by
volunteers—some are Girl Scout leaders who have been serving troops throughout the year, while others are involved in Girl Scouting in
other ways. Parents’ help is needed to ensure success of the camp. Come and share your knowledge and skills . . . try new things . . .
spend time with your daughter. The Osceola Day Camp Committee has already done the planning for you—you can come and HAVE FUN.
Training will be provided for you, and your younger children and boys are invited to join in the activities in their own special units. Please
indicate your desire to join us on the back of the registration form.
Day camp planning starts in September! You are not required to be a troop leader to be on the committee! Are you interested in being a
part of the planning committee for next year?
YES ___ NO ___ MAYBE ___ Please include e-mail address: _________________________________________________
Registration Closes: June 1, 2015
REGISTRATION FORM
Please complete both sides and mail to:
Jenny Tackett-Irwin 6 Kelsey Ct., Algonquin, IL 60102
Please Print
Girl Scouts of Northern Illinois
Office Use – Fees
Cash ______________________________________
Check ______________________________________
“Cookie Dough”/“S’More Dough” _________________
GSUSA Reg. ________________________________
FA _________________________________________
Overnight ___________________________________
Total
Camper’s Full Name
Age ________
Address
Home Phone (
)
Daytime Phone (
)
City and Zip Code
Parent’s/Guardian’s Name
Parent/Guardian E-Mail
Grade entering in fall
New Girl Scout? [
] check if yes
She is (Check all that apply):
She is Hispanic or Latina:
___American Indian or Alaskan Native
___Asian
___Black or African American ___Other
___Hawaiian or Pacific Islander
___Yes
___No
__White
___I choose not to share
___I choose not to
share
Media Permission: When participating in Girl Scout activities I (or the person that I am registering) give consent to be interviewed, photographed,
videotaped, or electronically imaged for the purposes of promotional materials, news releases, or other published formats for either the local Girl Scout
Councils or Girl Scouts of the USA. The images will be the sole property of the local Girl Scout Council or Girl Scouts of the USA,. I hereby release and
hold harmless the local Girl Scout Council and Girl Scouts of the USA from any claim arising from the use of these images.
_____ I wish to opt out of the media permission at this time.
[
] My daughter will be riding the bus [
] My daughter will NOT be riding the bus
Comments:
Camper Fees
Camp Fee
$125
Camper’s Name
Camper’s T-Shirt size: Youth: [ ] M [ ] L
Volunteer Fees
Name
New Scout
GSUSA Fee
$15
Overnight
Fee
$10
Total A
T-Shirt Cost
$10
Subtotal
Adult: [ ] S [ ] M [ ] L [ ] XL
Day
Camp
Patch
$2
Number of
Days
Attending
(1 – 5)
Fees
Boy: $15/Day
Toddler:
$10/Day
Adult:
Adult’s T-Shirt size: Adult: [ ] S [ ] M [ ] L [ ] XL [ ] XXL [ ] XXXL
Boy:
Boy’s T-Shirt size: Youth: [ ] M [ ] L
Adult: [ ] S [ ] M [ ] L [ ] XL
Toddler:
Toddler’s T-Shirt size: Youth: [ ] S [ ] M [ ] L
Please complete the other
Total B
side of this registration form.
Total Fees Enclosed
(Total A + Total B)
Camper’s Medical Information:
This camper,______________________________________________________ is in good physical condition
and can take part in usual outdoor activities. Special health considerations (allergies, diabetes, dietary restrictions, etc.),
include instructions for medication sent to camp with camper: ______________________________________
_______________________________________________________________________________________
Print name of parent/guardian _______________________________________________________________
I can be reached during camp at (_____) _____________________cell or pager ( ____ ) _______________
Date of last tetanus shot ___________________________________________________________________
Please list two (2) emergency contacts in case you cannot be reached.
Emergency contact #1 name ______________________ relationship _________
Emergency contact #2 name ______________________ relationship _________
Child’s physician __________________________________________________
Name of family insurance carrier _____________________________________
phone ( _____ ) __________
phone ( _____ ) __________
phone ( _____ ) __________
phone ( _____ ) __________
The bearer of this letter has my permission as a parent or legal guardian to act on my behalf in any emergency dealing with
the health and welfare of my daughter and to obtain emergency treatment for her by a licensed physician.
[
]This girl is not currently registered with Girl Scouts of the USA, and I am willing to have her become a Girl Scout.
_____________________________________________
(signature of parent/guardian)
_______________________________
(date)
Day Camp Volunteer Help Information:
I would love to help! Dads, grandparents, aunts and uncles at least age 18 are welcome. An Application for Volunteer Position
and CBC Authorization Form (Criminal Background Check) must be completed by all volunteers. Forms can be found at
www.girlscoutsni.org.
Name
address
phone (
)________________
I prefer to work with (check all that apply):
[ ] GS Daisy [ ] GS Brownie [ ] GS Junior [ ] GS Cadette [ ] overnight [ ] first aid/CPR*
[ ] with my camper [ ] not with my camper
[ ] crafts [ ] archery* [ ] toddlers [ ] boys
[ ] not in a unit
*requires specialized training
I can volunteer:
[ ] for all five days
[ ] for only the following days. Circle all that apply: Monday Tuesday Wednesday Thursday Friday
[ ] for Camp Set-Up on Sunday, July 26
[ ] for Camp Take-Down on Friday, July 31
[ ] I (and my boys/toddlers) will NOT be riding the bus [ ] I (and my boys/toddlers) will be riding the bus
Comments: _____________________________________________________________________________
Volunteer and Sibling Medical Information:
Name
Age as of 6/1
Doctor’s Name and Phone #
Special Health Considerations
Adult
Sibling
Sibling
Sibling
Please complete the other side of this registration form.