Download Celebrate Girls Summer Program brochure

Paterson
Summer
Program
Summer 2014
The Girl Scout
Promise
On my honor, I will try:
To serve God and my country,
To help people at all times,
And to live by the Girl Scout Law.
The Girl Scout Law
I will do my best to be
honest and fair,
friendly and helpful,
considerate and caring,
courageous and strong, and
responsible for what I say and do,
and to
respect myself and others,
respect authority,
use resources wisely,
make the world a better place, and
be a sister to every Girl Scout.
Dear Parent/ Guardian,
Thank you for considering GSNNJ’s Celebrate Girls Paterson Summer
Program as your daughter’s summer experience. This year we are delighted to
offer several trips, opportunities, and programs that have been suggested by
the Celebrate Girls participants.
The program is located at John F. Kennedy High School, 61-127 Preakness
Avenue, Paterson, New Jersey.
Some key highlights for this summer include:
»» Historic Tour of Philadelphia, PA
»» Trip to Dorney Park & Wildwater Kingdom
»» Tour of Newark International Airport
»» Broadway Show, “Wicked”
»» Trip to Sahara Sam’s Oasis Water Park
»» Overnight Trip to GSNNJ’s Camp Glen Spey in Glen Spey, N.Y.
Our Annual Court of Awards Ceremony will be held on Saturday, August 23rd
at 9 a.m. (location to be determined). Family and friends are welcome to
attend. More information will be available during the summer. Registration for
the Celebrate Girls Program opens on March 31, 2014. Space is limited!
If you have any questions regarding the program, you may contact Nelly Celi,
Program Director at:
GSNNJ Paterson Resource Center
Center City Mall, Upper Level
301 Main Street, Paterson
973-881-9400 or 973-906-0098
Hours of operation are Monday – Friday, 10am – 6pm
or you may reach me at 973-248-8200 x4103 or [email protected] .
Looking forward to a great summer!
Sincerely,
Charisse Taylor
Chief Program Officer
Girl Scouts of Northern New Jersey
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CELEBRATE GIRLS PATERSON SUMMER PROGRAM
John F. Kennedy High School
61-127 Preakness Avenue
Paterson, New Jersey
For girls entering grades 1-9
Session 1: Monday, June 30 - Friday, July 11, 2014
No camp on July 4
Trips: Shepherd Lake, Ringwood, NJ
Historic Tour of Philadelphia, PA
Session 2: Monday, July 14 - Friday, July 25, 2014
Trips: Dorney Park & Wildwater Kingdom, Allentown, PA
Newark International Airport, Newark, NJ
Edison National Historic Site, West Orange, NJ
Session 3: Monday, July 28 - Friday, August 8, 2014 Session 4: Monday, Aug. 11 - Friday, Aug. 22, 2014
Trips: “Wicked” on Broadway, NYC
Chocolate Tour, NYC
Bear Mountain State Park, NY
Trips: Camp Glen Spey, Glen Spey, NY (Overnight)
Sahara Sam’s Oasis Water Park, West Berlin, NJ
PROGRAM INFORMATION AND REGISTRATION
Want to learn more about the Celebrate Girls Paterson Summer Program?
Stop by the Paterson Resource Center during office hours.
Office Hours:
Monday - Friday
10 a.m. to 6 p.m.
Paterson Resource Center
Center City Mall, Upper Level
301 Main Street
Paterson, NJ
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FEES:
PROGRAM INFORMATION
ARRIVAL AND DEPARTURE:
One-time, non-refundable fee: $50
Parents/Guardians may drop off girls at John F. Kennedy High
School at 8:00 am to their counselors. For your child’s safety
please do not leave your child unattended prior to 8:00 am.
Girls must be picked up by 5:00 p.m. at John F. Kennedy High
School. No Exceptions! A late pick up penalty will be assessed
at $5.00 per 15 minute increment. Girls will only be released to
adults that are designated on child release form completed
with registration by parent/guardian.
Fee includes T-shirt and program supplies.
Girl’s Guide to Girl Scouting book: $22.50
Girl Scout Sash and Insignia: $15
Session 1 Fee: $150 due June 30, 2014
Session 2 Fee: $150 due July 14, 2014
Session 3 Fee: $150 due July 28, 2014
TRIPS:
Session 4 Fee: $150 due August 11, 2014
Buses leave John F. Kennedy High School promptly at 9:00 am
after morning attendance, and usually return to John F. Kennedy
High School in time for afternoon departure, unless noted in
program calendar. Girls must be ready to board the bus at 8:45
am. On trip days girls and staff must wear their program T-shirt.
Staff maintains a ratio of one adult to every six or fewer girls.
• Session fees are non-refundable or transferable.
• Parents must make other arrangements if girls choose
not to participate in trips.
REGULATIONS:
• For safety reasons, girls must be dressed appropriately
with comfortable clothes and sneakers everyday. Girls
are also asked to bring a backpack to camp everyday and
a full water bottle. No sandals, flip flops, open toe shoes,
clogs, or platform shoes. Program T-shirts are to be worn
every day. Additional T-shirts may be purchased for $5/
shirt from the Program Director.
Sending money is always optional for trips. Please remind
your daughter to follow counselors’ safety instructions.
Note: Due to the overnight at Camp Glen Spey on August 1314, there will be an early dismissal from camp on Thursday,
August 14. Girls should be picked up by 12 noon.
PAYMENT INFORMATION:
• Cell phones or electronic equipment are prohibited
during camp hours.
GSNNJ accepts Visa/Mastercard/Discover/AMEX credit
cards or money orders. No checks will be accepted. Make
money orders payable to GSNNJ and mail to:
PROGRAM STAFF:
All Girl Scout Summer activities are staffed by trained, skilled
and capable personnel who are screened prior to placement.
A first-aider is on duty at all times. Girl Scouts are supervised
by unit staff 18 years and older. The ratio of staff to campers
is 1 staff to every five 1st graders and 1 staff to every eight girls
2nd grade and up.
Girl Scouts of Northern New Jersey
Attention: Charisse Taylor
Planet 301 - Center City Mall
301 Main Street
Paterson, NJ 07505
BREAKFAST & LUNCH PROGRAM:
Breakfast and lunch will be provided everyday.
ACCEPTANCE POLICY:
Registration for Girl Scout Program will be accepted in order
of receipt of deposit and application. Registration does
not guarantee placement; only full payment of program
session guarantees placement. Rules for acceptance and
participation in the program are the same for everyone
without regard to race, sex, color, national origin, age or
handicap. All Girl Scouts must present a completed health
history form, listing all immunizations. Girl Scouts without a
completed health history will be excluded from the program.
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Girl’s Name: Grade in Sept.:
CELEBRATE GIRLS SUMMER PROGRAM - SESSION FORM 2014
Session
Camp Entering
Code Grades
Dates
Trips
Session Fee
Shepherd Lake, Ringwood, NJ
Historic Tour of Philadelphia, PA
q $150
Session 1
1001
1-9
6/30 - 7/11
(no camp
7/4)
Session 2
1002
1-9
7/14 - 7/25 Dorney Park & Wildwater Kingdom, Allentown, PA
Newark International Airport, Newark, NJ
Edison National Historic Site, West Orange, NJ
q $150
Session 3
1003
1-9
7/28 - 8/8
“Wicked” on Broadway, NYC
Chocolate Tour, NYC
Bear Mountain State Park, NY
q $150
Session 4
1004
1-9
8/11 - 8/22
Camp Glen Spey, Glen Spey, NY
Sahara Sam’s Oasis Water Park, West Berlin, NJ
q $150
Program Registration Fee: $
50
Girl’s Guide to Girl Scouting book: $22.50 (+)
Girl Scout Sash and Insignia: $15 (+)
Session 1: $150 (+)
Session 2: $150 (+)
Session 3: $150 (+)
Session 4: $150 (+)
Tax-deductible contribution - Your gift, in any amount, helps
a girl in financial need benefit from a week at camp (+)
Total Amount Due $
No personal checks. Total Amount Paid $
Payment Method: Money Order Cash Visa MasterCard AmEx Discover
NO CHECKS Money orders made payable to: Girl Scouts of Northern New Jersey
Card # Exp. Date V-Code Signature Date Signed: Print Name Check here to authorize the automatic payment of your balance in full on or after the week of June 30, 2014 for Session 1.
Check here to authorize the automatic payment of your balance in full on or after the week of July 14, 2014 for Session 2.
Check here to authorize the automatic payment of your balance in full on or after the week of July 28, 2014 for Session 3.
Check here to authorize the automatic payment of your balance in full on or after the week of August 11, 2014 for Session 4.
I understand that I authorize Girl Scouts of Northern New Jersey to charge my credit card for the balance on this registration.
Initial here to authorize automatic payment Date Amount Please send registration and payment to: For Office Use ONLY
Girl Scouts of Northern New Jersey
Registration Fee Received on: Attention: Charisse Taylor 1st Payment Received on:
Center City Mall2nd Payment Received on: 301 Main Street
Paterson, NJ 07505
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Girl Scouts of Northern New Jersey
Celebrate Girls Registration Form
Office Use Only:
□ NR
□ R
□ HFOS
□ HF Copies
Program Attending: Celebrate Girls Complete this form in its entirety and mail with payment to: Girl Scouts of Northern New Jersey, Center City Mall, 301 Main Street, Parterson, NJ
07505. Cash or money orders made payable to Girl Scouts of Northern New Jersey, or credit cards are accepted.
GIRL INFORMATION (please print all information in blue or black ink):
First Name: MI: Last Name: Age: Mailing Address: City: State: Zip Code: Home Phone: Date of Birth: /
/
Grade Completed June 2014: School in Sept. 2014: Active Girl Scout Member: Yes No Troop/Group #: Council Name: PARENT/GUARDIAN INFORMATION (fill out completely):
Girl may be released to: Both parents
Mother only
Father only Other If a non-custodial parent is denied access to a child by a court order, you must provide camp with a copy of the documentation.
I/We the parent(s)/guardian(s) of authorize the following people
as person(s) to whom she can be released into their care.
1. Name Phone # Relationship to girl 2. Name Phone # Relationship to girl Parent/Guardian Name: Relationship Address (if different from camper): Home Phone: Cell Phone: Work Phone: Email Address: Parent/Guardian Name: Relationship Address (if different from camper): Home Phone: Cell Phone: Work Phone: Email Address: MUST PROVIDE LOCAL EMERGENCY CONTACT INFORMATION (other than parent/guardian):
Please notify the individual of their role. Parents/guardians will always be the first contact.
Name: Relationship Home Phone: Cell Phone: Work Phone: The following information provides GSUSA and Girl Scouts of Northern New Jersey with essential statistical
data on the racial & ethnic population groups that are served. It helps to further our goal to serve all girls.
Am. Indian/Alaskan Native Asian Black/African American Hawaiian/Pacific Islander White Latina/Hispanic
Read This Statement Before Signing:
I give permission for my child to participate in all camp activities including selected overnights and bus trips outside of the program site. I consent that
my child may be photographed, videotaped, and/or recorded, and the electronic images/recordings may be made public and used for promotion of
Girl Scouting free of any claims. I agree not to send my camper to camp if she is not in physical and emotional condition to take part in program
activities. Girls are not permitted to have in their possession or use while attending the program: alcohol, tobacco, illegal drugs, MP3 players, personal
sports equipment, animals/pets, or weapons. Cell phone use is not permitted during the program. I understand that the program director reserves the
right to send home, without refund, any child who is unable to adjust, is repeatedly defiant, or in the case of an illness, accident or health hazard, where
it is in the best interest of the children and/or program. We acknowledge that the child will make the Girl Scout Promise and accept the Girl Scout Law.
The child has our permission to join Girl Scouts, if not already a member.
Parent/Guardian Signature: Date: Print Name: Relationship: Attach the Session Form to this Registration Form before submitting for processing.
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Celebrate Teens 2014!
Forgirlsenteringgrades10‐12
July14th‐25th
July30th
(weekdaysfrom8:30am‐5pm)
“Wicked”onBroadwayin
AND
JohnF.KennedyHighSchool
NewYorkCity
61–127PreaknessAvenue
Paterson,NJ07522
$150pergirl(SpaceisLimited)
Celebratesummerataone‐of‐a‐kind
Counselor‐in‐trainingprogramforoldergirls!
 Learnfromprofessionalsaboutavarietyofcareers
 BecometrainedinFirstAid&CPR
 Exploretopicsincluding:fashion,bullying,themedia,&
healthyliving.Learnskillstoworkwithyoungergirls.
 Learninterviewskillsandhowtodressforsuccess
(GirlswillbeinterviewedforJuniorCounselorPositions
onThursday,July24th.Girlsmustcompletetheentire
two‐weeksessiontobeconsideredforaposition.)
Girlswilltravelwith
theCelebrateGirls
PatersonProgramtosee“Wicked”onBroadway
inNewYorkCity.
RegistrationopensonMonday,March31st.
Contact:[email protected],orNelly
[email protected],orcall973‐881‐9400.
Girl Scouts of Northern New Jersey
www.gsnnj.org Paramus Service Center
300 Forest Avenue
Paramus, NJ 07652
201-967-8100
Paterson Resource Center
Center City Mall, 301 Main St
Paterson, NJ 07505
973-881-9400
Randolph Service Center
1579 Sussex Turnpike
Randolph, NJ 07869
973-927-7722
Riverdale Service Center
95 Newark Pompton Turnpike
Riverdale, NJ 07457
973-248-8200
Girl Scouts of Northern New Jersey
Celebrate Teens Registration Form
Office Use Only:
□ NR
□ R
□ HFOS
□ HF Copies
Program Attending: Celebrate Teens Complete this form in its entirety and mail with payment to: Girl Scouts of Northern New Jersey, Center City Mall, 301 Main Street, Parterson, NJ
07505. Cash or money orders made payable to Girl Scouts of Northern New Jersey, or credit cards are accepted.
GIRL INFORMATION (please print all information in blue or black ink):
First Name: MI: Last Name: Age: Mailing Address: City: State: Zip Code: Home Phone: Date of Birth: /
/
Grade Completed June 2014: School in Sept. 2014: Active Girl Scout Member: Yes No Troop/Group #: Council Name: PARENT/GUARDIAN INFORMATION (fill out completely):
Girl may be released to: Both parents
Mother only
Father only Other If a non-custodial parent is denied access to a child by a court order, you must provide camp with a copy of the documentation.
I/We the parent(s)/guardian(s) of authorize the following people
as person(s) to whom she can be released into their care.
1. Name Phone # Relationship to girl 2. Name Phone # Relationship to girl Parent/Guardian Name: Relationship Address (if different from camper): Home Phone: Cell Phone: Work Phone: Email Address: Parent/Guardian Name: Relationship Address (if different from camper): Home Phone: Cell Phone: Work Phone: Email Address: MUST PROVIDE LOCAL EMERGENCY CONTACT INFORMATION (other than parent/guardian):
Please notify the individual of their role. Parents/guardians will always be the first contact.
Name: Relationship Home Phone: Cell Phone: Work Phone: The following information provides GSUSA and Girl Scouts of Northern New Jersey with essential statistical
data on the racial & ethnic population groups that are served. It helps to further our goal to serve all girls.
Am. Indian/Alaskan Native Asian Black/African American Hawaiian/Pacific Islander White Latina/Hispanic
Read This Statement Before Signing:
I give permission for my child to participate in all camp activities including selected overnights and bus trips outside of the program site. I consent that
my child may be photographed, videotaped, and/or recorded, and the electronic images/recordings may be made public and used for promotion of
Girl Scouting free of any claims. I agree not to send my camper to camp if she is not in physical and emotional condition to take part in program
activities. Girls are not permitted to have in their possession or use while attending the program: alcohol, tobacco, illegal drugs, MP3 players, personal
sports equipment, animals/pets, or weapons. Cell phone use is not permitted during the program. I understand that the program director reserves the
right to send home, without refund, any child who is unable to adjust, is repeatedly defiant, or in the case of an illness, accident or health hazard, where
it is in the best interest of the children and/or program. We acknowledge that the child will make the Girl Scout Promise and accept the Girl Scout Law.
The child has our permission to join Girl Scouts, if not already a member.
Parent/Guardian Signature: Date: Print Name: Relationship: Attach the Session Form to this Registration Form before submitting for processing.
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THIS HEALTH HISTORY FORM MUST BE COMPLETED PRIOR TO ATTENDING CAMP.
The form is to be completed and signed by the parent/guardian of the girl or by adult staff.
Submit the completed form (two pages) no later than June 1, 2014. Do NOT Fax.
Girl/Staff Name: Date of Birth: Age: Address: Grade in Sept. 2014: City: State: Zip: Mother/Guardian Name: Home Phone: Email Address (REQUIRED): Work Phone: Cell Phone: Father/Guardian Name: Home Phone: Email Address (REQUIRED): Work Phone: Cell Phone: Do both parents have custody? Yes No If no, who is the custodial parent/guardian?
If a non-custodial parent is denied access to a child by a court order, you must provide camp with a copy of the documention.
Emergency Contact (Other than the Parent/Guardian)
Name: Primary Phone: Relationship to Child: Cell Phone: Name of Family Physician: Phone: Primary Insurance Carrier: Policy or Group #: General Health
Date of last health examination: REQUIRED: ATTACH A CURRENT COPY OF THE CHILD’S IMMUNIZATION RECORDS WITH DATES.
Provide Most Recent Dates for All That Apply:
Allergies (Indicate all that apply, specify known reactions)
REQUIRED: ATTACH A COPY OF ANY EMERGENCY ACTION PLAN(S) SPECIFIC TO YOUR CHILD.
Frequent Ear Infections
Heart Defect/Disease
Convulsions
Blood Disorders
Hypertension
Psychiatric Treatment
Mononucleosis
ADHD
Sickle Cell Trait/Disease
Insect Stings: Food Allergies: Penicillin: Other Drugs: Musculoskeletal Disorder
Chronic or Recurrent Illness
Diabetes: 1) Glucose Testing? No Yes
2) On Insulin? No Yes
3) Pump or Injection? No Yes
Asthma
1) Use of Inhaler?
No Yes
2) Self Administer?
No Yes
Seizures
1) Most recent: 2) Medications: Poison Ivy: Hay Fever: Other Allergies: Prescribed Epipen? No Yes
Can Self Administer Epipen? No Yes
Camper/ Staff Name: Date Rec’d: Session(s): Health History Form
Celebrate Girls Paterson Summer Program
Medication taken routinely (prescription and OTC): Disability or health condition limiting activities: Hospitalization / Operations / Injuries: Anything that we need to know about your child: Is the camper currently under the care of a physician or psychologist?
No Yes, please specify:
Are there any activities your camper should be exempted from for health reasons? Please explain: Has she started menstruation? No Yes
Please feel free to attach additional significant information that will assist us in providing an enriching day camp
experience for your camper.
EMERGENCY MEDICAL AUTHORIZATION
I give consent for my child,
, to receive medical treatment according to camp protocol written by standing orders
by the camp doctor, or otherwise directed in writing by the child’s physician. In the event of a known severe allergy, camp staff as per
physician’s instructions to prevent life-threatening conditions, will administer medication. In the event of an emergency, I give my consent for
the administration of emergency medical treatment and to transport the child to hospital facilities if necessary. I understand that a reasonable
attempt to contact me will be made.
I understand that part of the camp healthcare supervisor’s role at camp is to dispense medication and that this will not occur unless
she/he has written authorization and instructions from the child’s doctor to dispense non-prescription and/or prescription medication
(including vitamins, nutritional supplements, etc.). All medications must be in their original pharmacy containers, with an intact
current prescription label. No exceptions will be made.
All medications will be collected by the camp nurse on the first day. (Exceptions are Epi Pens & Inhalers).
I also give permission for my child to receive the following non-prescription medications that I have checked below if the nurse deems
it necessary. Dosages will be administered according to directions on the bottle unless a physician directs otherwise.
Child’s weight: lbs. Antacid
Cough drop
Advil
Benadryl
Topical creams/lotions
Tylenol
HIPPA Privacy Rule: I authorize the use of information to promote and monitor well-being while in camp, and as necessary,
provision of first aid/emergency care as best as possible, according and not limited to certifications, training, and availability.
This health history is complete and accurate. I know of no reason(s), other than the information indicated on this form, why my
daughter/I should not participate in prescribed camp activities except as noted.
Signature of parent/guardian: Date: Signature of staff member (18+): Date:

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