Blue Water Bound Camp Office Summer Sailing Program Address 196 South Field Park Stamford, CT 06902 | 203-348-9001 (After 6-27-14) Young Mariners Foundation Address 151 Harvard Avenue Stamford, CT 06902 | 203-348-9000 Dear Parents & 1st Year BWB Camper Applicants: 2014 It’s time to sign up for a summer of learning & fun. We are looking forward to a nice warm spring & summer. Young Mariner Foundation’s Blue Water Bound Summer Sailing Program is an extension of its Young Mariners After School Program. The goal of Blue Water Bound is to provide a safe, fun, on-the-water opportunity for boys and girls to learn about sailing this summer. We believe in teaching children about sailing because sailing is such a great teacher. Sailing helps children learn self-confidence, teamwork and respect for the environment and all living things. Blue Water Bound instructors are educators, recruited from the Stamford School System with a special understanding of the educational needs of children. Our fully certified instructors relate learning about navigation and marine life and weather and the tides to school subjects like math, science, geography, reading and writing. This summer will be the eighth season that Blue Water Bound operates from our location at Southfield/John Boccuzzi Park. This summer’s program will be five weeks long, from June 30 to August 1. Program hours are from 9am to 4pm. The BWB fee is $250. The full payment is due May 5, or you can pay as follows, I. A deposit of $125 due May 5, and a final payment of $125 due June 5 If you have two or more children in BWB camp this summer, please make the following deductions from the total amount, 1. Two children, deduct $50 2. Three children, deduct $75 3. Four children, deduct $100 Please fill out the attached Enrollment Form and the Waiver and Permission Form and mail them to: Young Mariners Foundation 151 Harvard Avenue Stamford, CT 06902 Please include your full or partial payment with your completed forms by May 5. If you need financial assistance, please include your Free or Reduced Lunch form. Make all checks payable to: Young Mariners Foundation. If you have any questions, please contact Peter Gunn at 203-240-0523 or email Peter at [email protected] If you know if someone who attended the camp last summer and has relocated, please ask them to contact Peter Gunn and give him their new address. There are a limited number of positions for this summer’s camp. The selection is based on a first come, first serve list of 50 children who send in their signed forms. When we receive your forms we will notify you if we need a new medical form. The medical forms are good for 3 years and we will check to see if yours is still current. Details of the program will be provided at an orientation meeting (time and location to be announced). All Blue Water Bound Program applicants will be swim tested at the YMCA (date to be determined by Peter Gunn). We look forward to providing your child with a wonderful summer experience. As our slogan says: Learning to Sail Is a Boatload of Fun! Sincerely, Peter Gunn Peter Gunn – Program Director BLUE WATER BOUND Summer Sailing Program 2014 Enrollment Form st 1 Year Campers Child’s Name: _______________________________________________________________________ please print (First Name) (Last Name) Date of Birth _______________ Male/Female ________School ___________________Grade in September: __________ Home Address ________________________________________________________________________________________________ (Street) (City) (State) (zip) I understand that by participating in the YMF Blue Water Bound program this summer, I agree to obey the rules as set forth by the Program Director and Instructors, I will use the utmost care in the use of the boats and equipment, and I will not engage in any horseplay or other disruptive behavior. I understand that failure to attend regularly, arrive promptly, and abide by the rules may result in my suspension from the program. _____________________________________________________________ Student’s Signature Parent/Guardian Name: __________________________________________________________ please print (First Name) (Last Name) Home Phone __________________Work Phone _______________ Cell Phone_______________ e-Mail Address__________________________________________ Emergency contact name______________________________________________________________ please print (First Name) (Last Name) Home Phone ____________________ Work Phone _______________ Cell Phone_____________ _____________________________________________________________ Parent/Guardian Signature ______________ Date Requirements: 1. A swim test is required of all students, which will consist of swimming 50 yards in the YMCA pool. All children already enrolled in the Young Mariners Foundation Young Mariners after School Program will be tested at the YMCA during their swim lesson program. Children not previously participating in the Young Mariners after School Program will be tested at the YMCA in May 2014. 2. Students will be required to wear a Personal Floatation Device, (supplied by BWB) when near the water. Children should arrive each day wearing proper footwear (water shoes) which will be worn at all times, both on land and on the water. Students will be required to bring a change of clothes, a towel, bagged lunch and sun protection for each day. 3. The Fee for Young Mariners Foundation’s Blue Water Bound is $250 for the 5 week program. Please make the check out to “Young Mariners Foundation”. If you are in need of financial assistance, please attach your child’s Free or Reduced Lunch form with this form. 4. Please complete the income and ethnic background information on the back of this form. Please note this information is requested by funders. No income verification is required. Information will be released in summary form only. This information is NOT used in determining eligibility for the Blue Water Bound program. Peter Gunn Program Director *** 203-240-0523 *** [email protected] Please complete and return this form no later than May 5, 2014 to: Young Mariners Foundation 151 Harvard Ave., Stamford CT. 06902 Income Information: 1. Number of people in the household: ____________ 2. Total income of all those who work in this household: ___________ 3. Number of children in Blue Water Bound: _____________ 4. Do(es) your children/child participate in the City of Stamford School District’s Free or Reduced Fee lunch program? __________yes __________no a. If you answered “Yes”, please provide YMF with a letter from your child(ren)’s school Family Background: Asian: ________ American Indian /Alaskan Native: ______ Black:_______ Black Hispanic: _______ White Hispanic: ________ White: ________ Multi Racial: ________ Thank you for completing this survey. Your individual information is confidential. We only share general summary information with our funders. Blue Water Bound Program Application Questions What are you looking forward to learning this summer at the Blue Water Bound Sailing Camp? ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ What do you feel you already know from the Young Mariners Foundation After School Program? ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ What do you expect to learn from sailing in general? ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Is there anything you can tell us that you are nervous about? ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Young Mariners Foundation Blue Water Bound Program 2014 WAIVER AND PERMISSION FORM Child’s Name ____________________________ Parent /Guardian ________________________________ Please print (First Name) (Last Name) (circle one) (First Name) (Last Name) Date of Birth ______________________ Male/Female ____________ School _________________ Grade _____ The undersigned is the Parent/Guardian of the Child named above and hereby acknowledges that the execution of this Form is a condition to the participation of the Child in the Young Mariners Foundation’s/Blue Water Bound Program (hereinafter referred to as the “Program”). The undersigned accepts that the sport of sailing and the conduct of the Program entail and are subject to certain inherent risks and, on behalf of the Child, accepts all risks on land and at sea related to participation in the Program. Now, therefore, the undersigned does hereby agree as follows: 1) The undersigned consents to the participation of the Child in the Young Mariners Foundation’s/Blue Water Bound Program. 2) The undersigned waives any claims against and releases any obligation of the Young Mariners Foundation and all of their respective members, employees, agents and any other person acting in any capacity for the conduct of the program in relation to any loss, injury or damage, on land or at sea, to the Child or other property of the undersigned to the fullest extent permitted by law. 3) The undersigned agrees to reimburse the Young Mariners Foundation, and all of their respective members, employees, agents and any other person acting in any capacity for the conduct of the Program for any loss or damage to property, and hold Young Mariners Foundation harmless from any claim, loss or injury caused by the negligence, or misconduct of, or failure to exercise reasonable care by the Child. 4) I give YMF permission to use pictures & quotations of and by my child in TV, Newspapers, Magazines, Posters, Brochures and YMF websites. 5) I give my child permission to travel and participate in off site programs scheduled for the 2014 program. YMF Staff will be in attendance on all trips. I have thoroughly read and understand the 2014 Waiver and Permission Form. By signing this document, I acknowledge the execution of this form and agree to each of the provisions listed above. Signature of Parent/Guardian ________________________________________________________ Dated ________________ (circle one) First Name Last Name E-Mail Address__________________________ (Please Print) Home Address ____________________________________________City __________________ ST ____ ZIP ___________ Home Phone ___________________ Work Phone ______________________ Cell Phone____________________________ MEDICAL INFORMATION Physician’s Name_____________________________________________________________Phone ___________________ Health Care Provider _________________________ Name Policy # ___________________Group # __________________ Please list any chronic illness, medical conditions, allergies or medication being taken by your child. If none, state none. MEDICAL AUTHORIZATION I hereby authorize an instructor from Young Mariners Foundation/Blue Water Bound Program, or an adult who bears this document, to authorize emergency treatment for the Child named above in the event that a parent or legal guardian cannot be reached at the above telephone numbers at the time of an emergency. Signature of Parent/Guardian ___________________________________________Dated ___________________ EMERGENCY CONTACTS IF PARENTS CANNOT BE REACHED: _____________________________________________________________________________________________________ Name Home Phone Work Phone Cell Phone Relationship to Child ________________________________________________________________________________________________________________________________ Name Home Phone Work Phone Cell Phone Relationship to Child Camp Summer Sailing Program 196 Southfield Park Stamford, CT 06902 2014 Blue Water Bound Office Mailing Address 151 Harvard Ave. Stamford, CT 06902 (203) 348-9000 1st Year Campers Please Note: Return Completed Form to above Mailing Address at Harvard Ave. You may use 5th grade medical form from school nurse.
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