Guardian:

Dear Parent/Guardian: Welcome to Cherry Hill Township’s Morning Fun Camp. Our goal this summer is to provide your child(ren) with a fun and safe camp ...
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Dear Parent/Guardian: Welcome to Cherry Hill Township’s Morning Fun Camp. Our goal this summer is to provide your child(ren) with a fun and safe camp experience. Morning Fun Camp will be open Monday – Thursday, June 27 – August 4, 2016. We have also organized optional field trip activities for campers to enjoy on Fridays. Morning Fun Camp is $98 for one child; $85 for each additional sibling. The registration price includes one t-shirt, which must be worn every day, including Friday Field Trips. After June 10, 2016, registration fees increase to $108 for one child; $85 for each additional sibling. Information for Friday field trips is available in this packet. Payment will not be accepted at your camp site or the field trip site; you must register by mail or in person with the Recreation Department. Registration will not be available on CommunityPass. To help our staff provide a safe environment and the best possible care for your child, please read the guidelines below. Before your child can attend camp, you must complete and return the Camper Information Form and Medical Information Form. A Physicians Care Plan must be attached where applicable. All forms must be returned and approved by the Township before your child(ren) can attend camp. GENERAL GUIDELINES 1. All campers MUST be 6 years old by October 1, 2016. This is dictated by the NJ State Department of Licensing. No exceptions will be made. 2. A Staff Supervisor is available at each site to address your concerns. 3. Camp opens at 8:30 am and closes at 12 pm. Failure to comply may result in expulsion without a refund. 4. Children are expected to remain at the site between 8:30 am and 12 pm. Under no circumstances are children permitted to leave at will. 5. Children must be picked up by a parent or approved guardian as designated on the attached Camper Information Form. Please make sure you note exactly who may pick up your child. Changes to this list must be made in writing. 6. Children permitted to walk or ride a bike to and from Morning Fun must have written permission attached to their registration forms or provided to the Site Supervisor. 7. Please send a snack and drink each day. Campers are not permitted to share food. 8. Medical Information Forms must be completed AND signed by a physician and be dated within one year of June 27, 2015. No exceptions will be made. 9. A physician’s care plan is required for any medication and/or special needs. 10. Again this year, all campers will be required to wear a camp T-shirt every day of camp and on trip days. Please indicate a shirt size on the Camper Information Form. 11. The Recreation Department will continue to provide the best experience for your child. Please contact the Department with any questions or concerns you may have. Sincerely,

Megan Brown, Director of Recreation

2016 Morning Fun Camp RegistraƟon Form Please fill out and return along with Universal Health Record Form prior to the start of camp for each registrant. The Morning Fun program is for Cherry Hill residents ONLY. Please check:  Barton  Harte  Kilmer  Knight (on-site nurse)  Sharp  West (Drama) (limit 60)  Woodcrest Child’s Name ____________________________________________________ D/O/B ________________ Grade (Sept ‘16) _________ Child’s Address _______________________________________________________ City ___________ State ______ Zip ____________ Parent/Guardian Full Name _____________________________________ Email _____________________________________________ Home # (

)________________________ Work # (

)____________________________ Cell # (

)_________________________

Emergency Contact InformaƟon: Name ___________________________________ Rela onship __________________________ Phone # __________________________ List those people, including yourself, who may pick up your child. No child will be released to anyone other than those listed. You must make any changes to this list in wri ng to the site supervisor. Name ___________________________ Home # (

) ________________ Work # (

) ________________ Cell # (

) _______________

Name ___________________________ Home # (

) ________________ Work # (

) ________________ Cell # (

) _______________

Name ___________________________ Home # (

) ________________ Work # (

) ________________ Cell # (

) _______________

Name ___________________________ Home # (

) ________________ Work # (

) ________________ Cell # (

) _______________

 Check this box to inform us if your child has special needs or a developmental or physical disability so that we may accommodate

your child. Please elaborate below: ________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________

Morning Fun aƩendees are REQUIRED to wear a Camp t-shirt EVERYDAY. One shirt is included with your registraƟon fee. AddiƟonal shirts are $5 each. T-Shirt Size: (circle one) YOUTH Small (6-8, 29” chest, 19.5” length) YOUTH Medium (10-12, 33” chest, 22” length) Adult Small (36” chest, 27” length)

Adult Medium (40” chest, 28” length)

Adult Large (44” chest, 29” length)

Indicate the number of addiƟonal shirts: _______ + 1 = _______ Total shirts

EMERGENCY RELEASE: In the event my child should become injured or ill at a Cherry Hill Township sponsored camp, I hereby authorize the staff of the camps to arrange for whatever emergency medical care is deemed necessary and reasonable at the me, including transporta on to a local hospital. NOTICE OF CODE OF CONDUCT/EXPULSION POLICY: Cherry Hill Township seeks to provide a safe environment for all par

cipants and staff in our recrea on programs. In order to preserve this safe environment, Cherry Hill Township reserves the right to dismiss any child who commits any act that may compromise the safety of our programs. Threats, assaults, vandalism, possession of drugs or alcohol are just some examples of inappropriate behaviors and ac vi es that could result in the dismissal of an individual from a Cherry Hill Recrea onal program.

By signing below, I acknowledge and understand the above No ce of Code of Conduct/Expulsion and Emergency Release Policy. I, the registrant/guardian (circle one), by applying to par cipate in a Cherry Hill Township Recrea on Program, do hereby waive, release, absolve, indemnify and agree to hold harmless Cherry Hill Township, the organizers, sponsors and supervisory of the program. Signature ________________________________ Printed Name ________________________________________ Date _____________

UNIVERSAL CHILD HEALTH RECORD

-

For Morning Fun Only

Camp Site: ____________________

Endorsed by: American Academy of Pediatrics, New Jersey Chapter; New Jersey Academy of Family Physicians; New Jersey Department of Health and Senior Services

SECTION I - TO BE COMPLETED BY PARENTS Child’s Name (Last)

(First)

Does your child have health insurance?

Gender

 Yes

 Male  Female

Date of Birth

/

/

If yes, name of child’s health insurance carrier:

 No

Parent/Guardian Name

Home Telephone Number

Work Telephone/Cell Phone Number

Parent/Guardian Name

Home Telephone Number

Work Telephone/Cell Phone Number

I give my consent for my child’s Health Care Provider and Child Care Provider/School Nurse to discuss the informaƟon on this form. Signature/Date

This form may be released to WIC.

 Yes

 No

 Yes

 No

SECTION II - TO BE COMPLETED BY HEALTH CARE PROVIDER

Results of physical examina on normal?

Date of Physical Examina on: Abnormali es Noted:

Weight (must be taken within 30 days for WIC) Height (must be taken within 30 days for WIC) Head Circumference (if < 2 years) Blood Pressure (if > 3 years)

 Immuniza on Record a ached

IMMUNIZATIONS

 Date Next Immuniza on due: MEDICAL CONDITIONS

Chronic medical condiƟons/related surgeries  List medical condi ons/ongoing surgical concerns

 None  Special care plan a ached

Comments:

MedicaƟons/Treatments  List medica ons/treatments

 None  Special care plan a ached

Comments:

LimitaƟons to physical acƟvity  List limita ons/special considera ons

 None  Special care plan a ached

Comments:

Special equipment needs  List items necessary for daily ac vi es

 None  Special care plan a ached

Comments:

Allergies/SensiƟviƟes  List allergies

 None  Special care plan a ached

Comments:

Special diet/Vitamin & Mineral supplements  List dietary specifica ons

 None  Special care plan a ached

Comments:

Behavioral issues/Mental health diagnosis  List behaviors/mental health issues/concerns

 None  Special care plan a ached

Comments:

Emergency plans  List plan needed & signs/symptoms to watch for

 None  Special care plan a ached

Comments:

PREVENTIVE HEALTH SCREENINGS Type Screening

Date Performed

Record Value

Type Screening

Hgb/Hct

Hearing

Lead: Capillary Venous

Vision

TB (mm of Indura on)

Dental

Other:

Developmental

Other:

Scoliosis

Box MUST be checked.

Note if Abnormal

I have examined the above child and reviewed his/her health history. It is my opinion that he/she is medically cleared to parƟcipate fully in all child care acƟviƟes, including physical educaƟon and compeƟƟve contact sports, unless noted above.

Name of Health Care Provider (Print) Signature

Date Performed

Health Care Provider Stamp Date

InstrucƟons for compleƟng the Universe Child Health Record (CH-14) SecƟon 1 - Parent Please have the parent/guardian complete the top sec on and sign the consent for the child care provider/school nurse to discuss any informaon with the health care provider. The WIC box needs to be checked only if this form is being sent to the WIC office. WIC is a supplemental nutri on program for Women, Infants and Children that provides nutri ous foods, nutri on counseling, health care referrals and breast feeding support to income eligible families. For more informa on about WIC in your area call 1-800-328-3838.

SecƟon 2 - Health Care Provider 1. Please enter the date of the physical exam that is being used to complete the form. Note significant abnormali es especially if the child needs treatment for that abnormality (e.g. creams for eczema; asthma medica ons for wheezing etc.)  Weight -Please note pounds vs. kilograms. If the form is being used for WIC, the weight must have been taken within the last 30 days.  Height -Please note inches vs. cen meters. If the form is being used for WIC, the weight must have been taken within the last 30 days.  Head Circumference - Only enter if the child is less than 2 years.  Blood Pressure - Only enter if the child is 3 years or older. 2. ImmunizaƟon - A copy of an immuniza on record may be copied and a ached. If you need a blank form on which to enter the immunizaon dates, you can request a supply of Personal Immuniza on Record (IMM-9) cards from the New Jersey Dept. of Health & Senior Services, Immuniza on Program at 609-588-7512.  The Immuniza on record must be a ached for the form to be valid.  “Date next immuniza on is due” is op onal but helps child care providers to assure that children in their care are up-to-date with immuniza ons. 3. Medical CondiƟons - Please list any ongoing medical condi ons that might impact the child’s health and well being in the child care or school se ng. a. Note any significant medical condi ons or major surgical history. If the child has a complex medical condiƟon, a special care plan should be completed and aƩached for any of the medical issue blocks that follow. A generic care plan (CH-15) can be downloaded at www.state.nj.us/health/forms/ch-15.doc. Hard copies of the CH15 can be requested from the Division of Family Health Services at 609-292-5666. b. MedicaƟons - List any go ongoing medica ons. Include any medica ons given at home if they might impact the child’s health while in child care (seizure, cardiac or asthma medica ons, etc.). Shortterm medica ons such as an bio cs do not need to be listed on this form. Long term an bio cs such as an bio cs for urinary tract infec ons or sickle cell prophylaxis should be included. PRN Medica ons are medica ons given only as needed and should have guidelines as to specific factors that should trigger medica on administra on. Please be specific about what over-the-counter (OTC) medicaƟons you recommend, and include informaƟon for the parent and child care provider as to dosage, route, frequency, and possible side effects. Many child care providers may require separate permission slips for prescripƟon and OTC medicaƟons. c. LimitaƟons to physical acƟvity - Please be as specific as possible and include dates of limita on as appropriate. Any limita on to field trips should be noted. Note any special considera ons such as avoiding sun exposure or exposure to allergens. Poten al severe reac on to insect s ngs should be noted. Special considera ons such as back-only sleeping for infants should be noted.

d. Special equipment - Enter if the child wears glasses, orthodon c devises, ortho cs, or other special equipment. Children with complex equipment needs should have a care plan. e. Allergies/sensiƟviƟes - Children with life-threatening allergies should have a special care plan. Severe allergic reac ons to animals or foods (wheezing etc.) should be noted. Pediatric asthma ac on plans can be obtained from The Pediatric Asthma Coali on of New Jersey at www.pacnj.org or by phone at 908-687-9340. f. Special diets - Any special diet and/or supplements that are medically indicated should be included. Exclusive breast feeding should be noted. g. Behavioral/Mental Health issues - Please note any significant behavioral problems or mental health diagnoses such as au sm, breath holding or ADHD. h. Emergency plans - May require a special care plan if interven ons are complex. Be specific about signs and symptoms to watch for. Use simple language and avoid the use of complex medical terms. 4. Screening - This sec on is required for school, WIC, Head Start, child care se ngs and some other programs. This sec on can provide valuable data for public health personnel to track children’s health. Please enter the date that the test was performed. Note if the test was abnormal or place an “N” if it was normal.  For lead screening state if the blood sample was capillary or venous and the value of the test performed.  For PPD enter millimeters of indura on, and the date listed should be the date read. If a chest x-ray was done, record results.  Scoliosis screenings are done biennially in the public schools beginning at age 10. This form may be used for clearance for sports or physical educaon. As such, please check the box above the signature line and make any appropriate nota ons in the Limita on to Physical Ac vies block. 5. Please sign and date the form with the date the form was completed (note the date of the exam, if different).  Print the health care provider’s name.  Stamp with health care site’s name, address and phone number.

MOVIE: WHERE: DROP OFF: PICK UP:

ICE AGE COLLISION COURSE AMC CHERRY HILL 24 212 ROUTE 38, CHERRY HILL 9 A.M. 11:30 A.M. (PLEASE ARRIVE ON TIME)

Admission and snacks (water, small popcorn, small candy) to be paid for by the Cherry Hill Alliance on Alcohol and Drug Abuse. Camp counselors will be chaperone’s at this event. Registration is required. | Questions 856-488-7889.

Morning Fun Camp 2016 Field Trip Registration Form Dear Parent/Guardian: The Recreation Department is happy to offer optional field trips for your child to participate in at an additional fee. Each trip requires your child to register prior to the date of the event and all forms MUST be returned to: Recreation Department, Room 102, 820 Mercer St. Please make checks payable to: Cherry Hill Township. There will be NO REFUNDS for any of the Morning Fun trips. Additional forms will be available at each camp site and in the Recreation Department. If you have any questions, please call 856-488-7868 or email [email protected]

------------------------------------------------------------------BOWLING TRIPS SKATING TRIP Location: The Big Event of Cherry Hill, 1536 N. Kings Highway Dates: Friday, July 1 and Friday, July 15 Cost: $15/ child (includes shoe rental, pizza and a soda)

Location: Cherry Hill Skating Center, 664 Deer Road Date: Friday, July 8

Arrival Time: 9:00 am / Pick Up Time: 11:45 am

Cost: $7/ child (includes skate rental, pizza and a soda)

Please check which dates you will be attending: July 1 July 15

Arrival Time: 9:00 am / Pick Up Time: 11:45 am

MOVIE DAY @ AMC LOWES (ICE AGE 5)

HAY RIDE @ SPRINGDALE FARMS

Location: AMC LOWES of Cherry Hill, 2121 Route 38 Date: Friday, July 22

Please indicate whether or not you will attend: Yes No

Location: Springdale Farms, 1638 South Springdale Road Date: Friday, July 29

Cost: FREE (includes small popcorn, small candy and water) Sponsored by Cherry Hill Township’s Alliance on Alcohol & Drug Abuse.

Cost: $15 / child (includes educational hay ride, corn picking and roasting, campsite activities and lunch (hot dog and water)

Arrival Time: 9:00 am / Pick Up Time: 11:45 am

Arrival: 9:00 am / Pick Up: 12:00 pm

Please indicate whether or not you will attend: Yes No

Please indicate whether or not you will attend: Yes No

NAME OF CHILD

PHONE #

CAMP LOCATION

I, __________________________ (Parent/Guardian), hereby give my child/children permission to attend a Cherry Hill Township Morning Fun Field Trip. Signature ____________________________________________________ Date: __________________

 

EXPULSION POLICY   

While  rare,  there  are  sometimes  reasons  we  have  to  expel  a  child  either  on  a  short  term  or  permanent  basis.    The  Township would like you to know that we have staff at each camp site that will do everything possible to work with the  family of the child(ren) in order to prevent this policy from being enforced.  The following are reasons we may have to  terminate or suspend a child from our camp site:   

CHILD’S ACTIONS FOR EXPULSION  o Ongoing physical or verbal abuse to staff or other children  o Repeated biting of other children  o Uncontrollable tantrums/angry outbursts  o Failure of child to adjust after a reasonable amount of time  o Having an illness/sickness that may be detrimental to other campers/staff   

PROACTIVE ACTIONS THAT WILL BE TAKEN IN ORDER TO PREVENT EXPULSION  o Staff will try to redirect child from negative behavior  o Staff will reassess classroom environment, appropriateness of activities and supervision  o Staff will always use positive methods and language while disciplining children  o Staff will praise appropriate behaviors  o Staff will consistently apply consequences for rules  o Child will be given verbal warnings  o Child’s disruptive behavior will be documented and maintained in confidentiality  o Parent/guardian will be notified verbally  o Parent/guardian will be given written copies of the disruptive behaviors that might lead to expulsion  o The director/supervisor and parent/guardian will have a conference to discuss how to promote positive behaviors   

SCHEDULE OF EXPULSION  o If actions above do not produce results, the child’s parent/guardian will be advised verbally and in writing about the  child’s or parent’s behavior warranting an expulsion.  An expulsion action is meant to be a period of time so that the  parent/guardian may work on the child’s behavior or to come to an agreement with the center.  o The parent/guardian will be informed regarding the length of the expulsion period.  o The  parent/guardian  will  be  informed  about  the  expected  behavioral  changes  required  for  the  child  or  parent  to  return to the program.  o Failure of the child/parent to satisfy the terms of the plan may result in permanent expulsion from the center.   

PARENTAL ACTIONS FOR CHILD’S EXPULSION  o Physical or verbal abuse to staff  o Physical or verbal abuse to any other child in camp  o Habitual tardiness when picking up your child   

A CHILD WILL NOT BE EXPELLED  o If a child’s parent(s):    Made a complaint to the Office of Licensing regarding a center’s alleged violations of the licensing requirements  (1‐877‐667‐9845)   Reported abuse or neglect occurring at the camp location (1‐877‐NJ ABUSE)