Summer Camps 2014
Registration Packet
Thank you for choosing Sacred Heart School Summer Camps! The purpose
of the Camps is to provide a fun, faith-filled environment that promotes
healthy friendships, positive role models, and an opportunity to grow
closer to God.
The Registration Packet contains helpful information that explains many
of the camp practices that promote a safe and healthy environment.
Application deadline: Tuesday, May 20
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SHS Summer Camps Schedule: 2014
Dates
Camp Theme
Times
June 23-27
Pre K Camp (ages 3-4)
9:00am-1:00pm
July 7-11
Crafty Camp (ages 5-9)
Soccer Camp ( ages 5+)
9:00am-1:00pm
July 14-18
Puppet Camp (ages 5-9)
9:00am-1:00pm
Basketball Camp (ages 10+)
July 21-25
Pre K Camp 2 (ages 3-4)
9:00am-1:00pm
Song & Dance Camp (ages 5+)
July 28-Aug 1
Pre-K Camp 3 (ages 3-4)
9:00am-1:00pm
July 28-Aug1
Wildcat Week: Boys & Girls Camp (ages 5+)
9:00am-1:00pm
July 29-August 2
Song & Dance Camp (ages 5+)
9:00am-1:00pm
AFTERCARE AVAILABLE FROM 1:00-4:00 PM MONDAY THROUGH FRIDAY -$8/hr.
- SHS Summer Camps offer a fun, faith-filled environment for youngsters to develop character, form healthy
friendships, and grow closer to God!
- Summer camps are open to the public!
- SHS Pre-K Teacher & Director, Mrs. Misty Rowell, Kelly Watson and Michele Bua are the Co-Directors of the SHS
Summer Camps.
- 13 year old campers will be trained to become Counselors in Training (C.I.T.)
- Youth ages 14-16 may volunteer to be Counselors in Training (C.I.T.)
- Youth ages 17+ may apply to be paid Counselors
- Each camp is $100 for the week; no hidden costs; scholarships and family rates available!
- Attendees receive 1 Camp T- shirt
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SHS SUMMER CAMPS REGISTRATION FORM
•
Please return completed Registration Form to SHS office by Tuesday, May 20
•
Please include your $25 non-refundable deposit for each camp registered.
Child’s Name: ____________________________________ DOB: _________________
School: ____________________________ Grade: _______ T-Shirt Size: ___________
Child lives with: _______________________ Counselor-in-Training Applicant: Y / N
Father/Guardian Name: __________________________________________________
Home Phone: _________________Cell: _________________ Work: ________________
Address: _______________________________________________________________
City: ___________________________ State: _________ Zip: _________________
E-mail address: ________________________________________________
Mother/Guardian Name: _________________________________________________
Home Phone: ________________Cell: ____________________ Work: ______________
Address: _______________________________________________________________
City: _____________________________ State: _________ Zip: ________________
E-mail address: _______________________________________________________
Emergency Contact: ________________________ Phone #: ______________________
Relation to Child: ________________
Please indicate which camp your child is registering to attend:
Pre-K Camp #1
Pre-K Camp #2
Song & Dance Camp
Basketball Camp
Soccer Camp
Crafty Camp
Puppet Camp
Wildcat Week!
Pre K Camp #3
I hereby certify that all information on this application, and all information submitted as part of this application, is complete and accurate. The
applicant has my approval to participate in all regular club activities including off-site trips to area parks. His/her name or picture may appear in camp
or local news publications. If you have concerns about the use of pictures of your child, please inform Sacred Heart School. I realize it is my
responsibility to consult a physician to assess my child’s health relating to participation. I agree to hold harmless Sacred Heart School, Sacred Heart
School Board, OLMM Parish, SAU 21 or their employees, volunteers and agents for any/all injuries and damages incurred during said program.
_________________________________________________ ______________
Parent Signature
Date:
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SHS SUMMER CAMPS INFORMATION
LOCATION
•
Sacred Heart School, (Miraculous Medal Parish), 289 Lafayette Rd., Hampton, NH.
MORNING DROPOFF
•
Campers will report to the SHS Gym at 9:00am. Please park in front of SHS and escort your child to the gym. SHS
Summer Camps do not offer “rolling drop-off.”
•
SHS is responsible for campers only after they have been signed in! Campers must sign in with the Counselor in
charge of their camp group.
AFTERNOON PICK UP
•
Campers will be in the Courtyard in front of the Gym at pick-up. Please park in front of SHS and come to the
Courtyard to meet your child. SHS Summer Camps do not have a “rolling pick-up.”
•
Campers must sign out with the Counselor in charge of their age group and will be released only to their parents,
legal guardians, and those authorized by such on the Camp Registration form.
•
Campers will automatically report to Aftercare if not picked up by dismissal time.
WHAT TO BRING
•
Backpack, including supplies for an outdoor day.
•
Sneakers & socks must be worn for sports; flip flops/crocs may be worn for water play
•
Lunch, two snacks, plenty of cold drinks, and a refillable water bottle (no glass containers!)
•
No video games. Cell phones for emergency use only and with the permission of the Counselor.
•
Sunscreen, bug spray, rain jacket—we avoid thunderstorms, but may play in a sun shower!
•
Change of clothes, bathing suit and towel for water play. Please label all clothing and personal items that your
child will bring to the camp.
HEALTH MATTERS
•
Completed health forms must be received no later than two weeks prior to camp start date. Please provide a
copy of the front and back of your insurance card. There must be written orders from the doctor in order to
dispense over the counter and prescribed medications. Health and related forms can be downloaded at:
http://www.shshampton.org/admissions/forms/2013-2014%20Child%20Health%20Form.pdf
•
•
•
There will be a full-time Nurse on site during camp week.
Medication must be entrusted to the Nurse unless “Authorization Form” has been signed.
NH State Law requires that the camps have written permission from the Camper’s physician for a child to keep
his/her epi-pen or inhaler in their possession.
EMERGENCIES:
•
In case of emergency please call Sacred Heart School at 603-926-3254.
LOST & FOUND
•
Please put a name on clothing and belongings make every effort to inventory your child's belongings before
leaving camp each day. The Lost & Found Table will be in the Gym.
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SHS Summer Camps
Parental/Guardian Consent & Waiver/Release
Name _______________________________________ Birth Date __________
I, the undersigned, being a parent or legal guardian of_______________________ do hereby give my
consent and permission for the above name to be transported to and from Sacred Heart Camps and
to participate in all activities. In consideration of the benefits to be derived from this activity, I hereby
voluntarily for myself and anyone entitled to act on my behalf, waive, release, and forever discharge
any claim or claims against Sacred Heart School Summer Camps, the Roman Catholic Diocese of
Manchester, Sacred Heart Parish and its or their staff and leadership in both their official and personal
capacities, and any of its or their agents, assigns, representatives, successors, or anyone acting on its
or their behalf, for any and all claims, demands or liabilities of whatever nature including but not
limited to injury, death, or damage, whether in property or nature, which may arise in connection
with said activities or any phase or parts thereof. This waiver/release extends to all claims of every
kind or nature whatsoever, foreseen or unforeseen, known or unknown, and includes liability that
may arise out of negligence or carelessness on the part of persons named in this waiver/release. In
the event of an emergency involving my child, where medical treatment is required, in the event I
cannot be reached, I do hereby authorize and consent to any x-ray examination, anesthetic, medical,
or surgical treatment rendered by a licensed physician. I understand that in the event of any such
emergency, the Camp will attempt to notify me immediately based upon the contact information
provided above. This completed form may be photocopied for trips out of Camp. I hereby certify
that I have read this Consent, and Waiver/Release, fully understand it, and voluntarily execute the
same on this ____ day of ___________________, 20_____.
________________________________________________________________
Signature
Date
Parent/Guardian
I understand and agree to abide by any restrictions placed on my Camp activities, per the health
examination report.
___________________________________________________________________________________________
Signature of minor
Date
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Authorization for Child to Keep and Self-Administer Medication
At Sacred Heart School Summer Camps Per NH RSA 485-A:25-b & f.
_____________________________________ _______________________
Child's name
Date of the order
_____________________________________________________________
Medication name
_____________________________________________________________
Route and dosage of medication
_____________________________________________________________
Frequency and time of medication administration or assistance
_____________________________________________________________
Diagnosis & other medical conditions requiring medication—if not confidential
_____________________________________________________________
Specific recommendations for administration
_________________________________________________________________
Side effects, contraindications, and adverse reaction? Any severe adverse reactions that may occur should
another child receive a dose of the medication
As the licensed physician for the above named child, I hereby confirm that the child has the knowledge
and skills to safely possess and use the above stated medication at Camp:
_________________________________________________________________
Printed name & signature of licensed prescriber
_________________________________________________________________ Business and emergency
numbers
_____________________________________________________
Printed parent’s name & Signature
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Procedure For The Release Of Minors At SHS
Summer Camps
Sacred Heart School (SHS) will not release a camper to any person other than the camp member’s parent
or legal guardian without written permission from the parent or guardian. SHS presumes that each parent
or guardian may legally pick up their camp member unless the custodial parent notifies the camp and
sends a supporting court order. Parents may authorize other persons on the camp registration form.
When notified, SHS shall not permit a parent or guardian to pick up a child against whom there is a courtordered restraining order or comparable court ruling. The burden of notification is on the legal parent or
guardian.
Anyone other than the parents/guardians picking up a club member must have written permission from
the parent/guardian. Please list here who you authorize to transport your child.
1. ________________________________________________________
2. ________________________________________________________
3. ________________________________________________________
4. ________________________________________________________
SHS Summer Camps Code of Conduct
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1. I will respect my fellow Campers and their personal belongings by not picking on or making fun of others,
instigating verbal or physical fights, going into and/or stealing other Camper’s belongings.
2. I will respect the counselors and staff by listening to and following their instructions.
3. I will respect the Camps by not stealing or causing damage to Camp property.
4. I will respect myself and others by not using inappropriate language, nor will I bring to Camp any weapons,
drugs/alcohol (aerosol cans), tobacco or inappropriate/explicit material (images, music, etc.)
5. I will respect the privacy of all in Camp by not posting any pictures taken at Camp on the internet.
6. I will act according to the “The One Project” which is “A Plan to Prevent Bullying & Build a Culture of Love”
which will be taught at the camp.
I understand that if I am in violation of these rules, my parents may be notified and I may be sent home,
and the SHS Summer Camp reserves the right to search my personal belongings if there are safety concerns.
Child’s Name _________________________________________ Date ____________
Parent’s Signature _____________________________________ Date ____________
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