Post Office Box 7136
Myrtle Beach, SC 29572
(843) 449-0554
www.sos-healthcare.com
April 15, 2015
Hello All!
This letter is to inform you of SOS Health Care’s new summer camp format. This year, we will be splitting
the camp into two sections; Camp at 21st Ave. N. and Career Camp. Career Camp will be geared towards
transition aged campers as it will be focusing on instilling and strengthening life skills and career goals.
The camp will be geared towards skills needed for independent living and exploring different working
environments. Those enrolled in Career Camp will still be participating in weekly field trips with the
other camp as well.
Throughout the summer we will be going on community outings, touring facilities for possible future
employment, having special guest speakers, and providing a structured daily schedule for all the camp
attendees. Camp counselors will be trained to assist campers with any needs and provide support
throughout all of the activities.
Registration and Fees:
Camp slots will be available on a first come, first served basis, and there is a limited availability, so act
quickly! Applications, registration fees, and first week’s tuition are due by April 22, 2015. Camp will run
from June 8, 2015 – August 14, 2015. After-camp care will be available for an additional fee.
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Registration fee - $45.00 (non-refundable)
Tuition for camp - $70.00 per week*
Tuition for second child (sibling) - $50.00 per week*
After-camp care (3:30-5:30pm) - $25.00*
*It is required to pay for all 10 weeks of camp regardless if the attendee is absent for any reason.
Tuition may be paid on a weekly basis, but must be paid in full by August 7, 2015. ($700 for 1 child,
$1200 for 2 children, $950 for 1 child with after-camp care, $1700 for 2 children with after-camp care).
Tuition includes field trips, outings, guest speakers, and bus transportation.
Schedule:
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Camp will run from June 8, 2015 – August 14, 2015, Monday through Friday, 8:30 am to 3:30 pm. After
camp care will be from 3:30 – 5:30 pm. We will be closed Friday July 3rd and Monday July 6th. You will
be receiving a weekly schedule of our planned activities and outings. Career Camp will meet at our
consignment store, “Making Change Consignment” (1106 N. Kings Highway in Myrtle Beach).
Tentatively, we will be going on outings/field trips on Mondays, Wednesdays and Fridays. We will have
guest speakers from the community coming to the store to speak with us on Tuesdays and Thursdays.
Lunch and Snacks:
Please provide a labeled lunch, beverages, and snack (if desired) for your child. Please provide
information on any diet restrictions and allergies.
Attire: Please make sure your child has closed-toed shoes either packed or worn. Please pack a bathing
suit and towel daily as the kids will be attending field trips to the pool. Feel free to provide a change of
clothing if you feel necessary. Please label clothing so it does not get misplaced.
Medications:
Please label any medications your child might need throughout the day with dosage instructions. Please
provide, as needed, medications such as inhalers, Epi-pens, etc. We must have a copy of your child’s
dosages and times as well as a permission form for us to administer these medications with your
signature for our records.
Please “like” us on SOS Health Care’s Facebook page and make us one of your favorites in order to
receive the most up-to-date information on camp.
In the event of an emergency, or any questions or concerns, please don’t hesitate to contact me, Sarah
Pope, Executive Director, SOS Health Care at 843-449-0554.
Parent Signature: _______________________________________________ Date: _______________
Print Name: ___________________________________________
Please mail this completed application, registration fee, and first week’s tuition (including After Camp)
to:
SOS Health Care
PO Box 7136
Myrtle Beach, SC 29572
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Post Office Box 7136
Myrtle Beach, SC 29572
(843) 449-0554
www.sos-healthcare.com
CAREER CAMP REGISTRATION
Child’s Name:
Birth Date:
Age:
Address:
Parent/Guardian:
Home Phone:
Cell Phone:
E-Mail Address:
Emergency Contact Person:
Relationship to Child:
Home Phone:
Cell Phone:
Medical Information:
Medical Diagnosis:
Is there a current condition of medical history of:
A)
B)
C)
D)
E)
Seizures
Visual/Hearing Impairment
Allergies
Infections
Other
Medications:
Will your child/children need medications while attending program?
YES
NO
If you checked YES please complete the following section.
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Name of Medication 1:
Purpose:
Dosage and time given:
How given:
Side effects:
Prescribed by Dr. :
Phone:
Name of Medication 2:
Purpose:
Dosage and time given:
How given:
Side effects:
Prescribed by Dr. :
Phone:
Please attach additional pages if necessary.
I authorize administering the described prescription medications:
Parent/Caregiver Signature
Date
Print Name ________________________________________________
Diet:
Food allergies:
Specific diet:
Choking/swallowing risks:
Supervision: please place an ‘X’ by the level of supervision your child requires.
Level 1 (Will stay with group with minimal supervision)
Level 2 (Will stay with group with supervision in close proximity)
Level 3 (Will wander from group, must have one-to-one supervision)
Assistance: please place an ‘X’ on the line if your child requires assistance with the following
Toileting
Eating
Communication
Behavior: Please describe any behavior problems such as hitting, screaming, refusing to follow
directions, self-abuse, etc. and how you would like the Program Staff to respond to such behaviors:
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Post Office Box 7136
Myrtle Beach, SC 29572
(843) 449-0554
www.sos-healthcare.com
SUMMER AFTER CAMP PROGRAM
Overview: The after camp program will have the same curriculum and agenda as the after-school
program. There will be planned activities such as wellness/fitness groups, social group games and
activities, gardening, crafts, snacks, etc.
Program Hours: The after camp program will run as a continuation from camp, from 3:30-5:30. As far as
closure days, please see the camp welcome letter.
Registration and fees: The cost of the after camp program will be $25 per week and will be collected
according to the same tuition policy as camp.
Late Fees: If you are unable to get here by 5:30PM to pick up your child, there will be a late fee charge
of $5 for every 10 minutes you are late.
Please sign that you have read and understand the Summer After Camp/Late Fee Policy:
Parent/Caregiver Signature:
Date:
Print Name _______________________________________________
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Post Office Box 7136
Myrtle Beach, SC 29572
(843) 449-0554
www.sos-healthcare.com
TUITION POLICY
Tuition for Career Camp will be collected on the Friday before each week in the amount of $70.00 per
week. Example: Payment on June 12 is for camp tuition for the following week (June 13-17). Failure to
make a payment by this day means your child will not be allowed to attend the following week. The
same policy applies for After Camp program tuition.
Please make checks payable to SOS Health Care. We will also be accepting all major credit/debit cards
via the Square app, as well as cash.
Your first week’s payment ($70.00) and a non-refundable registration fee of $45.00 is due by April 22,
2015 along with your registration form and all other documents to reserve your child’s slot.
You are required to pay for all 10 weeks of camp regardless if your child is absent for any reason. Tuition
may be paid for on a weekly basis or in full at any time. The final payment must be paid by August 7,
2015.
Please sign and date below that you acknowledge and accept our payment policy.
Signature_______________________________ Date_______________________________
Print name _________________________________
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Post Office Box 7136
Myrtle Beach, SC 29572
(843) 449-0554
www.sos-healthcare.com
PERMISSION TO ADMINISTER MEDICATION
Child’s Name: _____________________________________________
Medication:_______________________________________________
Time of distribution: ________________________________________
Parent/Guardian’s Name (print):_______________________________
By signing below I authorize for the camp coordinators, (Eileen Law, Jessica Paternoster and Ashley
Brigham), or the Executive Director of SOS, Sarah Pope, to administer my child their medication. No
other person will have access to your child’s medication.
Parent/Guardian signature: ___________________________ Date:______________________
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Post Office Box 7136
Myrtle Beach, SC 29572
(843) 449-0554
www.sos-healthcare.com
MODEL RELEASE
I hereby give permission to SOS Health Care, Inc. to use my name and photographic likeness in all forms
of media for advertising, trade and any other lawful purposes. I am doing so without compensation of
any sort.
Camper’s Name:
Signature:
Date:
If model is under 18; I,
, am the parent/legal guardian of the individual
named above. I have read this release and agree to its terms.
Parent Signature:
Date:
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Post Office Box 7136
Myrtle Beach, SC 29572
(843) 449-0554
www.sos-healthcare.com
WAIVER OF LIABILITY/ HOLD HARMLESS AGREEMENT
FOR TRANSPORTATION BY A
SOS HEALTH CARE STAFF MEMBER
Transporting student to and from SOS HEALTH CARE related activities by automobile by
a SOS HEALTH CARE Staff member.
Please read this form carefully and be aware in signing this waiver for you or your minor
child/ward to be transported by automobile by a SOS Healthcare staff member and any
activities associated therewith you will be waiving your rights to all claims for injuries you
and/or your minor child/ward might sustain arising out of being transported by automobile by a
SOS HEALTH CARE staff member.
In consideration of me or my minor child/ward being allowed to be transported by automobile
by a SOS HEALTH CARE staff member, I recognize and acknowledge that there are certain
risks of physical injury associated with being transported by automobile by a SOS HEALTH
CARE staff member. I agree to assume the full risk of injuries that may be sustained by me or
any minor child/ward of mine, as a result of being transported by automobile by a SOS
HEALTH CARE staff member and all activities connected or associated therewith. I agree to
waive and relinquish all claims on behalf of me or my minor child/ward that the minor
child/ward may have against SOS HEALTH CARE as a result of the minor child/ward’s being
transported by automobile by a SOS HEALTH CARE staff member.
I do hereby fully release and discharge SOS HEALTH CARE and its officers, agents and
employees from any and all claims from injuries, damage or loss which I, or any minor
child/ward may have or which may occur to my minor child/ward on account of his/her being
transported by automobile by a SOS HEALTH CARE staff member. I further agree to
indemnify and hold harmless and defend SOS HEALTH CARE, its officers, agents and
employees from any and all claims sustained by me or my minor child/ward, and arising out
of, connected with, or in any way associated with being transported by automobile by a SOS
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HEALTH CARE staff member.
The invalidity or unenforceability of any of the provisions hereof shall not affect the validity
or enforceability of the remainder of this Agreement.
I have read and fully understand the above Waiver and Release of all claims.
Name(s) of Minor, if applicable
Printed Name of Student or Parent/Legal Guardian
Signature of Student Parent/Legal Guardian
Date
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