Camp HTSACC 2019 Registration Materials › cms › lib › NJ02202604...Week 1 June 26 - June 28 Steppin & Stompin (held on 1st day of camp) NO TRIP SWIMMING for all grades Camp Olympics

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Camp HTSACC 2019

Registration Materials

HTSACC Office: 973-637-1563

[email protected] OR [email protected]

This packet is good for registering 1-2 children; please make copies for additional

children, if needed.

Bring the entire completed packet with you to registration. No registration will be

accepted prior to the in-person registration dates. All registration is in-person!

Payments will be made in full or in 2 installments, with all fees collected by 6/15/19.

It is very important that you thoroughly read and understand the entire contents of

this packet BEFORE registering. HTSACC will strictly adhere to the policies within.

Please fill out paperwork carefully and in pen.

WAIVER FORMS are included in this packet. If your child will attend the trips that

require the waiver, please fill out and bring to registration (Week 3 & Week 8).

REGISTRATION DATES

Last Name A - F Wednesday, May 8, 2019 6:00 PM – 7:30 PM

G - L 7:30 PM – 9:00 PM

Last Name M – R Thursday, May 9, 2019 6:00 PM – 7:30 PM

S – Z 7:30 PM – 9:00 PM

***In-person registration will be held in the Media Center at MJS***

(enter through the board office door)

In-person registration is the ONLY guarantee to get all requested days!

Would you like more information about the camp program? ***Join us for the Camp HTSACC Information Session***

Date: Wednesday, April 10, 2019 Time: 7:00pm – 8:00pm Place: Memorial Junior School IMC (enter through Board Office door)

mailto:[email protected]

mailto:[email protected]

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Camp HTSACC General Information

Description: The Hanover Township School Age Child Care program operates Camp HTSACC for children who are residents of Hanover Township and entering grades K-8. Camp HTSACC balances scheduled activities and a relaxed environment that is fun, safe and enriching. Camp HTSACC offers enrollment options to accommodate the many childcare needs of the families in Hanover Township. As with our school year program, Camp HTSACC operates as a totally self-sustaining program under the auspices of the Board of Education. HTSACC uses the tuition paid by program participants to support all of our activities.

Operating Hours/Location: Camp HTSACC operates from the hours of 8:30-4:30 for the regular camp day, with Before Care (7:30am start) and/or After Care (until 6:00pm) add-ons. Camp will operate at Memorial Junior School and utilizes a number of classrooms and large group spaces throughout the building.

Camp Drop off/Pick Up: For Before or After Care, pull into the main entrance and park in the lot. You will walk to the cafeteria and ring the bell to be admitted, where you will sign your child in or out. For the regular camp day, campers will enter and leave through the main entrance (near the commons/auditorium). Valet drop off is available from 8:30-8:45 daily or you can park in the lot and walk your child into camp. When picking up, please park and walk to the main entrance door where you will be let in to sign your child/ren out of camp. Please note, doors will be locked and no one will gain entrance to pick up their child/ren between 4:00-4:15. Please come before 4:00pm or at 4:15pm when doors will be open.

Please note: Due to increased school security, doors will be locked at all times during the camp day and you will be required to knock on the door to be admitted. Please have photo ID ready, as it may be requested. Please notify all people on your pick-up list that they must have ID as well. If someone who isn’t on your original list will be picking up your child – even if the person is a parent in our camp program – we must receive written approval from you PRIOR to their arrival. If a person isn’t on your authorized list and we have not received written permission, they will be denied access to the child until we can contact a parent or guardian.

Staff: Camp HTSACC staff consists of certified teachers, college students and high school students. The staff is trained in First Aid, CPR and various elements of childcare and development.

Groups: Children are separated into Juniors (entering K-3) and Seniors (entering 4-8) to provide age appropriate programming. They are further separated into grade level groups for daily activities and trips. Each grade group has a Leader and additional staff based on the number of children enrolled.

Field Trips: All children that are registered on trip days must attend the planned field trips. We do not leave anyone at camp. If a scheduled trip is not desired, please do not register for that day. Specific information about trips will be provided in weekly newsletters. Please arrive on time, as we will not hold busses for children who are late. Most trips are a full day, so please do not expect us to return prior to 4:30 PM. On longer distance trips, please understand if we arrive home later, due to traffic.

Swimming: All grade levels will swim on Wednesdays. Only Junior campers (K-3 graders) will swim on Thursdays. Children must be at camp by 9:00AM and ride the bus over to the Bee Meadow Pool. We do not hold busses waiting for children who arrive late. If you miss the bus, you must wait until we return to camp at noon to drop off your child/ren.

Activities: Activities are led by staff and include, but are not limited to, cooking, arts and crafts, sports and games, science experiments, and story time, and will have connection to weekly themes. Large camp events will occur on Friday mornings and Monday Funday events will take place on Monday afternoons.

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Lunch/Snacks: All children are required to bring a non-perishable lunch. Microwaves are available at camp, if needed. If you wish to purchase hot lunch, please do so through the Simply Gourmet website. On trip days, campers must bring a brown bagged lunch. A snack will be provided mid-afternoon. Extended School Year: If your child attends the Extended School Year program, they will be transported to and from camp, depending on their session times. On pool days, if their schedule allows, they will be dropped off at the pool by the shuttle and met by a staff member. ***Please note – you must choose to attend ESY or the Tuesday/Thursday field trips. If you will not be attending ESY, you must notify them.

Sample Weekly Schedule

MONDAY TUESDAY WEDNESDAY THURSDAY* FRIDAY

7:30-8:30 Before Care

8:30-9:00 Camp drop off – valet drop off through 8:45 am

9:00-10:00 Activity 1

FIELD TRIP

Swimming at Bee Meadow Pool

(all grades)

Swimming at Bee Meadow Pool

(Juniors ONLY)

Activity 1

10:00-11:00 Activity 2 FRIDAY SPECIAL EVENT 11:00-11:45 Activity 3

11:45-1:00 Lunch/Recess Lunch/Recess Lunch/Recess Lunch/Recess

1:00-2:00 Activity 4 Activity 1 Activity 1 Activity 2

2:00-3:00 Snack & Monday Funday

Snack/Recess Snack/Recess Snack and all camp movie 3:00-4:00 Activity 2 Activity 2

4:00-4:30 Camp pick up in the commons

4:30-6:00 After Care

*Trip Day for Seniors

Weekly Trips & Events

Monday Funday Tuesday Trip Thursday Trip 4-8 only

Friday Event

Week 1 June 26 - June 28

Steppin & Stompin (held on 1st day of camp)

NO TRIP SWIMMING for all

grades Camp Olympics

Week 2 July 1 - July 5

Ocean Dig (K-3) Majority Rules (4-8)

Camel Beach Waterpark

Camp Closed Camp Closed

Week 3 July 8 – July 12

Acro Action Bounce U (K-3)*

Coastal Sports (4-8)* Dutch Springs Waterpark**

Water Fun


Strong Man Show iPlay America Splashplex/Funplex Minute to Win It


Petting Zoo Sussex Miners Kids Rule Parties** HTSACC’s Got

Talent

Week 6 July 29 – August 2

FAMILY PICNIC Bowling (am) Movies (pm)

Jenkinson’s Aquarium & Bdwlk

Camp Carnival

Week 7 Aug 5 – Aug 9

Brainwash Game Show

Tomahawk Lake High Exposure** Color Games

Week 8 Aug 12 – Aug 16

Human Jungle Gym Show

Launch Trampoline Park*

Medieval Times Game Day

* paper waiver required **online waiver required

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Camp HTSACC Registration Information/Enrollment Guidelines/Fees

Registration: All registration is done in-person at Memorial Junior School. No registration will be accepted prior to the registration dates.

Registration Fee: All enrollees of Camp HTSACC must pay a non-refundable fee of $25 per family that is required when you register. If you register after in-person registration, you will be required to pay a $50 late registration fee.

Camp Payments: Payment in full, less the 5% discount, OR 50% of your TOTAL summer fees plus registration fee are due when registering. The second payment of 50% is due on or before June 15, 2019. If payment is not received, your child will be unable to start camp until all accounts are current. If you are facing financial hardship and wish to discuss a payment plan, please call the office for more information. All payments should be mailed or brought to the HTSACC office. At no time should payments be given to program staff.

Camp T-shirts: All registered children will receive one free camp HTSACC t-shirt. Additional shirts can be purchased at a cost of $10.00 each. Camp shirts must be worn on all field trips.

Schedule Changes: Two schedule changes will be allowed, per family, at a charge of $20 per change. No changes will be accepted after June 7, 2019. Changes to your child’s schedule after registration can only be accommodated if space is available. Changes must be made IN WRITING and received by noon on June 7. There are no refunds, credits, or make up days due to absences.

# of children

5 Days 4 Days 3 Days 2 days

Full Day Camp

1 $240 $196 $153 $104

2 $468 $382 $298 $203

Before Care & Camp

1 $275 $224 $174 $118

2 $538 $438 $340 $231

Camp & After Care

1 $290 $236 $183 $124

2 $568 $462 $358 $243

Before Care, Camp & After Care

1 $325 $264 $204 $138

2 $638 $518 $400 $271

Payment Reminder Payments not received when due will result in camp privileges

being suspended

Additional Camp Fees

Registration Fee: $25 per family

Late Registration Fee: $50 per family, if registering after May 9th.

Schedule Changes: $20 per change. No changes after 6/7/19. Limit 2 changes per family.

Camp HTSACC T-shirt: 1 t-shirt per child is included, $10 per extra shirt

Late Pick-Up Fee: $15.00 per 15 minute increment or part thereof – per child. More than 4 offenses may result in termination of program services.

Drop-in Hours: If an emergency comes up and you need Before or After care, you must contact the camp Welcome Center on the day before care is needed for Before Care or NOON on the day After Care is needed. The fee is $10 per child for before care and $20 per child for after care.

IMPORTANT REMINDER:

If your child/ren attended HTSACC in the 2018-2019 school year,

your account must be paid in full by May 31, 2019 (the final day for

June payments) or your registration will be returned. Registration will

not be processed until your account is current! Please call the office at

973-515-2449 for a current account statement.

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Child’s Name: _____________________________________________ Grade entering in Fall 2019: _______ School Attending Last First

Registration Guidelines T-Shirt Size – Circle One Minimum Enrollment of 2 days per week. Only 2 changes will be accepted until 6/7/19 at a charge of $20.00

per change. There will be NO changes accepted after 6/7/19. One Enrollment Form PER Child. Duplicate as necessary. Enrolling after May 9 (in-person registration) will incur a $50

late registration fee!

Youth XS

Youth S

Youth M

Youth L

Youth XL

Adult S

Adult M

Adult L

Adult XL

Week #1

CHOOSE DAYS-

Minimum of 2 Wed. 6/26 Thu. 6/27 Fri. 6/28

PLUS

Before Care After Care Fee $ ______

Week #2

CHOOSE DAYS-

Minimum of 2 Mon. 7/1 Tues. 7/2 Wed. 7/3 CLOSED 7/4 CLOSED 7/5

PLUS


Week #3

CHOOSE DAYS-

Minimum of 2 Mon. 7/8 Tues. 7/9* Wed. 7/10 Thu. 7/11** Fri. 7/12

PLUS


Week #4 CHOOSE DAYS-

Minimum of 2 Mon. 7/15 Tues. 7/16 Wed. 7/17 Thu. 7/18 Fri. 7/19

PLUS Before Care After Care Fee $ ______

Week #5 CHOOSE DAYS

Minimum of 2 Mon. 7/22 Tues. 7/23 Wed. 7/24 Thu. 7/25** Fri. 7/26


Week #6

CHOOSE DAYS Minimum of 2

Mon. 7/29 Tues. 7/30 Wed. 7/31 Thu. 8/1 Fri. 8/2


Week #7


Mon. 8/5 Tues. 8/6 Wed. 8/7 Thu. 8/8** Fri. 8/9


Week#8 CHOOSE DAYS

Minimum of 2 Mon. 8/12 Tues. 8/13* Wed. 8/14 Thu. 8/15 Fri. 8/16


# of children

5 Days

4 Days

3 Days

2 Days

Full Day Camp

1 $240 $196 $153 $104

2 $468 $382 $298 $203

Before Care & Camp 1 $275 $224 $174 $118

2 $538 $438 $340 $231

Camp & After Care

1 $290 $236 $183 $124

2 $568 $462 $358 $243


1 $325 $264 $204 $138

2 $638 $518 $400 $271

Tuesday Field Trips ALL GRADES

Week 1 NO TRIP Week 2 Camelbeach Waterpark Week 3 Bounce U (K-3)* Costal Sports (4-8)* Week 4 iPlay America Week 5 Sussex Miners Baseball Game Week 6 Hanover Lanes Bowling (am) East Hanover Movies (pm) Week 7 Tomahawk Lake Week 8 Launch Trampoline Park*

Thursday Field Trips SENIORS (entering 4th-8th) ONLY

Week 1 SWIMMING FOR ALL GRADES

Week 2 4th of JULY

Week 3 Dutch Springs Waterpark**

Week 4 Splashplex/Funplex

Week 5 Kids Rule Parties**

Week 6 Jenkinson’s Aquarium and

Boardwalk

Week 7 High Exposure**

Week 8 Medieval Times

Payments Due: To be filled out by HTSACC Billing Department

Paid in Full $ Check # 50% at registration $ Balance due 6/15/19 $

CAMP HTSACC 2019 ENROLLMENT FORM

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Camp HTSACC 2019 Enrollment Agreement

Child’s Name: _____________________________________________ School: _________________________ Grade in Sept. ‘19:___________

The Camp HTSACC 2019 Enrollment Agreement must be signed by the parent or guardian to validate your child’s enrollment in the program. By your signature below, you understand and agree to abide by the information included in the Program Description, Enrollment Form and the Enrollment Agreement that includes the following:

1. You are enrolling your child, named above, in the Hanover Township School Age Child Care summer camp program located at Memorial Junior School for the days you have selected on the registration form.

2. Enrollment is required to be a MINIMUM of two days per week. 3. You must submit the NON-REFUNDABLE $25 Summer Enrollment Fee along with the registration materials to validate enrollment. 4. You must keep your Family/Health information up to date and completed for safety/emergency purposes. 5. You are responsible for fees according to the enrollment on the reverse side. 6. Payments must be made according to the schedule on the registration paperwork. 7. You are entitled to change your child’s schedule two times until June 7, 2019. You will be charged a $20 schedule change fee for each

change made to your child’s schedule. If the changes you make result in a change in your payment, we will notify you by mail. Changes resulting in a refund to fees paid at registration will be issued as a credit to a future HTSACC programs.

8. Changes to your child’s schedule can only be accommodated if space is available. 9. There are no refunds, credits or make up days due to absences for any reason. 10. An authorized adult that is listed on the Family/Child Information form must sign your child out of the program each day. 11. The HTSACC program staff will assume full responsibility for your child from the time they are checked in, until the time they are signed out. 12. Transportation to and from Camp HTSACC is your responsibility. No bus transportation will be provided. 13. You give permission for your child to attend the field trip locations that you have registered for on the enrollment form. 14. You give permission for your child to ride on the provided school bus to the Bee Meadow Pool in Whippany, NJ and to field trip venues as

enrolled. 15. Your child must be picked up by the end time of the program(s) in which they are enrolled. 16. You will be fined $15 for each 15 minute increment or part thereof – per child - for pick-up any time later than enrolled. The fourth occurrence

will result in enrollment termination. 17. Your child should not be dropped off before the start time of the program(s) enrolled. If you child is dropped off early they will be brought to

the Before Care program and you will be billed for an unscheduled attendance. Before Care cannot open before 7:30 AM. 18. HTSACC reserves the right to amend the program’s daily schedule without notice due to weather or any other reason deemed necessary. 19. I hereby grant permission to the HTSACC program to use the name or likeness of my child, named above, while they are attending Camp

HTSACC in all out-of-school media types including: news releases, photographs, audiotapes, videotapes, internet transmissions, and any publication or news release that may be used by or for the HTSACC program while my child is attending camp. YES______ NO________

Signature : ___________________________________________________________ Date: ________________

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Child’s Name: _____________________________________________ Grade entering in Fall 2019: _______ School Attending Last First

Registration Guidelines T-Shirt Size – Circle One Minimum Enrollment of 2 days per week. Only 2 changes will be accepted until 6/7/19 at a charge of $20.00

per change. There will be NO changes accepted after 6/7/19. One Enrollment Form PER Child. Duplicate as necessary. Enrolling after May 9 (in-person registration) will incur a $50

late registration fee!

Youth XS

Youth S

Youth M

Youth L

Youth XL

Adult S

Adult M

Adult L

Adult XL

Week #1

CHOOSE DAYS-

Minimum of 2 Wed. 6/26 Thu. 6/27 Fri. 6/28

PLUS


Week #2

CHOOSE DAYS-

Minimum of 2 Mon. 7/1 Tues. 7/2 Wed. 7/3 CLOSED 7/4 CLOSED 7/5

PLUS


Week #3

CHOOSE DAYS-

Minimum of 2 Mon. 7/8 Tues. 7/9* Wed. 7/10 Thu. 7/11** Fri. 7/12

PLUS


Week #4 CHOOSE DAYS-

Minimum of 2 Mon. 7/15 Tues. 7/16 Wed. 7/17 Thu. 7/18 Fri. 7/19


Week #5 CHOOSE DAYS

Minimum of 2 Mon. 7/22 Tues. 7/23 Wed. 7/24 Thu. 7/25** Fri. 7/26


Week #6


Mon. 7/29 Tues. 7/30 Wed. 7/31 Thu. 8/1 Fri. 8/2


Week #7


Mon. 8/5 Tues. 8/6 Wed. 8/7 Thu. 8/8** Fri. 8/9


Week#8 CHOOSE DAYS

Minimum of 2 Mon. 8/12 Tues. 8/13* Wed. 8/14 Thu. 8/15 Fri. 8/16


# of children

5 Days

4 Days

3 Days

2 Days

Full Day Camp

1 $240 $196 $153 $104

2 $468 $382 $298 $203

Before Care & Camp 1 $275 $224 $174 $118

2 $538 $438 $340 $231

Camp & After Care

1 $290 $236 $183 $124

2 $568 $462 $358 $243


1 $325 $264 $204 $138

2 $638 $518 $400 $271

CAMP HTSACC 2019 ENROLLMENT FORM

Tuesday Field Trips ALL GRADES

Week 1 NO TRIP Week 2 Camelbeach Waterpark Week 3 Bounce U (K-3)* Costal Sports (4-8)* Week 4 iPlay America Week 5 Sussex Miners Baseball Game Week 6 Hanover Lanes Bowling (am) East Hanover Movies (pm) Week 7 Tomahawk Lake Week 8 Launch Trampoline Park*

Thursday Field Trips SENIORS (entering 4th-8th) ONLY

Week 1 SWIMMING FOR ALL GRADES

Week 2 4th of JULY

Week 3 Dutch Springs Waterpark**

Week 4 Splashplex/Funplex

Week 5 Kids Rule Parties**

Week 6 Jenkinson’s Aquarium and

Boardwalk

Week 7 High Exposure**

Week 8 Medieval Times

Payments Due: To be filled out by HTSACC Billing Department

Paid in Full $ Check # 50% at registration $ Balance due 6/15/19 $

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Camp HTSACC 2019 Enrollment Agreement

Child’s Name: _____________________________________________ School: _________________________ Grade in Sept. ‘19:___________

The Camp HTSACC 2019 Enrollment Agreement must be signed by the parent or guardian to validate your child’s enrollment in the program. By your signature below, you understand and agree to abide by the information included in the Program Description, Enrollment Form and the Enrollment Agreement that includes the following:

1. You are enrolling your child, named above, in the Hanover Township School Age Child Care summer camp program located at Memorial Junior School for the days you have selected on the registration form.

2. Enrollment is required to be a MINIMUM of two days per week. 3. You must submit the NON-REFUNDABLE $25 Summer Enrollment Fee along with the registration materials to validate enrollment. 4. You must keep your Family/Health information up to date and completed for safety/emergency purposes. 5. You are responsible for fees according to the enrollment on the reverse side. 6. Payments must be made according to the schedule on the registration paperwork. 7. You are entitled to change your child’s schedule two times until June 7, 2019. You will be charged a $20 schedule change fee for each

change made to your child’s schedule. If the changes you make result in a change in your payment, we will notify you by mail. Changes resulting in a refund to fees paid at registration will be issued as a credit to a future HTSACC programs.

8. Changes to your child’s schedule can only be accommodated if space is available. 9. There are no refunds, credits or make up days due to absences for any reason. 10. An authorized adult that is listed on the Family/Child Information form must sign your child out of the program each day. 11. The HTSACC program staff will assume full responsibility for your child from the time they are checked in, until the time they are signed out. 12. Transportation to and from Camp HTSACC is your responsibility. No bus transportation will be provided. 13. You give permission for your child to attend the field trip locations that you have registered for on the enrollment form. 14. You give permission for your child to ride on the provided school bus to the Bee Meadow Pool in Whippany, NJ and to field trip venues as

enrolled. 15. Your child must be picked up by the end time of the program(s) in which they are enrolled. 16. You will be fined $15 for each 15 minute increment or part thereof – per child - for pick-up any time later than enrolled. The fourth occurrence

will result in enrollment termination. 17. Your child should not be dropped off before the start time of the program(s) enrolled. If you child is dropped off early they will be brought to

the Before Care program and you will be billed for an unscheduled attendance. Before Care cannot open before 7:30 AM. 18. HTSACC reserves the right to amend the program’s daily schedule without notice due to weather or any other reason deemed necessary. 19. I hereby grant permission to the HTSACC program to use the name or likeness of my child, named above, while they are attending Camp

HTSACC in all out-of-school media types including: news releases, photographs, audiotapes, videotapes, internet transmissions, and any publication or news release that may be used by or for the HTSACC program while my child is attending camp. YES______ NO________

Signature : ___________________________________________________________ Date: _______________

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Camp HTSACC 2019 Family/Child Information Form

(one form per family)

Child 1 Name: _________________________ School: ______________Grade in Sept. ‘19: ______



FAMILY INFORMATION PRIMARY CONTACT:

Relationship to child/ren:

Address:

Preferred Phone:

Additional Phone:

Employer:

Email:

SECONDARY CONTACT:

Relationship to child/ren:

Address:

Preferred Phone:

Additional Phone:

Employer:

Email:

***Do both people listed have custody of the child(ren) named above? YES____ NO____ If no, you must provide court order information regarding custodial rights of both parties.

Emergency Contacts (At least 2, other than the primary and secondary contacts):

Person’s Name Relationship Telephone Numbers 1. 2. 3. Individuals Authorized for Pick-up: (Besides primary/secondary contact) ID will be checked daily, so please make sure you and other individuals have PICTURE ID at pick-up. Parents, emergency contacts, and authorized persons listed below will be the only individuals permitted to pick up your child from camp. If an individual’s name is not on the list below, they will not be allowed to pick up your child(ren). Any additions or deletions must be made in writing.

Person’s Name Relationship Telephone Numbers 1.

2.

3.

4.

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Hanover Township Public Schools

Hanover Township School Age Child Care

Camp HTSACC

61 Highland Avenue Whippany, New Jersey 07981 973-515-2449 FAX 973-637-5516

Child Behavior Policy

The child behavior policy is in place to assure that there are uniform guidelines for behavior management within

all HTSACC programs. It is expected that all families enrolled understand the policy that HTSACC follows

when dealing with matters regarding inappropriate behavior. It is the goal of the HTSACC staff to set appropriate

limits for the children to succeed within. Staff will give acknowledgement to children when they cooperate, share

and participate. The staff will also encourage children to resolve their own conflicts using conflict resolution

methods and will intercede when needed.

When inappropriate behavior occurs and/or persists, HTSACC staff will help a child modify this behavior by

talking with the child to help them understand why the behavior is not acceptable. They will also discuss the

consequences of that behavior, as well as alternatives to use in the future. It is required that HTSACC staff

document any inappropriate behavior that results in physical or verbal harm to a child’s peers, staff or themselves.

Parents/guardians will be notified of the inappropriate behavior.

The family of the child may be contacted by the Program Coordinator and/or Camp Supervisor. The desired

outcome from the conversation is to produce positive behavior guidelines for the child, with the staff and families

in agreement. The behavior guidelines should then be met and improvements seen within a pre-determined

period of time. After this period, the decision will be made for the continuation or discontinuation of the child’s

enrollment in the HTSACC program. If enrollment is cancelled, the Program Coordinator will decide the length

of time that suspension is necessary. There will be no refund of fees paid if a child is suspended from a program.

The Program Coordinator has the discretion to temporarily or permanently remove a child from the program if

behavior problems persist or if immediate action is necessary. It is the discretion of the Camp Supervisor if a

child’s behavior requires that a family member pick up a child earlier than time of program closing. If you are

called to pick your child up early due to a behavioral issue, we expect you or one of your authorized adults to pick

up within 15 minutes of the call.

Enrollment in all HTSACC programs requires agreement to the behavior policy.

I have read and I understand the HTSACC Child Behavior Policy and by my signature accept the policy as stated.

Child 1 Name: Grade in Sept. ‘19: _____



Parent Signature: Date

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Camp HTSACC 2019 Health Information Form

Child’s Name: Age: DOB: Gender:

Grade Entering in Sept. 2019 Height: Weight: Eye Color:

Home Address:

Primary Contact in Emergency: Phone #:

Health Guidelines/Procedures: HTSACC staff is trained in First Aid and CPR and will administer first aid for minor injuries. Parents will be notified of injuries that require extensive first aid or additional observation by a physician There is no nurse on duty at any time during the program. HTSACC staff does not administer any form of medication at any time (with exception of EpiPens – see policy*). In the case of a major medical emergency, 911 will be called. You will be contacted immediately afterward. HTSACC operates under the guidelines of the Hanover Township Public Schools Communicable diseases policy, all

of which policy applies to Camp HTSACC. I hereby give permission for the child named above to be transported by emergency vehicle to the hospital

emergency room and given whatever medical treatment is necessary. I understand that an HTSACC staff member

will accompany them. YES____ NO____

ALLERGIES - CHRONIC ILLNESSES - DIETARY RESTRICTIONS - OTHER HEALTH ISSUES

Be specific - describe reaction and/or management

MEDICATIONS/TREATMENTS

(for any allergy, condition, or health issue)

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Does your child have a Health Care Plan on file with the school Nurse? (for allergies, medications, asthma)

Yes _____ No _____

If yes, do we have permission to view the plan?

Yes_____ No _____ ________________ Parent/Guardian Initials

Does your child have an inhaler for asthma?

Yes _____ No _____

If YES, I understand that I must provide a Self-Administer Order signed by the doctor with these forms in order for my child to use the inhaler.

_______________ Parent/Guardian Initials

Is an EpiPen required for any of the allergies listed?

Yes ***If YES, please read and sign the statement below

No If my child has an allergy requiring the use of an EpiPen and has an Individual Health Care Plan on file for such with the school nurse during the school year, I give my permission for a designated member of the Camp HTSACC staff to administer the EpiPen to my child if it is deemed necessary. I understand that this employee is not a trained health care professional, but a designee and has been trained to administer the EpiPen. I also understand that I will be responsible for providing the Camp HTSACC program with an EpiPen, in its original box with the original prescription, prior to the first day of camp. The pen will be labeled for my child and will be kept in a secure location at Camp HTSACC. If my child’s allergy requires the need for an EpiPen, and I do not agree to these terms, my child will not be permitted to participate in the Camp HTSACC program. Parent/Guardian Signature ____________________________________________________

Primary Care Physician: Phone: (_____)

Insurance Provider:

Policy # Group #

Signature : Date:

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Camp HTSACC 2019 Health Information Form

Child’s Name: Age: DOB: Gender:

Grade Entering in Sept. 2019 Height: Weight: Eye Color:

Home Address:

Primary Contact in Emergency: Phone #:

Health Guidelines/Procedures: HTSACC staff is trained in First Aid and CPR and will administer first aid for minor injuries. Parents will be notified of injuries that require extensive first aid or additional observation by a physician There is no nurse on duty at any time during the program. HTSACC staff does not administer any form of medication at any time (with exception of EpiPens – see policy*). In the case of a major medical emergency, 911 will be called. You will be contacted immediately afterward. HTSACC operates under the guidelines of the Hanover Township Public Schools Communicable diseases policy, all

of which policy applies to Camp HTSACC. I hereby give permission for the child named above to be transported by emergency vehicle to the hospital

emergency room and given whatever medical treatment is necessary. I understand that an HTSACC staff member

will accompany them. YES____ NO____

ALLERGIES - CHRONIC ILLNESSES - DIETARY RESTRICTIONS - OTHER HEALTH ISSUES

Be specific - describe reaction and/or management

MEDICATIONS/TREATMENTS

(for any allergy, condition, or health issue)

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Does your child have a Health Care Plan on file with the school Nurse? (for allergies, medications, asthma)

Yes _____ No _____

If yes, do we have permission to view the plan?

Yes_____ No _____ ________________ Parent/Guardian Initials

Does your child have an inhaler for asthma?

Yes _____ No _____

If YES, I understand that I must provide a Self-Administer Order signed by the doctor with these forms in order for my child to use the inhaler.

_______________ Parent/Guardian Initials

Is an EpiPen required for any of the allergies listed?

Yes ***If YES, please read and sign the statement below

No If my child has an allergy requiring the use of an EpiPen and has an Individual Health Care Plan on file for such with the school nurse during the school year, I give my permission for a designated member of the Camp HTSACC staff to administer the EpiPen to my child if it is deemed necessary. I understand that this employee is not a trained health care professional, but a designee and has been trained to administer the EpiPen. I also understand that I will be responsible for providing the Camp HTSACC program with an EpiPen, in its original box with the original prescription, prior to the first day of camp. The pen will be labeled for my child and will be kept in a secure location at Camp HTSACC. If my child’s allergy requires the need for an EpiPen, and I do not agree to these terms, my child will not be permitted to participate in the Camp HTSACC program. Parent/Guardian Signature ____________________________________________________

Primary Care Physician: Phone: (_____)

Insurance Provider:

Policy # Group #

Signature : Date:

15

16

17

Documents

Camp HTSACC 2019 Registration Materials › cms › lib › NJ02202604...Week 1 June 26 - June 28 Steppin & Stompin (held on 1st day of camp) NO TRIP SWIMMING for all grades Camp Olympics