Beat the Streets – Baltimore/Morgan State University Center for Excellence in Science and Math Education

Summer Day Camp Program 2013

May 18, 2013 Dear Summer Day Camp Program Applicant: Thank you for considering Beat the Streets – Baltimore/Morgan State University Center for Excellence for

Mathematics and Science Education (CEMSE) for your day camp needs this summer. It is our desire to provide you

with a high quality program for your developing youth. Our camp is for children ages 10-18, and runs for twelve (12)

days from June 23rd through July 3rd, 2013.

The Beat the Streets-Baltimore STEM Wrestling camp is a rigorous hybrid summer camp program that will combine

amateur wrestling with Science, Technology, Engineering and Mathematics (STEM) at Morgan State University. The

residential program will focus on the holistic development of youth while providing a mentally and physically

enriching summer program for 60 students from Baltimore City Public schools. The participants will be exposed to

the atmosphere of a collegiate campus, upper level wrestling instruction and higher learning through our partnership

with the Morgan State University’s Center of Excellence in Mathematics and Science Education (CEMSE).

Student-athletes will have segmented wrestling instruction from highly skilled wrestling coaches/instructors. The

wrestling portion will feature focused technical instruction, high pace drilling, proper nutrition guidance, strength and

conditioning coaching, mental preparation and character development classes. The coaches include various Olympians,

NCAA and State place-winners; headlined by 2012 Olympic gold medalist Jordan Burroughs. Students will develop

their content knowledge in STEM through tutoring, mentoring and various STEM-related research activities. These

activities will be followed-up and linked to the 2014 Morgan State University Annual Mathematics-Science-

Engineering Fair and participation in the Beat the Streets Wrestling program.

Through our partnership with Morgan State University, we are planning a very exciting and enriching summer for

your youth. Our summer program will include activities such amateur wrestling, scientific research, math

development, nutrition education, organized recreation and other exciting activities.

We look forward to serving you this summer. If you have any questions, please contact us at 443.765.6748.

Sincerely, Lydell Henry

Lydell Henry

Camp Director

Morgan State University

1700 E. Coldspring Lane – Baltimore, MD – 443-765-6748 2013 BTS/CEMSE SUMMER CAMP PROGRAM Application AN ENTIRE APPLICATION MUST BE COMPLETED FOR EACH CHILD.

Please DO NOT put information for more than one student on a form.

Child’s Name Age: Birth date

Current Grade Current School Age as of June 10, 2013

Male: _____ Female: _____

T-Shirt/Short Size:

Child or Adult S M L XL Circle one Circle one

Parent/Guardian Name

Address Zip Code

Home Phone Cell Phone Work Phone

E-mail Address

Second Parent/Guardian Name(if applicable)

Address Zip Code

Home Phone Cell Phone Work Phone

E-mail Address

1. Emergency Contact Relationship to Child

Home Phone Cell Phone Work Phone

2. Emergency Contact Relationship to Child

Home Phone Cell Phone Work Phone

3. Emergency Contact Relationship to Child

Home Phone Cell Phone Work Phone

Does your child have any of the following? Allergies: ____No _____Yes:___________________________________________________

Check one if Yes, please list any known allergies (to foods or medications or

substances)

Medications/Special Conditions: _____No _____Yes:_________________________________________________

Check one if Yes, please list any medications, or special conditions

Special disabilities/ Other

concerns: _____No _____Yes:_________________________________________________

Check one if Yes, please list any medications, or special conditions

Person(s) to whom my child may be released (other than parents) ID is necessary: 1.) \

2.) 3.) I understand that all forms must be fully completed and legible before my child may attend. I will also notify Beat the Streets –

Baltimore/Morgan State University CEMSE of any changes in the application form (i.e. phone numbers, medical information,

emergency contact information, etc.). I certify that all of the information contained in the application is true and correct to the best of my knowledge

Parent/Guardian Signature Date Relationship to Child_________________________________________________________________________________________________

Beat the Streets – Baltimore/ CEMSE STEM Wrestling Camp

Program Eligibility Requirements

The BTS/CEMSE STEM Wrestling Camp is designed for rising 6th

through rising12th

student-athletes, ages 10-

18. Eligibility requirements for the program are for students to attend Baltimore City Public Schools, receive free

lunch in their respective schools, and to submit STEM research projects in 2014 Morgan State University Science

Fair.

Enrollment Information: The cost of the Summer Camp Program is free for students that attend Baltimore City

Public Schools and receive free lunch. Enrollment is limited to 60 children and a lottery system may be used as a

part of the application process.

Application Completion and Submission: A completed application must be submitted for each child. Please do

not put information for more than one student on a form. Completed applications should be submitted to your

principal NO LATER than Friday, June 7, 2013 or submitted online at www.btsbaltimore.org.

Email: info@btsbaltimore.org

Hours of Operation: The program is a residential camp, and participants will remain on campus under supervision

for the duration of the camp; Sunday, June 23 through Monday, July 3, 2013.

Room and Board:

Students will reside in campus dormitories. They will dine on campus at the University’s refectory. Breakfast,

lunch and dinner will be provided.

Orientation: All parents/guardians are strongly encouraged to attend the Summer Day Camp Program Orientation which is scheduled to be held on Thursday, June 20, 2013 at 5:00 PM at Morgan State University,

Banneker Room 101. If you are unable to attend, please contact us. Camp Necessities Children should come to camp be appropriately dressed. The following are not permitted: T-shirts with improper

language or pictures or revealing clothing, etc. Please see the Camp Necessities attachment. Conduct Policy Please read and sign that you understand the Beat the Streets/Morgan State CEMSE Discipline and Behavior

policy attachment.

Check In

Check in/Registration hours are from 10:00 am – 11:00 pm. Failure to adhere to registration times may result in

the program being delayed or registration closure.

Pool Days Children will go swimming during the summer camp at Morgan State University Aquatic Center. Participants

are required to have appropriate bathing suit, a towel and shower shoes/ flipflops. Please label all apparel with

your child’s name. Field Trips Students may take a field trip during the course of the progam. Information can be found in the program. Program.

Health Parents will be notified immediately if their children become ill at Summer Camp and will need to arrange to

have their children picked up within one (1) hour of notification. No medications, with the exception of inhalers

(must be in original box, with prescription on it), are dispensed during camp by our staff. Parents must make

arrangements to administer any necessary medications to their children.

Personal Belongings Policy BTS/Morgan State University is not responsible for lost, stolen or damaged property. DO NOT allow your child

to bring equipment to Summer Camp. To prevent any disruption, cell phones, handheld games, mp3 players,

IPods, etc are not allowed while camp is in session.

Discipline Policy

All participants are expected to maintain proper behavior during the camp sessions. If a child displays inappropriate, disruptive or disrespectful

behavior toward teachers and other children, we will first approach the problem through positive discipline. If this does not work we will

contact the parents. If the disruptive behavior continues the child will be dismissed from the program.

Curfew Violation

Students are to be in bed and remain in their rooms with lights off during “Lights Out”. 11pm -7am

Violation of curfew will result in the following consequences:

First violation – A meeting with the Director, a phone call to parents/guardians. The nature of the first violation may result in

dismissal from the program.

Second violation – A meeting with the Director, a phone call to parents/guardians and dismissal from the program

Tardiness Violations

1. Tardiness (5 minute late) will result in the following consequences:

First violation – Documented positive reinforcement

Second violation – Documented positive reinforcement.

Third violation – Meeting with the Director, and a phone call to parents/guardians.

Unexcused Absences

2. Unexcused absences are defined as any absence that does not have documentation from a physician, parent, the University Health

Center or one that has not been approved by the Director. Once students arrive on Sunday, June 23, 2012, they will not be able to leave

campus unless there is an emergency. Unexcused absences from class, tutoring sessions, morning exercise, wrestling sessions, and

other program activities will result in the following:

First violation – Meeting with the Director and a phone call to parents.

Second violation – A meeting with the Director, and a phone call to parents. Dismissal from the program.

Behavior Management

3. Classroom and clinic disruptions will be met with strict consequences. Disruptions that inhibit or interfere with the educational

environment may result in immediate suspension. The following are examples of disruptive conduct: (a) using foul or distasteful

language (b) using a computer/laptop for unrelated course work, (c) engaging in conversations with peers without the permission of the

instructor, (d) leaving class without permission/excessive bathroom breaks, (e) insubordination, and (f) use of electronic devices i.e.

cell phones and mp3 players.

First violation – Documented positive reinforcement.

Second violation –– Removal from class*, a meeting with the Director, and a phone call to parents/guardians.

Third violation – Dismissal from the program.

*Students removed from class cannot make up the coursework.

I read the policy with my child and understand the Beat the Streets – Baltimore/Morgan State University CEMSE STEM Wrestling Camp

Discipline Policy. I realize that my child must conduct him or herself in an acceptable manner at all times.

Parent’s name Signature Date

Student-athlete Signature Date

DEMOGRAPHIC INFORMATION

To better understand the demographic composition of those participating in the Youth Programs we invite

you to complete this demographic survey (regarding the applicant's ethnicity and income). Providing this

information is strictly voluntary on your part, and is not required to participate.

If you choose not to respond, please select that option in each of the two lists below.

CHILD’S ETHNICITY: Please only mark one option from the list below. __ American Indian

__ Asian

__ Black or African American

__ Hispanic or Latino

__ Multiethnic

__ White

__ Other (please specify) _______________

__ I choose not to respond (will be listed as unknown)

ANNUAL INCOME OF THE HOUSEHOLD THIS CHILD RESIDES WITH?

Please only mark one box. __ $5,000-$14,999 __ $35,000-$49,999

__ $15,000-$24,999 __ $50,000-$74,999

__ $25,000-$34,999 __ $75,000 +

9

* * * * * IMPORTANT NOTICE FOR ALL RESIDENTIAL PROGRAMS ONLY * * * * *

MENINGOCOCCAL VACCINE

FOR HIGHER EDUCATION STUDENTS

WHAT YOU NEED TO KNOW Effective, June 1, 2000, Maryland law requires that an individual enrolled in an institution of higher education in Maryland or anyone who resides in on-campus student housing must be vaccinated against meningococcal disease. An individual may be exempt from this requirement if (1) the institution of higher education provides the individual or the individual’s parent or guardian if the individual is a minor (under 18 years of age) detailed information on the risks associated with meningococcal disease and the availability and effectiveness of any vaccine, and (20 the individual or a minor individual’s parent or guardian signs a waiver stating that the individual or the parent or guardian has received and reviewed the information provided and has chosen that the individual will not be vaccinated against meningococcal disease.

What is Meningococcal Disease? Meningococcal disease is a rare but life threatening illness, caused by the bacterium, Neisseria meningitidis. It is a leading cause of bacterial meningitis (an infection of the brain and spinal cord coverings) in the United States. The most severe form of the disease is meningococcemia, infection of the bloodstream by this bacterium.

Deaths from meningococcal disease have occurs among Maryland college students in recent years. Students living in dormitories or residence halls are at increased risks. The Maryland Department of Health and Mental Hygiene encourages meningococcal vaccination of higher education students.

About 2,600 people get meningococcal disease each year in the U.S. 10-15% of these people die, in spite of treatment with antibiotics. Of those who live, 10% lose their arms or legs, become deaf, have problems with their nervous systems, become mentally retarded, or suffer seizures or strokes.

About the Vaccine: Meningococcal vaccine can be effective in preventing four types of meningococcal disease. The vaccine is not effective in preventing all types of disease, but it does help to protect many people who might become sick if they don’t get the vaccine. Drugs such as penicillin can be used to treat meningococcal infection. Still, about one out of every ten people who get the disease dies from it, and many others are affected for life.

A vaccine, like any medicine, is capable of causing serious problems, such as severe allergic reaction. People should not get meningococcal vaccine if they have ever had a serious allergic reaction to a previous dose of meningococcal vaccine. Some people who get meningococcal vaccine have mild side effects, such as redness or pain where the shot was given (which is usually under the skin of the upper arm). A small percentage of people who receive the vaccine develop a fever. The vaccine may be given to pregnant women

EPIDEMIOLOGY & DISEASE CONTROL PROGRAM Meningococcal Disease Fact Sheet

Neisseria meningitidis (the meningococcus) is a bacterium (germ) that can cause serious infections.

The meningococcus cause: meningitis, an infection of the covering of the brain and spinal cord. It also causes serious infections of the blood (meningococcemia) and of other normally sterile body sites (e.g., joints). These infections may lead to death.

The meningococcus is spread by droplets or by direct contact

The meningococci are sprayed into the air through sneezing and coughing. Many people may carry the bacteria in their noses and throats, and they will not become ill – they are healthy carriers. These carriers can spread the germ to other people.

Symptoms to look for: High fever Nausea and vomiting Severe headache Stiffness and pains in the neck, shoulders, and back Skin rash of small bright red spots

Symptoms occur within 2 – 10 days (usually 3-4 days) after the person has been exposed. Symptoms often begin suddenly.

See a doctor immediately for treatment

People who think they may have an infection due to the meningococcus should see a doctor immediately. Treatment with an antibiotic should be started right away to stop the infection from causing brain damage or death. Lab tests are needed to prove what kind of infection a person has.

People in close contact with a case may need an antibiotic

Check with your doctor or your local health department for advice. Preventive treatment with certain antibiotics is recommended and should not be delayed. Your doctor or health department will decide which medicine is best in your best situation.

People in close contact may include: Somebody who lives in the same house

A person who has contact with the patient’s mouth or nose secretions, such as through kissing or by sharing cigarettes, or using the same eating and drinking utensils, glasses and plates.

A person who has done medical treatments like giving mouth-to-mouth resuscitation on the patient, or intubating or suctioning the patient.

Children sharing toys, such as in group day care centers, family child care homes, or in nurseries. A vaccine is available to prevent some types of meningococcal disease

The vaccine protects against groups A, C, Y and W-135. Check with your doctor or your local health department to see if you should get the vaccine

MORGAN STATE UNIVERSITY STUDENT HEALTH CENTER

MENINGITIS IMMUNIZATION FORM Dear On-Campus Housing Student:

Effective June 1, 2000, Maryland law requires that every student enrolled at a University, and who resides in on-campus housing, be vaccinated against meningococcal disease, or sign a specified waiver; requiring the parent or guardian of the student to sign the waiver if the student is a minor (under age 18).

MENINGOCOCCAL VACCINE REQUIREMENT

I have received the meningococcal vaccine as required by Maryland Law for individuals residing in on-campus student housing at an institution of higher education. Documentation from a physician or health clinic of receipt of vaccine, and date vaccine was administered is attached to this form.

__________________________________________________________ __________________ Student’s Signature Date __________________________________________________________ _________________ Student’s ID #: Student’s Age __________________________________________________________ __________________ Signature of Parent/Guardian of Individual Under 18 Years of Age Date

MORGAN STATE UNIVERSITY MENINGOCOCCAL VACCINE WAIVER FORM

Dear On-Campus Housing Student:

Effective June 1, 2000, Maryland law requires that every student enrolled at a University, and who resides in on-campus housing, be vaccinated against meningococcal disease, or sign a specified waiver; requiring the parent or guardian of the student to sign the waiver if the student is a minor (under age 18).

WAIVER AGE IS 18 YEARS OR OLDER

I am 18 years of age or older. I have received and reviewed the information provided on the risk of meningococcal disease and the effectiveness and availability of meningococcal vaccine. I understand that meningococcal disease is a rare but life threatening illness. I understand that Maryland law requires that an individual enrolled in an institution of higher education in Maryland who resides in on-campus student housing shall receive vaccination against meningococcal disease unless the individual signs a waiver to the vaccination.

I voluntarily agree to release, discharge, indemnify and hold harmless the State of Maryland, the University, its officers, employees and agents from any and all costs, liabilities, expenses, claims, demands or causes of action on account of any loss or personal injury that might result from my non-compliance with the law. I choose to waive receipt of meningococcal vaccine.

Signature __________________________________________________________ Date ___________________ Social Security # ____________________________________________________ Age ____________________

WAIVER FOR INDIVIDUALS UNDER THE AGE OF 18

I have received and reviewed the information provided on the risks of meningococcal disease and the effectiveness and availability of meningococcal vaccine. I understand that meningococcal disease is a rare but life threatening illness. I understand that Maryland law requires that an individual enrolled in an institution of higher education in Maryland who resides in on-campus student housing shall receive vaccination against meningococcal disease unless a waiver to the vaccination is signed.

I voluntarily agree to, release, discharge, indemnify and hold harmless the State of Maryland, the University, its officers, employees and agents from any and all costs, liabilities, expenses, claims, demands or causes of action on account of any loss or personal injury that might result from my non-compliance with the law. I choose to waive receipt of meningococcal vaccine for my child.

Child’s Name _________________________________________ Child’s Social Security # _______ ___

____________________________________________________ _______________________________ Signature of Parent/Guardian