cross island day camp 2011

Inside: Registration & Medical FormsInside: Registration & Medical Forms

Early Bird

Special

10% Registration

Discount

before Saturday,

May 15.

CROSS ISLANDYMCA DAY CAMP

Summer 2011June 29 - August 26

LETTER FROM THE EXECUTIVE DIRECTOR

Welcome to the Summer of 2011! Our youth programs are the core of all that we do at theCross Island YMCA, which is reflected in the vast array of options available to your child thisyear in Summer Day Camp. We are excited to offer you our recreational and specialtycamps such as Teen Trip Camp, Tennis Camp, Dance Camp, and In-Depth Drama Camp.

Our mission of building the spirit, mind, and body of all our campers is reflected in ourhighly qualified staff, unique activity schedule, and unsurpassed safety protocol. Thank youfor considering the Cross Island YMCA for your child’s summer experience. We are confidentthat 2011 will be our best summer yet!

Sincerely,

Dana Feinberg

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OUR CAMP MISSIONThe Cross Island YMCA summer day camp provides youth withsupervised activities that teach core values, conflict resolu-tion and leadership skills. Kids have fun while making newfriends, developing new skills, learning core values, buildingself-confidence, appreciating teamwork and growing in self-reliance. For kids, Y camps is a fun and happy place to enjoythe summer. YMCA Day Camp gives children the opportunityto play games, create arts and crafts, explore science andtechnology, swim, participate in field trips, appreciate natureand discover and value our many cultures. The Cross IslandYMCA is licensed by the New York City Department of Healthand accredited by the American Camping Association.

CAMP DATES TO REMEMBERRegistration Begins February 1

Financial Assistance Deadline April 30

Camp Open HouseSaturday, 10am-4pm March 12

April 16 May 14

Early Bird Deadline May 14

Payment Due DatesSessions I & II May 1Sessions III, IV June 1

Transportation Registration May 31Deadline

Completed Medical Form June 20 Deadline

CONTACT INFORMATIONFor more information on Early Childhood Summer Camp, contact Early Childhood Director at 718-551-9313. For moreinformation on all other camps, contact Javon Clark at 718-551-9316 or email [email protected].

CAMP LOCATIONCROSS ISLAND YMCA238-10 Hillside Ave.Bellerose, NY 11426Tel: 718-479-0505 Fax: 718-468-9568Web: ymcanyc.org/crossisland

FINANCIAL AIDAt the YMCA, we work to ensure that no child is ever turnedaway for inability to pay. Every year, our Strong KidsCampaign raises funds to support YMCA youth programs likeday camp and sleepaway camp, and enable us to offer need-based scholarships to participants on a case by case basis.Applications are available at the Membership Office and mustbe submitted with the proper documents by April 30.

STRONG KIDS CAMPAIGNThe Cross Island YMCA Annual Strong Kids Campaign raisesmoney for youth programs and scholarships at the Cross IslandYMCA. The scholarships allow young people in financial needto experience the Cross Island YMCA through memberships inTeen Programs, After-School activities and Summer Camp. Asa non-profit organization, we depend upon yearly contribu-tions from our members and other friends to help us provideeducational, health-enhancing programs for the youth in ourcommunity. With the Strong Kids Campaign, 100% of thesecontributed dollars goes to support youth programs and schol-arships in our YMCA. Please Donate Today! For more infor-mation about this campaign, to volunteer, or to make a dona-tion, please contact Jamé Cohn, Fund Development Directorat 718-551-9314 or [email protected].

STRONG KIDS CARDThe YMCA Strong Kids Card is part of the YMCA of GreaterNew York’s commitment to improving the health and fitnessof New York City’s kids age 5-17. Every YMCA branch in NewYork City is reaching out to kids in their neighborhood pro-grams to enroll them in the YMCA Strong Kids Card initiative.To register your child for a free YMCA Strong Kids Card, simplypick up a brochure at the membership desk, fill it out, andsend it with your child to their YMCA program. Then we’lltake their picture and print their very own Strong Kids Card.They’ll use their card to access their local YMCA during desig-nated days and times of the Strong Kids Card activities.

CHILDHOOD CAMPAges 2 - 5.8 • Sessions I - IV

Our primary goal is for each child to develop a positiveself-image. The staff is made up of carefully selectedteachers and assistant teachers. They provide guidanceand supervision so that each child can achieve self-con-fidence and awareness.

Our camp offers air-conditioned classrooms, outdoorplayground, picnic area, indoor pool and gym. Childrenparticipate in a wide variety of activities, including arts& crafts, swim, gym, music, and organized games. Eachweek will feature a special theme, and each session willhave a trip to the zoo, children's museum or park. Allactivities are geared to meet individual needs, abilities,and interests.

DAY CAMP SESSIONMonday - Friday, Monday, Wednesday & Friday Tuesday & Thursday

DAY CAMP HOURS9:00am - 4:00pm Extended hours morning and evening available

TRANSPORTATIONCall Early Childhood for Transportation Services.

EARLY CHILDHOOD CAMP Call 718 551-9313 or 718-479-0505 for more info.

FEES$50 - Registration fee for campers who are not YMCAmembers or currently enrolled in the Cross Island YMCAEarly Childhood Center $100 - Deposit for each session.(both non-refundable)

EARLY CHILDHOOD MEDICAL FORM Completed Medical Form deadline June 14.

CROSS ISLA

ND

YMCA

CHILD

HO

OD

CAM

P

Session Dates Final Payment Due

I * June 29 - July 15* May 1

II July 18 - July 29 May 1

III Aug 1 - Aug 12 June 1

IV Aug 15 - Aug 26 June 1

*Session I is adjusted to reflect 12 days.

CHILDHOOD CAMP SESSIONS

Session AM / PM Time Fee per session

Session I

(12 days)

AM 7:00am -9:00am $102

PM 4:00pm-6:00pm $102

AM & PM 7:00am-6:00pm $204

Session II,

III, IV

(10 days)

AM 7:00am -9:00am $85

PM 4:00pm-6:00pm $85

AM & PM 7:00am-6:00pm $170

CHILDHOOD EXTENDED HOURS

5 Days (Mon - Fri) Payment

Session I (12 days) $570

Session II, III, IV (10 days) $475

3 day (M,W,F)Session II, III, IV

Payment$345

2 day (T,TH)Session II, III, IV

Payment$265

PreSchool Program CAMP RATES 3 to 4.5 years




Early Childhood CAMP RATES4.5-5.8 years

CROSS ISLAND YMCA CHILDHOOD CAMP

Cross Island YMCA * 238-10 Hillside Ave * Bellerose, NY 11426




3 day (M,W,F)Session II, III, IV

Payment$365

2 day (T,TH)Session II, III, IV

Payment$285

Toddler Program CAMP RATES 2-3.4 years

Sessions and Fee Schedule Check all sessions and circle all prices that apply to you.

Cross Island YMCA Summer Day Camp 2011 2 to 5.8 years Registration Form

Name: ________________________________________________________________________________________ Last First MI

Age: ________________________ DOB: _______________________________ Sex: _________________

Home Address: __________________________________________________________________________________ Street City-Town Zip

Home Phone Number: ___________________________ Parent’s Business Phone: ___________________________

Attention all members of 1199 and TWU: Please staple your voucher to this form. We will not accept any registration forms that are not accompanied by a voucher.

Session I (6/29 - 7/15) runs 12 days and is adjusted for camps and services as listed above.

A non-refundable deposit of $100 per session is required at the time of regis-tration.

A $50 non-refundable registration fee is required for campers who are not YMCA members.

Accepted forms of payment are cash or credit card.

Financial Aid is available to those that qualify. Forms are available at the Members Services Desk.

Toddler Camp 2 to 3.4 years 5 Days (Monday—Friday) □ Session I 6/29 - 7/15 $600 □ Session II 7/18 - 7/29 $500

□ Session III 8/1 - 8/12 $500 □ Session IV 8/15 - 8/26 $500

Fees

(12 Days) Session I $______________

Session II $______________

Session III $______________

Session IV $______________

— Discounts $______________

Extended Hours (Rate multiplied by # of sessions) $______________

Total Session Fee $______________

$50 Registration Fee (applies to non-members only) $______________

Grand Total $______________

Additional Services

Extended Hours AM only PM only Both

Session I Only $102 $102 $204

Sessions II, III, IV $85 $85 $170

3 Days (Monday, Wednesday, Friday)

□ Session II 7/18 - 7/29 $365

□ Session III 8/1 - 8/12 $365

□ Session IV 8/15 - 8/26 $365

2 Days (Tuesday, Thursday) □ Session II 7/18 - 7/29 $285

□ Session III 8/1 - 8/12 $285

□ Session IV 8/15 - 8/26 $285

PreSchool Camp 3 to 4.5 years 5 Days (Monday—Friday) □ Session I 6/29 - 7/15 $570 □ Session II 7/18 - 7/29 $475


3 Days (Monday, Wednesday, Friday)

□ Session II 7/18 - 7/29 $345


2 Days (Tuesday, Thursday) □ Session II 7/18 - 7/29 $265 □ Session III 8/1 - 8/12 $265

□ Session IV 8/15 - 8/26 $265

Early Childhood Camp 4.5 to 5.8 years 5 Days (Monday—Friday) □ Session I 6/29 - 7/15 $564 □ Session II 7/18 - 7/29 $470 □ Session III 8/1 - 8/12 $470 □ Session IV 8/15 - 8/26 $470

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TYPE OF EXAM: NAE Current NAE Prior Year(s)

Comments

REVIEWER:

Date Reviewed:

DOHMHONLY

PROVIDER I.D.

__ __ / ___ ___ / ___ ___

I.D. NUMBER

Health Care Provider Signature Date__ __ / ___ ___ / ___ ___

Health Care Provider Name and Degree (print) Provider License No. and State

Facility Name National Provider Identifier (NPI)

Address City State Zip

Telephone ( __ __ __ ) ___ ___ ___ – ___ ___ ___ ___

Fax ( __ __ __ ) ___ ___ ___ – ___ ___ ___ ___

Hep B __ __ / ___ ___ / ___ ___ __ __ / ___ ___ / ___ ___ __ __ / ___ ___ / ___ ___ __ __ / ___ ___ / ___ ___

Rotavirus __ __ / ___ ___ / ___ ___ __ __ / ___ ___ / ___ ___ __ __ / ___ ___ / ___ ___

DTP/DTaP/DT __ __ / ___ ___ / ___ ___ __ __ / ___ ___ / ___ ___ __ __ / ___ ___ / ___ ___

__ __ / ___ ___ / ___ ___ __ __ / ___ ___ / ___ ___ __ __ / ___ ___ / ___ ___

Hib __ __ / ___ ___ / ___ ___ __ __ / ___ ___ / ___ ___ __ __ / ___ ___ / ___ ___ __ __ / ___ ___ / ___ ___

PCV __ __ / ___ ___ / ___ ___ __ __ / ___ ___ / ___ ___ __ __ / ___ ___ / ___ ___ __ __ / ___ ___ / ___ ___

Polio __ __ / ___ ___ / ___ ___ __ __ / ___ ___ / ___ ___ __ __ / ___ ___ / ___ ___ __ __ / ___ ___ / ___ ___

RECOMMENDATIONS � Full physical activity � Full diet

� Restrictions (specify) ___________________________________________________________________________

Follow-up Needed � No � Yes, for _________________________ Appt. date: __ __ / ___ ___ / ___ ___

Referral(s): � None � Early Intervention � Special Education � Dental � Vision

� Other ________________________________________________________________________

ASSESSMENT � Well Child (V20.2) � Diagnoses/Problems (list) ICD-9 Code

_____________________________________________________________ __ __ __ __ __

_____________________________________________________________ __ __ __ __ __

_____________________________________________________________ __ __ __ __ __

Health insurance � Yes(including Medicaid)? � No

Does the child/adolescent have a past or present medical history of the following?

� Asthma (check severity and attach MAF/Asthma Action Plan): � Intermittent � Mild Persistent � Moderate Persistent � Severe PersistentIf persistent, check all current medication(s): � Inhaled corticosteriod � Other controller � Quick relief med � Oral steroid � None

� Attention Deficit Hyperactivity Disorder � Orthopedic injury/disability� Chronic or recurrent otitis media � Seizure disorder� Congenital or acquired heart disorder � Speech, hearing, or visual impairment� Developmental/learning problem � Tuberculosis (latent infection or disease)

� Diabetes (attach MAF) � Other (specify) ___________________

Explain all checked items above or on addendum

Birth history (age 0-6 yrs)

� Uncomplicated � Premature: ________ weeks gestation

� Complicated by _______________________________

Allergies � None � Epi pen prescribed

� Drugs (list)

� Foods (list)

� Other (list)

STUDENT ID NUMBEROSIS

CHILD & ADOLESCENT HEALTH EXAMINATION FORMNYC DEPARTMENT OF HEALTH & MENTAL HYGIENE — DEPARTMENT OF EDUCATION

Please Print Clearly

Press Hard

Child’s Last Name First Name Middle Name

Child’s Address

City/Borough State Zip Code

� Parent/Guardian Last Name First Name� Foster Parent

School/Center/Camp Name

Sex � Female � Male

Hispanic/Latino?

� Yes � NoRace (Check ALL that apply) � American Indian � Asian � Black � White

� Native Hawaiian/Pacific Islander � Other ____________________________

PHYSICAL EXAMINATION

Height ____________________ cm ( ___ ___ %ile)

Weight ____________________ kg ( ___ ___ %ile)

BMI ____________________ kg/m2 ( ___ ___ %ile)

Head Circumference (age ≤2 yrs) ______________ cm ( ___ ___ %ile)

Blood Pressure (age ≥3 yrs) _________ / __________

DEVELOPMENTAL (age 0-6 yrs) � Within normal limits

If delay suspected, specify below

� Cognitive (e.g., play skills) ____________________________

� Communication/Language _________________________

� Social/Emotional __________________________________

� Adaptive/Self-Help ________________________________

� Motor ___________________________________________

SCREENING TESTS Date Done Results

Blood Lead Level (BLL)__ __ / ___ ___ / ___ ___ _________ μg/dL

(required at age 1 yr and 2 yrsand for those at risk) __ __ / ___ ___ / ___ ___ _________ μg/dL

Lead Risk Assessment � At risk (do BLL)(annually, age 6 mo-6 yrs)

__ __ / ___ ___ / ___ ___ � Not at risk

Hearing

� Pure tone audiometry � Normal� OAE __ __ / ___ ___ / ___ ___ � Abnormal

—— Head Start Only ——

Hemoglobin or __________ g/dLHematocrit (age 9–12 mo)

__ __ / ___ ___ / ___ ___ __________ %

Date Done Results

Tuberculosis Only required for students entering intermediate/middle/junior or high schoolwho have not previously attended any NYC public or private school

PPD/Mantoux placed __ __ / ___ ___ / ___ ___ Induration ______mm

PPD/Mantoux read __ __ / ___ ___ / ___ ___ � Neg � Pos

Interferon Test __ __ / ___ ___ / ___ ___ � Neg � Pos

Chest x-ray � Nl � Not(if PPD or Interferon positive)

__ __ / ___ ___ / ___ ___� Abnl Indicated

Vision

__ __ / ___ ___ / ___ ___

Acuity Right ___ / ___(required for new school entrants Left ___ / ___and children age 4–7 yrs) � with glasses Strabismus � No � Yes

General Appearance:

Nl Abnl Nl Abnl Nl Abnl Nl Abnl Nl Abnl

� � HEENT � � Lymph nodes � � Abdomen � � Skin � � Psychosocial Development� � Dental � � Lungs � � Genitourinary � � Neurological � � Language� � Neck � � Cardiovascular � � Extremities � � Back/spine � � Behavioral

Date of Birth (Month/Day/Year )__ __ / ___ ___ / ___ ___ ___ ___

Phone Numbers

Home _____________________

Cell ______________________

Work ______________________

TO BE COMPLETED BY PARENT OR GUARDIAN

TO BE COMPLETED BY HEALTH CARE PROVIDER If “yes” to any item, please explain (attach addendum, if needed)

CH-205 (5/08) Copies: White School/Child Care/Early Intervention/Camp, Canary Health Care Provider, Pink Parent/Guardian

Medications (attach MAF if in-school medication needed)

� None � Yes (list below)

Dietary Restrictions

� None � Yes (list below)

Influenza __ __ / ___ ___ / ___ ___ __ __ / ___ ___ / ___ ___ __ __ / ___ ___ / ___ ___

MMR __ __ / ___ ___ / ___ ___ __ __ / ___ ___ / ___ ___ __ __ / ___ ___ / ___ ___

Varicella __ __ / ___ ___ / ___ ___ __ __ / ___ ___ / ___ ___

Td __ __ / ___ ___ / ___ ___ __ __ / ___ ___ / ___ ___ __ __ / ___ ___ / ___ ___

Tdap __ __ / ___ ___ / ___ ___ Hep A __ __ / ___ ___ / ___ ___ __ __ / ___ ___ / ___ ___

Meningococcal __ __ / ___ ___ / ___ ___ __ __ / ___ ___ / ___ ___

HPV __ __ / ___ ___ / ___ ___ __ __ / ___ ___ / ___ ___ __ __ / ___ ___ / ___ ___

Other, specify: ____________ __ __ / ___ ___ / ___ ___ ; _______________ __ __ / ___ ___ / ___ ___

IMMUNIZATIONS – DATES CIR Number of Child

Describe abnormalities:

District __ __Number __ __ __

EARLY CHILDHOOD CAMP & SCHOOL MEDICAL FORM ONLY

EARLY CHILDHOOD CENTER (AGES 2 - 5.8)Our teachers will welcome your child in a warm and safe, licensed environment. With a wide range of activities to stimulate your child's creativity, self-esteem, and independence, our YMCA values-based program willhelp your young child learn the essential social, physical, and intellectual building blocks.

NURSERY SCHOOL (JANUARY 2010 - AUGUST 2010)The Early Childhood Center is licensed with the New York Division of Day Care and registeredwith the New York State Education Department. Classrooms are staffed with an Early Childhoodteacher and a qualified teacher's assistant. All voucher programs are welcome. Children attending 3or 5 day Preschool program will swim 1 day a week. Not available for 2 day option. Please Note:Children in Toddler Program need not be fully toilet trained. Children in Preschool programs mustbe toilet trained.

EXTENDED HOURSAM: 7:30am - 9:00am PM: 4:00pm - 6:00pmAM: 5 Day - $80 3 Day - $50 2 Day - $35PM: 5 Day - $105 3 Day - $65 2 Day - $45

PAYMENT AND REGISTRATION PROCEDURETo register, a $50 Registration Fee and a $100 Deposit are required. Both are non-refundable.Tuition for each month is due one month ahead on the first of the month. Completed medical formwith proof of immunization is required 2 weeks before the first day of school. Automatic Monthlydraft is available through checking account or credit card.Month Payment Due DateJuly June 1, 2010August July 1, 2010

NURSERY SCHOOL (SEPTEMBER 2011 - AUGUST 2012)Registration for the 2011 - 2012 School Year starts March 1, 2011. For more information and fees or to arrange a tour, call the Early Childhood Director at 718-551-9313.

Monthly Rates Full Y Members Program Members

5 day $460 $485

3 day (M,W,F) $350 $370

2 day (T,TH) $270 $290

TODDLER PROGRAM (Ages 2.0 - 3.4 years)Half Day 9:00am - 12:00pm


5 day $430 $450

3 day (M,W,F) $325 $345

2 day (T,TH) $260 $275

PRESCHOOL PROGRAM (Ages 3.0 - 5.8 years) Half Day

9:00am - 12:00pm or 1:00pm - 4:00pm


5 day $840 $860

3 day (M,W,F) $645 $665

2 day (T,TH) $500 $520

PRESCHOOL PROGRAM (Ages 3.0 - 5.8 years) Full Day

9:00am - 4:00pm


5 day $910 $935

3 day (M,W,F) $695 $725

2 day (T,TH) $550 $565

TODDLER PROGRAM (Ages 2.0 - 3.4 years)Full Day 9:00am - 4:00pm

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EARLY CH

ILDH

OO

D CEN

TER

2008

Outstanding Early ChildhoodProgram Award from

the NYSDepartment of

Education

RECREATIONAL CAMPSAges 6 - 12 • Sessions I - IV Recreational Camp is split into age groups. All Units participate in the following activities: Morning Assembly • Arts & Crafts • Swimming •Academic Enhancement • Trips • Lunch • Character Development • Sports & Games

DAY CAMP SESSIONMonday - Friday

DAY CAMP HOURS9:00am - 4:00pm Extended hours morning and evening available

UNITSUnit I: Campers born in 2005

who are 6 years old or have completed Kindergarten.

Unit II: Campers born in 2003 & 2004who are 7 or 8 years old.

Unit III: Campers born in 2001 & 2002who are 9 or 10 years old.

Unit IV: Campers born in 1999 & 2000who are 11 or 12 years old.

Teen: Campers born in 1996 - 1998who are 13 to 15 years old.

TEEN CAMPAges 13 - 15 • Sessions I - IVAt the Cross Island YMCA, we recognize that teenagershave a variety of changing interests. This awarenessprovides the foundation for our approach to the 2011camping experience for young adults. Teen Camp willhave three major components: sports and recreation,visual and performing arts, and leadership training. Allactivities, trips, and additional programming will be anoutgrowth of these three components. See page 7 for Teen Specialty Camps.

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Session Dates Final Payment Due

I * June 29 - July 15* May 1

II July 18 - July 29 May 1

III Aug 1 - Aug 12 June 1

IV Aug 15 - Aug 26 June 1

*Session I is adjusted to reflect 12 days. See Pg. 10

CAMP SESSIONS

5 Day (Mon - Fri) AM Only PM Only Both

Session I

(12 days)$144 $144 $288

Session II, III, IV

(10 days)$120 $120 $240

TRANSPORTATION*Subject to change pending fuel costs

Session AM / PM Time Fee per session

Session I

(12 days)

AM 7:00am -9:00am $102

PM 4:00pm-6:00pm $102

AM & PM 7:00am-6:00pm $204

Session II,

III, IV

(10 days)

AM 7:00am -9:00am $85

PM 4:00pm-6:00pm $85

AM & PM 7:00am-6:00pm $170

EXTENDED HOURS


Session I

(12 days)$444

Session II, III, IV

(10 days)$370

CAMP FEES

6

RECREATION

AL &

SPECIALTY CA

MPS

ADVENTURE CAMPAdventure campers enjoy & participate in: Hiking,Environmental awareness, Songs, Nature-based arts & crafts,Basic first aid, Team building challenges, Basic survival skills,Swimming & more! See Pg. 10

OUTDOOR CAMP LOCATIONOutdoor Adventure Camp is held at the Queens County Farmon Little Neck Parkway, which is just a couple of miles fromthe Cross Island YMCA. With plenty of outdoor open space,the Queens County Farm provides the opportunity to grow,learn, and appreciate the outdoors. Campers are to bedropped off and picked up at Queens County Farm. Allextended day programs take place on-site, not at the YMCA.

OUTDOOR ADVENTUREAges 6 - 14 • Sessions I - IVThe farm provides children with memorable and exciting out-door experiences. The setting enables each camper to enjoymore individualized attention from staff members. Childrenwill be provided with hands-on experiences and challenges,both physically and intellectually. The philosophy behind thiscamp is that the children will develop self-esteem, respect fornature and lasting friendships. Rates: $504 Session I (12 days)

$420 Session II, III, IV (10 days)

CREATIVE CAMPS At the Cross Island YMCA, we strive to build the spirit, mind,and body of every child in our programs. This mission wouldnot be fulfilled without allowing our children to explore theircreative side. Our Creative Camps do just that! These campwill allow campers to explore their interest in the arts on adeeper level. Try all three camps or master your favorite.

DANCE CAMPAges 6 - 12 • Sessions I & IISharpen your sense of rhythm, flexibility, and coordination inCross Island YMCA’s Dance Camp! In addition to learning thenewest moves on the hip hop scene, young dancers will beexposed to ballet, modern, and basic ballroom dance moves.Dancing improves self-esteem and total health. Join us for afun and exciting camp experience which will culminate in aperformance at each session’s end. Rates: $504 Session I (12 days)

$420 Session II (10 days)

CRAFTS CAMPAges 6 - 12 • Sessions III - IV Cross Island YMCA Crafts Camp will expose youngsters ages 6-12 to a vast array of creative arts, including sculpture, paint-ing, collaging, scrapbooking, drawing, and more. This proj-ect-based camp will give young artists hands on experiencetrying new mediums. Campers will make different art proj-ects every day, learn new skills, and develop lasting friend-ships in Crafts Camp! Rate: $420 per session

IN-DEPTH DRAMA CAMP Ages 6 - 12 • Sessions II & III(Campers MUST sign up for both sessions to be in this camp)Give your young performer the chance to be on stage inDrama Camp! Campers will learn the fundamentals of acting,character study, and more, as they prepare to perform in aculminating production. Children will learn the ins and outsof theatre, do improvisation exercises, and even try scriptwriting. The campers will have a stage performance for theCross Island YMCA every 2 weeks. Rate: $840 (2 sessions)

7

TEEN SPECIALTY CAMPS Adventure Camps Enjoy & Participate in: Hiking,Environmental awareness, Songs, Nature-based arts & crafts,Basic first aid, Team building challenges, Basic survival skills,Swimming & more! See Pg. 10See page 5 for Teen Recreation Camp

LEADERS-IN-TRAININGAges 16 - 17 • Sessions I - III Leaders are responsible for assisting Day Camp staff in provid-ing a variety of activities in a safe and well-supervised envi-ronment. The LIT program provides practical learning experi-ence for working with children. Interested teens must com-plete the application process and demonstrate the maturitynecessary to serve as a staff trainee. LITs will attend weeklytrainings revolving around each of the following themes: Howto Get a Job, Child Development, and Business Management.Each week LITs will be assigned to work with counselors invarious age groups. Note: LITs can be removed for lack ofparticipation To be eligible for the L.I.T. program, an applicant: • Must be at least 16 yrs.• Three letters of recommendation from a teacher/ guidancecounselor or community leader • Demonstrate a willingness to learn and work Rate: $100 per session

SPORTSAges 13 - 15 • Sessions I - III The Teen Sports camp gives active teens, both girls and boysthe opportunity to practice teamwork and play competitivesports. The camp will also focus on teaching fitness andhealthy lifestyles. Rates: $504 Session I (12 days)

$420 Session II & III (10 days)

TEEN TRIPAges 11 - 15 • Sessions II - III Join us as we go on a fun trip every single day of the session.Trips will not repeat, and campers will get to experienceplaces they have never gone before! Come travel Long Island,Connecticut, and NYC each and every day! Please note:Campers in Trip Camp will not participate in swimming, asthey will not be on site to do so. Trip camp children mustprovide their own lunch or bring money to purchase lunch onthe trips. Lunch is not provided for this camp.Rate: $600 per session

LISA BETH GERSTMAN CAMPFOR CHILDREN WITHPHYSICAL CHALLENGESAges 6 – 14 Session A & B The Cross Island YMCA is extremely proudto offer The Lisa Beth Gerstman YMCASummer Day Camp program serving chil-dren with physical challenges in an inte-grated setting. Every child deserves theopportunity to participate in a safe, car-ing, and fun learning environment. Ourgoal is to develop each child’s spirit,mind, and body through quality driven programs. This spe-cial camp is made possible through the generous support ofthe Lisa Beth Gerstman Foundation. Its donation has offsetthe expenses of equipment, transportation and staffingrequired to serve youngsters with physical disabilities. Allchildren will receive wheelchair accessible transportation,one-on-one swimming instruction, adaptive physical activitiesand equipment. One coordinator and a minimum of five per-sonal assistants will be available for every 10 campers. Rates: Session A: $607 (14 days) Session B: $650 (15 days)

LBG DAY CAMP SESSION DATESMonday - Friday Session A July 5 - July 22Session B July 25 - Aug. 12

LBG DAY CAMP HOURS9:00am - 4:00pm

LBG CONTACT INFORMATIONJean Dattner at 718-551-9325, [email protected] Dianne DiPeri at 718-551-9319, [email protected]

If you have a child that is developmentally disabledplease contact Jean Dattner or Dianne DiPeri.

TEEN &

SPECIALTY CA

MPS

8

SPORTS CAMPSOur Sports Camps aim to challenge young people to developtheir skills, enhance their knowledge and practice sportsman-ship and teamwork. To illustrate this concept, the CrossIsland YMCA is implementing an evaluation process of allSports Camps. By measuring levels of ability through an initial“skills assessment,” campers can spend each session focusingon their specific areas of need. At the end of the session,another evaluation will be administered so that children cansee how much they have improved. These campers will worktowards a culminating event for each session. *Session Iprices are adjusted to reflect 12 days. See Pg. 10

BOYS TEAM SPORTS CAMPAges 6 - 12 • Sessions I - IV Team Sports Camp will incorporate four sports for boys:Baseball, Basketball, Soccer and Flag Football. Campers willlearn basic fundamentals and rules for each of the sports.Each day of the week our staff will focus on one of the foursports. Our goal is to expose the children to a variety ofsports. Join us as we take our sports camps to a new level.Camper should bring proper equipment for each sport. Rates: $504 Session I (12 days)

$420 Session II & III & IV (10 days)

GIRLS TEAM SPORTS CAMP Ages 6 - 12 • Sessions I - IVThis summer Team Sports Camp will incorporate four popularsports for girls: Softball, Basketball, Soccer and Volleyball.Campers will learn basic fundamentals, rules and skills foreach of the sports. Each day of the week our staff will focuson one of the four sports. Our goal is to expose the childrento a variety of sports. Join us as we take our sports camps toa new level. Campers should bring proper equipment for eachsport. Rates: $504 Session I (12 days)


PROGRESSIVE BASKETBALLAges 6 - 12 • Sessions I - IVClasses are based on appropriate age and level of play. Allability levels are welcomed. Offensive and defensive skillsand team concepts develop the most complete basketballplayer possible. Rates: $504 Session I (12 days)


BASEBALL CAMPAges 6 - 12 • Session I In this brand new camp, children will practice hitting, pitch-ing, fielding, and other defensive and offensive techniques.They will review the rules of baseball and practice teamworkand sportsmanship. Campers should bring their own glove! Rates: $504 Session I (12 days)

GYMNASTICS CAMPAges 6 - 12 • Session II Drills and skills in all Olympic events, following a progressiveprogram. Dance, conditioning, stretching and performancetips will focus on fun for gymnasts of every level. The lastday exhibition will give gymnasts an opportunity to show theirnew skills. Rate: $420 Session II (10 days)

MARTIAL ARTS CAMPAges 6 - 12 • Session IIIIn this camp, participants will learn techniques and positivecharacteristics such as self-respect, self-discipline, honor, andrighteousness, Martial arts has been proven to be effective indefense situations. There will be an exhibition on the lastday.Rate: $420 Session III (10 days)

TENNIS CAMPAges 6 - 12 • Session I - IIIThe Tennis Camp offers drills and activities carefully designedfor different developmental levels so each camper will have asuccessful learning experience. The camp will focus on posi-tioning, court layout and rules and regulations. The camperswill also learn about the basic fore-hand and back handstrokes and compete in both singles and doubles activities. Campers must bring a racket and a sun visor or hat. Rates: $504 Session I (12 days)

$420 Session II & III (10 days)

REGISTRATIO

N FO

RM

Sessions and Fee Schedule Check all sessions and circle all prices that apply to you.

Cross Island YMCA Summer Day Camp 2011 Registration Form

Name: ________________________________________________________________________________________ Last First MI Age: ________________________ DOB: _______________________________ Sex: _________________

Home Address: __________________________________________________________________________________ Street City-Town Zip Home Phone Number: ___________________________ Parent’s Business Phone: ___________________________

Attention all members of 1199 and TWU: Please staple your voucher to this form. We will not accept any registration forms that are not accompanied by a voucher.

Session I (6/29 - 7/15) runs 12 days and is adjusted for camps and services as listed above. Days and sessions may be split for recreational camp (units 1-4 & teen camp) but NOT specialty camps. A non-refundable deposit of $100 per session is required at the time of registration. A $50 non-refundable registration fee is required for campers who are not YMCA members. Accepted forms of payment are cash or credit card. Financial Aid is available to those that qualify. Forms are available at the Members Services Desk.

Recreational Camps

Early Childhood Camp *Register at Desk for the Monthly Early Childhood program

Session I 6/29 - 7/15 $564 Session II 7/18 - 7/29 $470 Session III 8/1 - 8/12 $470 Session IV 8/15 - 8/26 $470

Recreational Camp (Units 1-4 & Teen Camp)

Session I 6/29 - 7/15 $444 Session II 7/18 - 7/29 $370 Session III 8/1 - 8/12 $370 Session IV 8/15 - 8/26 $370

Specialty Camps Baseball Camp Tennis

Session I 6/29 - 7/15 $504 Session I 6/29 - 7/15 $504 Session II 7/18 - 7/29 $420

Session III 8/1 - 8/12 $420 Session I 6/29 - 7/15 $504 Session II 7/18 - 7/29 $420 Crafts Camp Session III $420 Session III 8/1 - 8/12 $420 Session IV 8/15 - 8/26 $420 Session IV 8/15 - 8/26 $420

Boys Team Sports Gymnastics Camp

Session I 6/29 - 7/15 $504 Session II 7/18 - 7/29 $420 Session II 7/18 - 7/29 $420 Session III $420 In-Depth Drama Camp

Session IV 8/15 - 8/26 $420 Session II &III 7/18 - 8/12 $840

Girls Team Sports Teen Trip Camp Session I 6/29 - 7/15 $504 Session II 7/18 - 7/29 $600 Session II 7/18 - 7/29 $420 Session III 8/1 - 8/12 $600 Session III $420 Session IV 8/15 - 8/26 $420

Teen Sports Dance Camp Session I 6/29 - 7/15 $504

Session I $504 Session II 7/18 - 7/29 $420 Session II 7/18 - 7/29 $420 Session III 8/1 - 8/12 $420

Martial Arts Camp Leaders In Training

Session III 8/1 - 8/12 $420 Session I 6/29 - 7/15 $100 Session II 7/18 - 7/29 $100

Outdoor Adventure Camp Session III 8/1 - 8/12 $100 Session I 6/29 - 7/15 $504 Session II 7/18 - 7/29 $420 Lisa Beth Gerstman Camp

Session III 8/1 - 8/12 $420 Session A 7/5 - 7/22 $607 Session IV 8/15 - 8/26 $420 Session B 7/25 - 8/12 $650

Basketball Camp

8/1 - 8/12

8/1 - 8/12

8/1 - 8/12

6/29 - 7/15

Fees

(12 Days) Session I $______________

Session II $______________

Session III $______________

Session IV $______________

Mini Camp $______________

— Discounts $______________ Extended Hours

(Rate multiplied by # of sessions) $______________ Transportation

(Rate multiplied by # of sessions) $______________

Total Session Fee $______________ $50 Registration Fee (applies to non-members only) $______________

Grand Total $______________

Additional Services Extended Hours AM only PM only Both Session I Only $102 $102 $204 Sessions II, III, IV $85 $85 $170 Transportation (ages 6+ only) AM only PM only Both Session I Only $144 $144 $288 Sessions II, III, IV $120 $120 $240

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11

Cross Island YMCA Summer Day Camp Emergency Contact Form

Name: ______________________________________________________________________________________

Last First MI

Age: ________________________ DOB: _______________________________ Sex: _______________

Home Address: ________________________________________________________________________________ Street City-Town Zip Home Phone Number: __________________________ Cell Phone Number: _____________________________

Mother’s Name: _______________________________ Mother’s Work Number: __________________________

Father’s Name: ________________________________ Father’s Work Number: ___________________________

IF THERE IS AN EMERGENCY AND PARENTS CANNOT BE REACHED:

Name: _____________________________ Phone Number: ____________________ Relationship: ___________



IF MEDICAL CARE IS NEEDED:

Doctor’s Name: _______________________________ Phone Number: __________________________________

Does your child have any allergies? Please list them here: ______________________________________________

Is your child currently taking any medication? (If so, list type and what for): ______________________________

I am the legal parent/guardian of ______________________________ and do hereby give my permission for any medical treatment deemed necessary in case of an emergency.

All information concerning your child will be available to the Camp Supervisory Staff as well as their Counselors, at the discretion of the Camp Director. I acknowledge that I have received the Parent Handbook and Health Examination Form to be returned before the child attends camp.

I assume all financial responsibilities for my child. I understand that camp deposit and registration fees are non-refundable. I give permission for my child to attend field trips under the supervision of the Cross Island YMCA staff. My child is permitted to participate in all camp activities as described in the camp brochure and Parent Handbook. Standard Release Form - I HEREBY CONSENT to the use, publication, and display, by or on behalf of the Cross Island YMCA, any photograph, digital image or videotape and any reproduction thereof in which I or my minor child may be portrayed or identified by name. It is understood that the YMCA of Greater New York and member organizations may use, publish and display such photographs or digital images or reproductions thereof, in whole or in part, for any business purpose in their individual discretion. I waive all claim for any compensation for such use. I understand that my child will participate in all camp activities.

____________________________________________ ______________________

Signature Date

Alternate Escorts: (We will not release your child to anyone not listed below without your written consent.)

1. ________________________________________ 2. ________________________________________

3. ________________________________________ 4. ________________________________________

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12

CON

TACT &

MED

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R R R R R R is si e to e i e in arent e ore presentation to si ian

_________________________________________________________________________________________________ R R : ______________________________________________ Permit No. 85: ________________

______________________________ _____________________________ ____/____/____ Male Female Child’s Last Name First Name Date of Birth Sex Home Address: ________________________________________________ Tel. No. _______________________

Parent or Guardian: _____________________________________________ Tel. No. _______________________

Place of Employment:

Father Guardian: _________________________________________ Tel. No. _______________________

Mother Guardian: ________________________________________ Tel. No. _______________________

In Case of Emergency, please notify: _______________________________ Tel. No. _______________________

If Parent/Guardian are not available in an emergency, please notify: 1. ___________________________________________________________ Tel. No. _______________________ 2. ___________________________________________________________ Tel. No. _______________________ Important: Has this camper been exposed to any communicable disease during the three weeks prior to camp attendance. Yes No If yes, state type of exposure: _________________________________________________

R : (Check and give approximate dates) Allergies Diseases

Ear Infections __________________ Hay Fever _____________________ Check Pox ____________________ Rheumatic Fever _______________ Ivy Poisoning, etc. ______________ Measles ______________________ Convulsion ___________________ Insect Stings ___________________ German Measles _______________ Diabetes _____________________ Penicillin ______________________ Mumps ______________________ Behavior _____________________ Other Drugs ____________________ Other Contagious Illnesses _______ Asthmas ____________________ ____________________________ Other Past Illnesses: ________________________________________________________________________________

Operations or Serious Injuries (Dates): _________________________________________________________________

Hospitalization (Dates): _____________________________________________________________________________

Chronic or Recurring Illness: ________________________________________________________________________

Any specific activities to be encouraged? _______________________________________________________________

Conditions that require activity to be restricted? __________________________________________________________

Permission for all program activities unless otherwise noted by doctor: ________________________________________

Appliance worn (glasses, contacts, etc.): _________________________________________________________________

Medication taken: __________________________________________________________________________________

Suggestion from Parent/Guardian: _____________________________________________________________________

R R R I do hereby give authority to the Day Camp and Year Round Afterschool and Youth Center Program staff to obtain necessary emergency medical treatment for my child with the understanding that the family will be notified as soon as possible. ________________________ _________________________________ _______________ _________________________ Relationship Signature Date Telephone No.

CAMP MEDICAL FORM (EARLY CHILDHOOD CAMP USE PG. 3 ONLY)

CAMP MEDICAL FORM (EARLY CHILDHOOD CAMP USE PG. 3 ONLY)

13

(To be filled out by Physician. Please note information on reverse side)

The purpose of this health record is to provide the staff with pertinent information, which will help to serve the needs of this child in Day Camps and Afterschool and Youth Center programs.

R : This is a record of dates of basic immunization and most recent booster doses.

Type Date Date Date Date Date

DtaP, DTP or TD

OPV/IPV

MMRHemophilus Influenza Type

Hepatitis B

Varicella

Other (Specify):

: To be filled out by license physician Examination is acceptable when performed no more than 12 months prior to arrival at camp.

Code: S = SatisfactoryX = Not Satisfactory, Explain: O = Not examined

General Appearance: ________________________________________________________________________________ Height: __________ Weight: _________ Blood Pressure: _____________ Hgb Test (Date): ____________________Urinalysis: Date: _______________ Posture & Spine: _______________ Throat & Tonsils: ______________________ Eyes ________ Vision __________ W/ Glasses ____________ Extremities ___________ Heart ___________________ Ears ________ Hearing _________ Feet: _________ Lungs _______________ Skin __________________________Nose _____________ Teeth __________________ Abdomen _______________ Hernia _________________________Genitalia __________________________________________________________________________________________ Neurological Findings _______________________________________________________________________________ Describe Abnormal Findings and/or Handicapped Conditions _______________________________________________ __________________________________________________________________________________________________ Has child ever received products containing horse serum? __________________________________________________ Allergy: (Please specify) _____________________________________________________________________________

Recommendations and restrictions while in After-school: Special Diet: _______________________________________________________________________________ Special Medicine (Name it) ____________________________________________________________________ Is parent/guardian sending special medicine? ______________________________________________________ Swimming _________________________________ Diving _________________________________________ Activity Restrictions __________________________________________________________________________

General Appraisal: ____________________________________________________________________________________________________________________________________________________________________________________ __________________________________________________________________________________________________

I have examined the person herein described, reviewed his/her health history and it is my opinion that he/she is physically able to engage in Day Camp/Year Round Afterschool and Youth Center activities, except as noted above.

___________________________________MD _________________________________________________ Physician’s Name (PLEASE PRINT) Examining Physician’s Signature

Telephone: ____________________________ Address: _________________________________________ Date of Examination: ____________________ _________________________________________

14

REGISTRATIO

N &

PAYMEN

TREGISTRATION & PAYMENTPOLICY• The enclosed registration form must be submitted at theMembership Office at the Cross Island YMCA. Registrationbegins on February 1, 2011. You must register in person. • Prior to First Day of Camp you must provide a completedmedical form, which must be filled out by a doctor and signedby parent or guardian. Your child/children cannot attendcamp without this form. The forms are enclosed or availableonline.• To reserve a space, a non-refundable deposit of $100 persession must be submitted with the application. This paymentwill be applied to your child’s first week of camp. • $50 non-refundable registration fee is required for camperswho are not YMCA members at the time of registration. • Accepted forms of payment are cash or credit card. • Refunds - YMCA Day Camp fees are non-refundable. In theevent of illness or injury, a doctor's note would be necessaryfor withdrawal. • There will be a $25 (per change) transaction fee for anychanges made with regard to camp or transportation afterregistration is completed.

DISCOUNTS AND FINANCIAL ASSISTANCE • 10% Early Bird Registration Discount when registration iscompleted before Saturday, May 14.• 10% Sibling Discount - discount on camp and transportationrates applies to the second child from the same family livingin the same household. Only siblings qualify for the discount.The discount applies to the lowest fee. Cannot be combinedwith early bird discount.• Financial Aid is available to those that qualify. Applicationscan be obtained from the Member Registration Desk and aredue back to the desk by April 30.

TRANSPORTATION The Cross Island YMCA has partnered with the RivlabTransportation to provide our summer campers with the besttransportation service possible. Each bus will meet all DOTsafety requirements. Transportation to and from the CrossIsland YMCA is available only to campers in Recreational orSpecialty Camps (not Early Childhood Camp, contact directly)who attend regular hours (9:00am – 4:00pm). We do not offertransportation for our “Extended Hours” campers. The registration deadline for transportation service isTuesday, May 31. The Cross Island YMCA offers transportation within the follow-ing communities:

ABOUT YOUR Y DAY CAMPSTAFF • Staff are hired based on experience and commitment toworking with children from varied backgrounds. Lead coun-selors are at least 18 and have certification in CPR, First Aidand Water Safety. • All camp staff receives a minimum of 40 hours of pre-camptraining. Employment applications will be available at theMember Registration Desk beginning Feb. 1, 2011.

LUNCH • On trip days campers receive a cold lunch consisting of asandwich, fruit and a drink. Hot lunch is served on all otherdays. Lunches & menus are provided by the Department ofEducation. • Early Childhood Camp and Center will not provide lunch.Lunch must be provided by the parent or guardian of eachcamper.

SNACK • Snack must be provided by the parent or guardian of eachcamper. The Cross Island YMCA will not be distributing snacks.

WHAT TO BRING • It is suggested to wear shorts, sneakers and T-shirts. Forsafety purposes, do not wear skirts or sandals. • Bathing suit, bathing cap and towel are required on swimdays; however, it is recommended that swim items be broughtevery day. • Sunscreen and water bottles are also recommended. • Bathing caps are available for purchase at the MemberRegistration Desk. • Campers are to wear a camp shirt everyday. Campers willreceive two camp shirts on their first day. • Additional YMCA camp t-shirts available for purchase in thecamp office.

FAMILY NIGHTS • Occur on special dates throughout the summer. Informationwill be distributed to campers as it becomes available.

ArverneBaysideBelleroseCambria HeightsDouglastonElmontFar RockawayFloral ParkFlushingForest HillsFranklin Square

Fresh MeadowsGlen OaksHempsteadHollisJamaicaJamaica EstatesKew GardensLaureltonLittle NeckNew Hyde ParkOzone Park

Queens Village Rego ParkRochdaleRosedaleSt. AlbansSpringfieldGardensValley Stream West Hempstead

REGISTER

Non-ProfitOrganizationU.S. Postage

PAIDJamaica, NY

Permit No. 871

CROSS ISLAND YMCA238-10 Hillside Ave.Bellerose, NY 11426Tel: 718-479-0505 Fax: 718-468-9568Web: ymcanyc.org/crossisland

cross island day camp 2011

Documents

dance camp

tennis camp

sleepaway camp

camp dates

early childhood summer

teen trip camp

camp open housesaturday

indepth drama camp