dear campers and families, - merritt clubs · return them via fax, email or complete them online....

Dear Campers and Families,Welcome to Summer Camp 2016 at Merritt Athletic Clubs. If you are returning to our Summer Camp Programs, WELCOME BACK! If this is your first summer experience with us, then we want to thank you for giving Merritt Athletic Clubs the chance to make this the best summer ever for your child(ren). Merritt Athletic Clubs summer camps offer a wide variety of programs and events for a variety of ages and ensures that your child(ren) will have a summer to remember.

We specialize in letting kids be kids and we are thrilled that you have chosen to be a part of that experience. We have created this guide for all parents who would like to enroll their child(ren) in our programs. You will find exactly what to expect this summer as well as policies and procedures, general rules, enrollment forms and much more. If you have any concerns regarding our programs, please feel free to contact the camp director at the location your child will be attending and we will be happy to answer any questions you have.

To finalize your registration, all families must complete the attached forms and return them via fax, email or complete them online. Payment is due at the time of registration. Please ensure that the following information is complete.•Registration Agreement•2016 Registration Form•Emergency Contact•Medication Administration Authorization Form (DHMH 4758)•Emergency Care Plan (Allergies and Asthma – if applicable)•Camper Health History Form (DHMH 4768)

Please note your camp fees must be paid in full prior to the first of the month in which your child will be attending camp. Discounts only apply for camp payments made in full at the time of registration.

Please visit our website, www. Merrittclubs.com for additional information for Days Off, Day Camps and other programs offered for children throughout the year. We look forward to meeting you and your child(ren) and to having an exciting summer! Please feel free to contact the camp director at your club/program location with any questions.

Thank you again. We look forward to a great summer season!

Sincerely,

Maria MillerRegional Programs Director

http://merrittclubs.com/

TABLE OF CONTENTS1

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Canton Camps

Eldersburg Camps

TOWson Camps

White Marsh Camps

Registration Agreement

Registration Form

Emergency Contact and Health Info

Medical Administration Authorization

Emergency Care- Allergies

Allergy Action Plan

Asthma Action Plan

Our Goals:-Grow Personally

-Improve Personal and Social Relationships

-Appreciative Diversity

-Develop Skills

-Have Fun!

What to Bring:-Camp Bag (for personal belongings)

-Healthy snack(s) and lunch if applicable

-Sneakers (closed toe shoes)

-Bathing Suits and Towels

-Water Bottle

-Sunscreen

All Items MUST BE LABELED with child’s name (first and last name)Specialty Camps may require specific items – you will be notified on a case by case basis

Special treats/lunches may be provided by your camp – Please refer to your specific camp materials for more information.

ALL campers must be potty trained.

Camp Directors by Club:Canton- Mandy Sheckard, [email protected],410.563.0225

Eldersburg- Sherri Lively, [email protected],410.549.8855

Towson- 410.821.0160

White Marsh- Dianne Frager, [email protected], 410.773.9007

mailto:[email protected]



Camps by WeekAloha Summer - June 20th - 24th

Movie Week - June 27th - July 1st

Spirit Week - July 5th - 8th (Off July 4th)

Disney - July 11 - 15th

Science & Nature - July 18th - 22nd

Rockstar - July 25th - 29th

Olympics - August 1st - 5th

Sports & More - August 8th - 12th

Super Hero - August 15th - 19th

CANTON3401 Boston Street, Baltimore, MD 21224

410.563.0225

Camp Director: Mandy [email protected]

1


ALOHA SUMMER JUNE 20TH - 24TH Summer has begun and it’s time to welcome kids back to camp! This week will be filled with plenty of beach themed games and a luau on the last day of camp.

Member $239; Non Member $269

MOVIE WEEK JUNE 27TH - JULY 1ST Campers can wear their pajamas all week as we watch a variety of movies and play trivia games! There will be plenty of popcorn!


SPIRIT WEEK JULY 5TH - 8TH (NO CAMP JULY 4TH)This four day camp will feature a different theme each day. Themes include Red, White and Blue Day, Crazy Sock Day, Pajama Day, and Mismatch Day.


DISNEY JULY 11TH -15TH Experience the wonderful world of Disney! Inspired by all kids’ favorite Disney characters and movies, this camp will include activities to make all of their fairytale dreams come true!


SCIENCE & NATURE JULY 18TH - 22ND Our exciting science and nature-based theme emphasizes fun and provides hands-on experiences for campers to discover nature. Children will participate in educational activities all while having fun.


ROCKSTAR JULY 25TH - 29TH It’s time to Rock and Roll! We’ll celebrate each Rock Star’s moves and talent with a Jam Session at the end of the week!


OLYMPICS AUGUST 1ST - 5TH Get ready to go for the Gold as we teach children about the Olympics.


SPORTS & MORE AUGUST 8TH - 12TH Get ready, as we play a different sport each day. Don’t forget to wear the jersey of your favorite football team for Friday’s mini Superbowl!


SUPER HEROAUGUST 15TH -19TH BAM! POW! KAZAM! Activities include super games, super crafts and super fun! Where else can kids spend the day as their favorite character, meet other superheroes and save the world?


2

AGE JUNE 20TH-24TH

JUNE 27TH-JULY 1ST

JULY 5TH-8TH

JULY 11TH-15TH

JULY 18TH-22ND

JULY 25TH-29TH

AUGUST 1ST-5TH

AUGUST 8TH-12TH

AUGUST 15TH-19TH

4-6 Mini Splashers Pirate Island Mini Splashers Super Hero Splash

& Swim

Secret Agent Spy

Groovey Science

Watch Your

Dinner Grow

Fairy Tale

Super Hero

Mini Splashers

Jr. ZooKeeper

Planes Trains &

Automobiles

Beach

Mini Splashers

Dragon

6-10 Art Art

Dance

Cheer Dance Amazing Race Jr. American Girl

Game Show

Amazing Race Jr.

Cheer

Dance

American Girl

Art

Game Show

Dance

7-13 Sports & More

Splash & Swim

Sports & More

Splash & Swim

Sports & More

Jr. LifeGuard

Sports & More

Splash & Swim

Elite Basketball

Elite Soccer

Jr. Fitness

Splash & Swim

Sports & More

Triathlon

Sports & More

Jr. LifeGuard

Sports & More

Splash & Swim

Sports & More

Splash & Swim

8-11 Build Your Own CSI Camp

Musical Theater

Musical Theatre

Harry Potter

Cake-Tastic

Descendants

Build Your Own

Musical Theater

10-13 Art

Amazing Race Sr.

ELDERSBURG1388 Progress Way Eldersburg, MD 21784410.549.8855

Camp Director: Sherri [email protected]

Camps by Week

3


AGES 4-6BEACH CAMP - HALF DAY PMAUGUST 8TH -12TH (1PM-4PM)Come join us as we explore under the sea this summer in our half day beach camp. We will discuss sea creatures, participate in deep ocean adventures and play in the outdoor family fun pool. Swim vests/Puddle Jumpers or safety floatation devices are welcome.


DRAGON CAMP - HALF DAY PMAUGUST 15TH - 19TH (1PM-4PM)The magical world of Dragons has made its way to Merritt and we are ready to explore. Boys and girls will learn through imagination and crafts as we create and become the mystical creatures found in fairy tales.


FAIRY TALE - HALF DAY AMJULY 25TH -29TH (9AM-12PM)Every day, campers will experience a beloved princess through story, dance and crafts. This is a wonderful opportunity for your child to feel like a princess and inspire a love of dance.


GROOVY SCIENCE - HALF DAY AMJULY 18TH – 22ND (9AM-12PM)Become a groovy scientist as you participate in experiments and hands on demonstrations, while working alongside your friends. Every day campers will create hypothesis and draw conclusions as they investigate the science of the world they live in.


JR. ZOOKEEPER - HALF DAY PMAUGUST 1ST - 5TH (1PM - 4PM)Come experience a fun filled week of wild adventures. Campers will explore different animals and their habitats each day and at the end of the week they will receive a surprise visit from some of our furry, or not so furry friends!

Member - $159; Non Member – $189

MINI SPLASHERS- HALF DAY AMJUNE 20TH - 24TH, JULY 5TH - 8TH (NO CAMP ON

JULY 4TH), AUGUST 1ST -5TH & AUGUST 15TH -19THCampers must be potty trained to attend this camp. Give your child a Fun and Exciting swim experience. Campers will begin their day with fun water relay games that help work on endurance. They will also participate in a set of swim lessons every day. Campers will enjoy scavenger hunts, crafts and group games in and out of the water

Member $174; Non Member $204Week of July 4th: $139 Members; $159 Non Members

PIRATE ISLAND JUNE 27TH -JULY 1STCampers must be potty trained to attend this camp. Argghhh….Matey’s come join Peck the Parrott for a fun filled day of many pirate adventures! Campers will participate in treasure hunts, create their own bandanna, walk the plank and make their own treasure maps. X marks the spot this summer at Pirate Island Camp.


PLANES, TRAINS AND AUTOMOBILES - HALF DAY AMAUGUST 8TH - 12TH (9AM -12PM)Take an adventure with us as we race, conduct, soar and float along through the world of motion. Campers will create crafts, ride the rails, be a part of a pit crew and build a life size boat in a week full of movement and creativity.


4

SECRET AGENT SPY - HALF DAY PMJULY 11TH - 15TH (1PM - 4PM)Attention Boys and Girls! Your Mission… should you choose to accept it… is to train as a Secret Agent with your friends. Please report to Spy Camp at Merritt Athletic Clubs for a thrilling creative week of solving mysteries and using your skills as you decode the riddle in an all out scavenger hunt!


SUPER HERO - HALF DAY PMJULY 25TH -29TH (1PM - 4PM)Become a superhero for the afternoon with this dynamic camp. Kids will participate in relays, obstacle courses, fitness tests and games. Every day there will be a themed craft to add to the fun. Your child will learn about their favorite superheroes and embark on an adventure each day!


SUPERHERO SPLASH & SWIM- HALF DAY AMJULY 11TH -15TH( 9AM-12PM)Come join us for a fun filled week of super heroes under the sea! Swim, Splash & Swim and soar through this camp. Get you own super swimming powers with a set of swim lessons every day.


WATCH YOUR DINNER GROW - HALF DAY PMJULY 18TH – 22ND (1PM - 4PM)It’s time to take a real look at what we put in our bodies and what it can do for us! Campers will learn about basic food groups and healthy eating as well as get hands on experience with growing food, creating fun snacks and testing a multitude of fruits and vegetables in basic and not so basic ways.


AGES 6-10AMAZING RACE JR. JULY 18TH - 22ND & AUGUST 1ST - 5THTime to travel around the world! Kids will work together in teams to complete physical and mental challenges as they try to outsmart, outpace and compete to win in a multitude of different countries.


AMERICAN GIRL JULY 25TH - 29TH & AUGUST 8TH -12THWhat does it mean to be an American Girl? Girls will discover themselves and learn how they can make a difference wherever they are through the stories and characteristics of the beloved American Girl Doll collection. Don’t forget to bring your doll!


ART CAMPJUNE 20TH - 24TH, JUNE 27TH - JULY 1ST & AUGUST 8TH - 12THArt camp encourages children to let out their inner artist, regardless of their ability. We’ll foster individual expression while teaching new skills, ideas and techniques. There will be an art show at the end of the week to display the talented camper’s efforts.


CHEER CAMPJULY 5TH - 8TH (NO CAMP JULY 4TH) & AUGUST 1ST-5THCampers get ready to get your “Cheer On” and learn all there is to know about being a cheerleader. Basic fundamentals of cheerleading – jumps, chants, dances, and safety as well as campers will learn Pom and Dance routines. Week of July 4th: Member $207; Non Member $231

August 1st-5th:Member $259; Non Member $289

5

DANCE CAMPJUNE 27TH - JULY 1ST, JULY 11TH - 15TH, AUGUST 1ST - 5TH & AUGUST 15TH - 19THThis camp is for children that love to dance and want explore all different types of dance. Technique in the studio will vary daily and students can expect to learn a variety of different dance styles. Along with dancing, everyday will include a craft and pool time. At the end of each week, there will be a performance for family and friends!


GAME SHOW WEEKJULY 25TH - 29TH & AUGUST 8TH - 12THTry your skills as we jump into the screen and compete! Spin the Wheel of Fortune, test your knowledge in Jeopardy and be ready to race in a life sized Bop-It competition.


AGES 7-13ELITE BASKETBALL CAMP- HALF DAY AMJULY 18TH - 22ND (9AM -12AM)Learn the fundamentals of the game along with introductory to advanced skills development. Campers will participate in skills to improve speed, agility, and endurance while incorporating strength training, plyometrics and coordination.


ELITE SOCCER CAMP-HALF DAY AMJULY 18TH - 22ND (9AM -12AM)Learn the fundamentals of the game along with introductory to advanced skills development. Campers will participate in skills to improve speed, agility, and endurance while incorporating strength training, ball handling skills, kicking and dribbling techniques.


JUNIOR FITNESS CAMP- HALF DAY PMJULY 18TH - 22ND (1PM - 4PM)It’s time to get off the couch and out from behind the electronic devices and move, move move! Campers will learn the importance of health and exercise in a fun and safe environment. Proper nutrition, body image, exercise safety and lots of “working the muscles” will take place every afternoon!


JUNIOR LIFEGUARDJULY 5TH - 8TH (NO CAMP JULY 4TH) & AUGUST 1ST-5THCampers will be taught water safety rules, basic boating safety and skills to assist a distressed swimmer. Swimming skills will also be taught and practiced as part of this camp as well as rescue skills and proper use of safety equipment.Campers must be able to swim independently in deep water.

Week of July 4th: Member $179; Non Member $199


SPLASH & SWIM CAMPJUNE 20TH - JUNE 24THJUNE 27TH - JULY 1ST SHARK WEEKJULY 11TH - 15TH SURVIVAL WEEKJULY 18TH - 22ND AUGUST 8TH - 12TH OLYMPIC WEEKAUGUST 15TH - 19TH Campers should be able to swim independently in deep water. Campers will enjoy playing water games, scavenger hunts and participate in team competitions. Campers will also receive swim lessons throughout the camp to improve stroke techniques, and increase endurance/speed.


6

SPORTS & MOREJUNE 20TH - 24TH (Featured Sport- Basketball)JUNE 27TH - JULY 1ST (Featured Sport- Soccer)JULY 5TH - 8TH (No camp on July 4th) (Featured Sport – Backyard Games)JULY 11TH - 15TH (Featured Sport- Lacrosse)JULY 25TH - 29TH (Featured Sport- Indoor and Outdoor Hockey)AUGUST 1ST - 5TH (Featured Sport- Baseball and Football)AUGUST 8TH - 12TH – Olympic WeekAUGUST 15TH - 19TH (Round Robin – a different sport featured every day)

Children will learn the basics of basketball, soccer, football and baseball while playing games in each sport. Campers should dress comfortably and must wear sneakers.


Week of July 4th Member $192; Non Member $216

Daily Rate – Member $54; Non Member $60

TRIATHLON CAMPJULY 25TH - 29THCampers should be able to swim independently in deep water. Campers will be taught the basics of endurance swimming, biking and running using our indoor and outdoor areas. At the end of the week campers will have the option to compete in an indoor triathlon to show off their skills.


AGES 8-11BUILD YOUR OWN

JUNE 27TH - JULY 1ST & AUGUST 15TH - 19THIt’s time to think outside of the box and find new ways to make things work. Children will explore different types of construction through multiple mediums and finishing techniques in one on one and team projects.


CAKE-TASTICJULY 25TH - 29THTime to take your decorating skills to the next level. This camp will challenge your little Cake Boss to create, design and compete in the world of sugar and spice!


CSI CAMP

JULY 5TH - 8TH (NO CAMP JULY 4TH)Interested in problem solving, evidence collecting, and how a crime scene works? Campers will learn the art of crime solving as they learn about fingerprints, trace evidence, handwriting analysis and deductive reasoning as they figure out “who dunnit” in a week long investigation.


DESCENDANTSJULY 25TH - 29THWhat would happen if Disney’s creepiest villains all had a child? Come find out as we explore the Isle of the Lost, get into a little mischief and try to win our way back to Auradon Prep school with Mal, Evie, Jay and Carlos.


HARRY POTTERJULY 18TH - 22NDWelcome to the world of Hogwarts! Take a magical journey with us from Platform 9 3/4 to the great hall and Diagon Alley. From Olivanders to Quiddich Pitch, the week will be one magical adventure after another.


7

MUSICAL THEATERJULY 5TH - 8TH (NO CAMP JULY 4TH), JULY 18TH - 22ND & AUGUST 15TH - 19THFor children who love to sing, act and dance, this camp allows students to learn techniques through games and scene study. Students will also study improv; learn theater terminology and much more! At the end of the week, family and friends are invited to see a performance that will showcase the week’s accomplishments. Member $259; Non Member $289 Week of July 4th PriceMember $208; Non Member $232

AGES 10-13AMAZING RACE SR. JULY 11TH - 15THTime to travel around the world! Kids will work together in teams to complete physical and mental challenges as they try to outsmart, outpace and compete to win in a multitude of different countries.


ART CAMP

JULY 11TH - 15THThis creative camp encourages older kids to explore their inner artist, regardless of their ability. We’ll foster individual expression while teaching new skills, ideas and techniques. There will be an art show at the end of the week to display the talented camper’s efforts.


8

AGE JUNE 27TH-JULY 1ST

JULY 5TH-8TH

JULY 11TH-15TH

JULY 18TH-22ND

JULY 25TH-29TH

AUGUST 1ST-5TH

AUGUST 8TH-12TH

AUGUST 15TH-19TH

4 Mini-Kickers Mini-Kickers

5 Karate

American Girl

Mini-Kickers

Spy

Dance

Karate

Disney

Tumbling Mini-Kickers

6 Karate

American Girl

Splash & Swim

Diva

Amazing Race

Mini-Kickers

Spy

Dance

Karate

Disney

Splash & Swim

Tumbling

Mini-Kickers

Diva

Karate

Nature

Splash & Swim

Cheer

7 Karate

Sports & More

American Girl

Splash & Swim

Diva

Amazing Race

Spy

Dance

Karate

Science

Disney

Splash & Swim

Tumbling

Sports & More

Fit and Fun

Diva

Karate

Nature

Splash & Swim

Cheer

Sports & More

8 Jr.Lifeguard

Karate

Sports & More

American Girl

Splash & Swim

Diva

Amazing Race

Spy

Dance

Jr.Lifeguard

Karate

Science

Disney

Splash & Swim

Tumbling

Sports & More

Fit and Fun

Diva

Jr.Lifeguard

Karate

Nature

Harry Potter

Splash & Swim

Cheer

Sports & More

9 Jr.Lifeguard

Karate

Sports & More

American Girl

Splash & Swim

Diva

Amazing Race

Spy

Dance

Jr.Lifeguard

Karate

Science

Disney

Splash & Swim

Tumbling

Sports & More

Fit and Fun

Diva

Jr.Lifeguard

Karate

Nature

Harry Potter

Splash & Swim

Cheer

Sports & More

10 Jr.Lifeguard

Karate

Sports & More

American Girl

Splash & Swim

Diva

Amazing Race

Spy

Dance

Jr.Lifeguard

Karate

Science

Disney

Splash & Swim

Tumbling

Sports & More

Fit and Fun

Diva

Jr.Lifeguard

Karate

Nature

Harry Potter

Splash & Swim

Cheer

Sports & More

11 Jr.Lifeguard

Karate

Sports & More

American Girl

Splash & Swim

Diva

Amazing Race

Elite Soccer Jr.Lifeguard

Karate

Science

Disney

Splash & Swim

Sports & More

Tumbling

Fit and Fun

Diva

Jr.Lifeguard

Karate

Nature

Harry Potter

Splash & Swim

Cheer

Sports & More

12 Jr.Lifeguard

Karate

Sports & More

American Girl

Splash & Swim

Diva

Amazing Race


Karate

Science

Disney

Splash & Swim

Sports & More

Tumbling

Fit and Fun

Diva

Jr.Lifeguard

Karate

Harry Potter

Nature

Splash & Swim

Cheer

Sports & More

13 Jr.Lifeguard

Karate

Sports & More

American Girl

Diva

Amazing Race

Splash & Swim


Karate

Science

Disney

Sports & More

Tumbling

Spash & Swim

Fit and Fun

Diva

Jr.Lifeguard

Karate

Harry Potter

Nature

Cheer

Sports & More

Spash & Swim

TOWSON8757 Mylander Lane, Towson, MD 21286410.821.0160

Camps by Week

9

AGES 3.5-6MINI-KICKERS-HALF DAY AMJULY 11TH - JULY 15TH (PIRATE ISLAND THEME) &

AUGUST 1ST - AUGUST 5TH (USA THEME)Campers will begin their day with water games that will incorporate tips on needed swim skills. They will also get a set of lessons every day mixed with crafts and group games outside of water. Campers must be potty trained to attend this camp.


AGES 5-13AMERICAN GIRL JUNE 27TH - JULY 1STDescription: Each day is focused on a different American Girl and her story. All activities, games, and crafts are centered on the American Girl for the day. Campers should bring a doll (not required).

Full Day: Member $259; Non Member $289Half Day: Member $179; $209

DANCEJULY 11TH - JULY 15THOur little dancers will learn the basics of ballet and tap as well as proper technique.


DISNEY MAGICJULY 18TH - 22NDChildren will experience some “Disney Magic” at this camp! The camp will include crafts, games, and lots of fun.


KARATE AND MORE JUNE 27TH - JULY 1ST, JULY 18TH - 22ND & AUGUST 8TH - 12THCampers will learn the basic techniques of the traditional Japanese style of martial arts, Seido Karate. They will work on practical self-defense, work on conditioning and endurance and learn drills and games that work on motor skill improvement.

Full Day: Member $319; Non Member $369 Half Day: Member $189; Non Member $209

SECRET AGENT SPYJULY 11TH - JULY 15THChildren will “transform” into secret agent spies! We will host a variety of games, obstacle courses, “secret missions” and arts and crafts.


TUMBLING JULY 25TH - JULY 29THChildren will learn the basic principles of dynamic movements through the basics of tumbling and mat work.


10

AGES 6-13AMAZING RACE JULY 5TH - JULY 8TH- NO CAMP JULY 4THTime to travel the world. Kids will work together in teams to complete physical and mental challenges as they try to outsmart, outpace and compete to win in a variety of different countries.

Member $207; Non-member $231

CHEER CAMP AUGUST 15TH - AUGUST 19THCampers get ready to get your cheer on! They will learn all there is to know about being a cheerleader from jumps to chants to dances and safety.


DIVAJULY 5TH - JULY 8TH & AUGUST 1ST - AUGUST 5THCome join us for a “divaliscious” experience! This camp will include crafts, nail painting, dancing, games and much more. We will also hold a runway show on Friday of each camp.


Week of July 5TH -8TH (Full Day Only):Member $192; Non Member $216

NATURE EXPLORATIONAUGUST 8TH - AUGUST 12THCampers will learn about plants and animals native to Maryland. They will participate in scavenger hunts, planting and explore outside.


SPLASH & SWIM JULY 5TH - JULY 8TH (SHARK WEEK THEME), JULY 25TH - JULY 29TH (PIRATE ISLAND THEME) & AUGUST 15TH - 19TH (USA THEME)Campers will enjoy playing water games, scavenger hunts and participate in team competitions. Campers will also receive swim lessons throughout the camp to improve stroke techniques, and increase endurance/speed.Campers must be able to swim independently in deep water to enroll.


Week of July 5TH -8TH (Full Day Only):Member $192; Non Member $216

AGES 7-13FIT AND FUN AUGUST 1ST - AUGUST 5THCampers will learn healthy living skills including exercise and healthy meal preparation.

Full Day: Member $259; Non Member $289Half Day: Member $179; Non Member $209

SPORTS & MOREJUNE 27TH - JULY 1ST, JULY 25TH-29TH & AUGUST 15TH - 19THChildren will learn the basics of basketball, soccer, football and baseball while playing games in each sport. Campers should dress comfortably and must wear sneakers.


SUPER SCIENCEJULY 18TH - JULY 22NDWe will explore the wonders of science through experiments, “field trips” at the gym and science projects.


11

12

AGES 8-13HARRY POTTER AUGUST 8TH - AUGUST 12THWelcome to the world of Hogwarts! Take a magical journey with us from Platform 9 ¾ to the great hall and Diagon Alley. The week will be one magical adventure after another.


JUNIOR LIFEGUARDJUNE 27TH - JULY 1ST, JULY 18TH - JULY 22ND &AUGUST 8TH - AUGUST 12TH Campers will be taught water safety rules, basic boating safety and skills to assist a distressed swimmer. Swimming skills will also be taught and practiced as part of this camp as well as rescue skills and proper use of safety equipment.Campers must be able to swim independently in deep water to attend this camp.


AGES 11-13ELITE SOCCER CAMPJULY 11TH - JULY 15THCampers will participate in drills to improve speed, agility and endurance while taking their ball-handling and kicking skills to the next level.


AGE JUNE 20TH-24TH

JUNE 27TH-JULY 1ST

JULY5TH-8TH

JULY11TH-15TH

JULY18TH-22ND

JULY25TH-29TH

AUGUST1ST-5TH

AUGUST8TH-12TH

AUGUST15TH-19TH

3.5 Disney Mini- Kickers

Dance Disney

Mini-Kickers

Mini-Kickers Mini-Kickers

Dance

Disney Mini-Kickers

4 Disney

Diva

Mini Kickers

Dance Diva

Spy

Disney

Mini Kickers

Tumbling Diva

Mini Kickers

Spy

Dance

Diva

Mini Kickers

Disney Diva

Mini Kickers

5 Disney

Diva

Mini Kickers

Sports & More

Dance

Fit & Fun

Diva

Spy

Disney

Mini Kickers

Sports & More

Fit & Fun

Tumbling

Diva

Mini Kickers

Sports & More

Spy

Dance

Diva

Mini Kickers

Sports & More

Spy

Disney

Sports & More

Diva

Mini Kickers

6 Disney

Diva

Mini Kickers

Splash & Swim

Sports & More

Dance

Fit & Fun

Science

Splash & Swim

Diva

Splash & Swim

Spy

Disney

Mini Kickers

Science

Sports & More

Fit & Fun

Splash & Swim

Tumbling

Diva

Mini Kickers

Splash & Swim

Sports & More

Spy

Dance

Diva

Mini Kickers

Sports & More

Spy

Disney

Splash & Swim

Sports & More

Diva

Mini Kickers

Science

Splash & Swim

Spy

7 Disney

Diva

Mini Kickers

Splash & Swim

Sports & More

Dance

Fit & Fun

Science

Splash & Swim

Diva

Splash & Swim

Spy

Disney

Mini Kickers

Science

Sports & More

Fit & Fun

Splash & Swim

Tumbling

Diva

Mini Kickers

Splash & Swim

Sports & More

Spy

Dance

Diva

Mini Kickers

Sports & More

Spy

Disney

Splash & Swim

Sports & More

Diva

Mini Kickers

Science

Splash & Swim

Spy

8 Diva

Splash & Swim

Sports & More

Dance

Fit & Fun

Science

Splash & Swim

Diva

Harry Potter

Splash & Swim

Spy

Jr. LifeGuard

Science

Sports & More

Fit & Fun

Splash & Swim

Tumbling

Diva

Splash & Swim

Sports & More

Spy

Dance

Diva

Jr. LifeGuard

Sports & More

Spy

Splash & Swim

Sports & More

Diva

Science

Splash & Swim

Spy

9 Splash & Swim

Sports & More

Dance

Fit & Fun

Science

Splash & Swim

Harry Potter

Splash & Swim

Jr. LifeGuard

Science

Sports & More

Fit & Fun

Splash & Swim

Tumbling

Splash & Swim

Sports & More

Dance

Jr. LifeGuard

Sports & More

Splash & Swim

Sports & More

Science

Splash & Swim

10 Splash & Swim

Sports & More

Dance

Fit & Fun

Science

Splash & Swim

Harry Potter

Splash & Swim

Jr. LifeGuard

Science

Sports & More

Fit & Fun

Splash & Swim

Tumbling

Splash & Swim

Sports & More

Dance

Jr. LifeGuard

Sports & More

Splash & Swim

Sports & More

Science

Splash & Swim

11 Splash & Swim

Sports & More

Dance

Fit & Fun

Science

Splash & Swim

Harry Potter

Splash & Swim

Jr. LifeGuard

Science

Sports & More

Fit & Fun

Splash & Swim

Tumbling

Splash & Swim

Sports & More

Dance

Jr. LifeGuard

Sports & More

Splash & Swim

Sports & More

Science

Splash & Swim

12 Splash & Swim

Sports & More

Dance

Fit & Fun

Science

Splash & Swim

Harry Potter

Splash & Swim

Jr. LifeGuard

Science

Sports & More

Fit & Fun

Splash & Swim

Tumbling

Splash & Swim

Sports & More

Dance

Jr. LifeGuard

Sports & More

Splash & Swim

Sports & More

Science

Splash & Swim

13 Splash & Swim

Sports & More

Dance

Splash & Swim

Splash & Swim Jr. LifeGuard

Sports & More

Splash & Swim Splash & Swim

Sports & More

Dance

Jr. LifeGuard

Sports & More

Splash & Swim

Sports & More

Splash & Swim

14 Splash & Swim

Sports & More

Dance

Splash & Swim

Splash & Swim Jr. LifeGuard

Sports & More

Splash & Swim Splash & Swim

Sports & More

Dance

Jr. LifeGuard

Sports & More

Splash & Swim

Sports & More

Splash & Swim

WHITE MARSH5301 Campbell Blvd., White Marsh, MD 21236410.773.9007Camp Director: Dianne [email protected]

Camps by Week

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AGES 3.5 - 7DISNEY MAGICJUNE 20TH - 24TH, JULY 11TH - 15TH & AUGUST 8TH - 12THChildren will experience some “Disney Magic” at this camp! The camp will include crafts, games, and lots of fun.


MINI-KICKERS - HALF DAYJUNE 20TH - 24TH, JULY 11TH - 15TH, JULY 25TH - 29TH, AUGUST 1ST - 5TH & AUGUST 15TH - 19THCampers will begin their day with water games that will incorporate tips on needed swim skills. They will also get a set of lessons every day mixed with crafts and group games outside of water. Campers must be potty trained.

Member $174; Non-member: $204

AGES 4 AND UPDANCE CAMPJUNE 27TH - JULY 1ST & AUGUST 1ST - 5THDancers will learn basics of Ballet and Tap as well as technique.

Members $259; Non-members $289

DIVAJUNE 20TH - 24TH, JULY 5TH - 8TH, JULY 25TH - 29TH, AUGUST 1ST - 5TH & AUGUST 15TH - 19THCome join us for a diva liscious experience! The week will include diva crafts, nails, dancing, games, and much more.


Week of July 4th:Member $192; Non Member $216

SECRET AGENT SPY CAMPJULY 5TH - 8TH, JULY 25TH - 29TH, AUGUST 1ST - 5TH & AUGUST 15TH - 19THChildren will “transform” into secret agent spies! The camp will include a variety of games, obstacle courses, “Secret Missions”, and Spy arts and crafts

Full day: Member $239; Non Member $269Half day: Member $159; Non Member $189


TUMBLING CAMPJULY 18TH - 22NDChildren will learn basic principles of dynamic movement through the basics of tumbling and much more.


AGES 5 AND UPFIT AND FUNJUNE 27TH - JULY 1STCampers will learn healthy living skills including exercise and healthy meal preparation.

Members $259; Non Members $289

SPORTS & MORE

JUNE 20TH - 24TH, JULY 25TH - 29TH, AUGUST 1ST - 5TH, AUGUST 8TH - 12TH Children will learn the basics of basketball, soccer, football and baseball while playing games in each sport. Campers should dress comfortably and must wear sneakers.

Full day: Member $239; Non Member $269Half Day: Member $159; Non Member $189

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AGES 6 AND UPSCIENCE CAMPJUNE 27TH - JULY 1ST, JULY 11TH - 15TH & AUGUST 15TH - 19THWe will explore the wonders of science through experiments, “field trips” at the gym, science projects and much more.


SPLASH & SWIM JUNE 20TH - 24TH, JUNE 27TH - JULY 1ST, JULY 5TH - 8TH, JULY 18TH - 22ND, JULY 25TH - 29TH, AUGUST 8TH - 12TH & AUGUST 15TH - 19THCampers will enjoy playing water games, scavenger hunts and participate in team competitions. Campers will also receive swim lessons throughout the camp to improve stroke techniques, and increase endurance/speed.Campers must be able to swim independently in deep water to enroll.

Members $269 Non-members $289


AGES 8 AND UPJUNIOR LIFEGUARDJULY 11TH - 15TH, AUGUST 1ST - 5TH Campers will be taught water safety rules, basic boating safety and skills to assist a distressed swimmer. Swimming skills will also be taught and practiced as part of this camp as well as rescue skills and proper use of safety equipment.Campers must be able to swim independently in deep water.


HARRY POTTER JULY 5TH - 8THWelcome to the world of Hogwarts! Take a magical journey with us from Platform 9 ¾ to the great hall and Diagon Alley. The week will be one magical adventure after another.


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REGISTRATION AGREEMENTEach camper attending Merritt Summer Day Camps must submit all the required paperwork one week prior to camp start date. Any forms that are submitted incomplete will be rejected and child will not be registered until all completed forms are submitted. Late fees will apply if a registration is rejected and not resubmitted prior to the on time registration deadline. Forms Required: -Registration Form -Emergency Contact & Camper Health History Form (DHMH 4768) -Medication Administration Authorization Form (DHMH 4758) (IF APPLICABLE) -Emergency Care Plan (Allergies and Asthma- IF APPLICABLE)

LATE REGISTRATIONAll registrations made after 5pm Sunday the week (7 days) BEFORE a camp week starts will be assessed a $40 late registration fee.

_________INITIALS OF PARENT/GUARDIAN

CANCELLATION / CHANGE POLICYIf you must cancel for any reason before June 1, 2016 your registration will be refunded less a $50 processing fee per week. Cancellations after June 1, 2016 will be refunded half of your registration. Cancellations must be received in writing at least 14 days prior to the start of your camp week; otherwise a refund will not be available.


CAMP CHANGESMerritt Athletic Clubs requires in writing any changes of camp choice one week prior to the camp to be attended. There will be a $20 change fee for all camp changes made. Camp changes made during the week of camper attendance are subject to a 24 hour change policy prior to when the camper is allowed to attend the new camp and a $40 change fee.


PAYMENT OPTIONS / DISCOUNTS-Early Bird Discount - Register and pay in full by March 31st to receive a 20% savings on camp. This savings does not apply to before and after care, swim lessons or camp lunches.

-Employee Discount – Employees of Merritt Athletic Clubs and Merritt Properties receive a 20% savings on camp registrations for their direct family members only. This savings does not apply to before and after care, swim lessons or camp lunches and cannot be combined with any other promotional discounts.

- Please note, discounts cannot be combined. This includes but is not limited to any promotional discounts received at Merritt Events or Merritt Sponsored Activities.

-Before and After Care – Before Care and After Care are an additional fee of $10 PER DAY or $40 PER WEEK per camper. Pricing is for both before and after care combined and cannot be pro-rated for partial care on any given day or week. Before Care begins at 7:30am and runs until camp begins at 9:00am daily. Aftercare begins at 4pm and runs until 6pm daily.

I have read and understand Merritt Athletic Clubs payment policy. I acknowledge that all payments in full, or on a payment plan, must be made on or before the first of the month of the camp that my child will attend. I understand that my child is not fully registered for the camp program until I make payment on the account and receive a confirmation email that payment has been made.


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CAMP RULES-Each camper is responsible for his/her own behavior. If your child is having difficulty with another camper, we ask that you help us in reminding your child to seek a camp staff member and allow them to assist in solving the problem.-Any acts of aggression, either provoked or otherwise, will not be tolerated and could result in camp suspension.-Each camper is expected to respect direction from any member of the camp staff, the first time.-Each camper is expected to use appropriate language at all times.-Our camper disciplinary policy is as follows: -Verbal warning with explanation given -Time away from the scheduled activity -Written incident report -Parent conference with possible suspension from the camp program -Removal from camp program without a refund of camp payment-Camper will not be permitted if experiencing any of the following: -Vomiting - Diarrhea -100+ degree in temperature - Suspicious rash - Any communicable disease (chicken pox, strep throat, ring worm, lice, etc.)


LUNCH PROGRAMParents must send their campers with a bag lunch or purchase a lunch package. Due to limited refrigeration and kitchen appliances’, please do not send items that require refrigeration or that may need to be heated. Please be sure that your child’s lunch box or bag is labeled with camper’s full name. *Certain locations will have the option to add the on-site lunch program to your child’s camp week. Monthly lunch calendar is available. Choose this program by the day or by the week. Food orders must be placed Monday thru Friday the week prior to the camp attending. Daily camp lunch fee $6 per day.


CLOSINGS AND EARLY DISMISSALSI acknowledge that there will be no reduction of fees for emergency closings, or if the site is forced to closed early or for an extended period of time due to circumstances beyond Merritt Athletic Clubs control (ie. A water main break, power outage, severe/inclement weather, etc).


CUSTODY ISSUESIf there are any custody issues, the parent will provide a court order indicating who is the custodial parent/guardian and the names of anyone in which the staff should NOT release the child. It should be noted that there is one account for each family. If the account is outstanding, regardless of whose responsibility it is to make a payment, then care may be suspended or terminated. We expect parents to communicate with each other and that they refrain from placing our staff in the middle of any custody issues. Failure to do so could result in immediate termination.


SIGN IN AND SIGN OUTChildren must be accompanied into and out of the program space by a parent or authorized adult(that is listed on the Emergency Contact Form and at least 18 years of age or older) at all times. An authorized adult must sign the in/out roster and may be required to present a photo ID to ensure that this safety regulation is enforced.


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EARLY ARRIVALMerritt Athletic Clubs Summer Camp Program Before Care begins promptly at 7:30am. A parent/guardian is required to accompany their camper until this time if they are on Merritt Athletic Clubs property. Campers are not allowed to be dropped off prior to this time. Merritt Athletic Summer Camp Program camp days begin at 9:00am. Campers who are not registered in before/after care are allowed to be dropped off between 8:45am and 9:00am. Campers who are not registered for before/after care and are dropped off prior to 8:45am will be charged the before/after care daily rate of $10 per child. All campers must be signed in daily by a parent or legal guardian before being left for camp. A photo ID may be required when dropping a child off for camp. Campers with medicine will be directed to the medical personnel on hand or authorized staff to fill out the required Medication Administration Authorization Form prior to camper being allowed to enter camp.


LATE PICK UPMerritt Athletic Clubs Summer Camp Program closes promptly 4:00pm and After Care at 6:00pm. Parents are considered late if the child had not been picked up by that time (regardless of the reason). Any parent arriving late will be charged a late fee of $5 per child for every 5 minute increment or fraction thereof. There is no cut off time for this fee and the authorities will be notified for any children remaining past 7:00pm. Repeated lateness could cause dismissal from the program. Payment for late fees is due within 24 hours of the date of late pick up – late payment fees and suspensions for non-payment may apply.


FORMS AND ACCOUNT INFORMATIONIt is the parent/guardian’s responsibility to notify staff of any medical information pertinent to their child’s health, safety and well being; and to provide updated medical records as necessary. It is the responsibility of the parent/guardian to keep telephone and emergency information updated in their child’s account with the camp directors or assistant directors.


MEDICATION SELF-ADMINISTRATIONSMerritt Athletic Club camps strongly encourage participants’ self-responsibility for personal health, including personal care and medications. We ask that whenever possible, participants take their medication before or after, rather than during programming. Please understand that Merritt Athletic staff will supervise self-administration of medication to participants only in situations that are absolutely necessary for a participant’s health. Authorized staff will only supervise self-administer medications during registered programs that are two hours or greater provided that the Medical Authorization Form (see attached-DHMH 4758) is completed.

REQUIREMENTS: PARENT/LEGAL GUARDIAN MUST-Complete, sign and have a licensed medical professional review and sign the Medical Authorization Form (DHMH 4758) and turn it in with registration. All specific instructions for medication must be included and Merritt Athletic Clubs has the right to refuse admission to any camp without required completed information.- Personally deliver all medication to the authorized staff in the original container. The container must include the pharmaceutical or over-the-counter manufacturer’s instructions to include: person’s name, medication, dosage, and time of day medication is to be administered.-Verify with authorized staff the amount of medication (i.e, 10 pills, half of 8oz. bottle) noted below.-Only send the amount of medication needed for the duration of the current program registration, not to exceed two weeks of time.-If pill tablets must be divided in order to administer the correct dosage, this must be done at home before bringing to the program.-Upon arrival to camp, DHMH form 4759 (Medication Administration Form) is signed with all necessary information. -All medications must be picked up at the end of the week and the DHMH form 4760 must be signed.


PERMISSION TO ADMINISTER MEDICATION & WAVIER RELEASE OF ALL CLAIMSPlease read this form carefully and be aware that you will be expressly assuming the risk of legal liability and waving and releasing all claims for injuries, damages or loss which you or your minor child/ward might sustain in connection with self-administration or use of medication at Merritt Athletic Clubs Camp program or facility.


PERMISSION TO ADMINSTER MEDICATIONMerritt will not allow for self-administration of medication to a minor child or other participant unless this permission and waiver to administer medication has been fully completed, signed and initialed by a parent or guardian and reviewed and signed by a licensed medical professional. I understand that it is my responsibility to ensure the medication is given directly to Merritt staff in original prescription containers clearly labeled with the following information: Participant’s name, name of medication, and complete dosage instructions.

________INITIALS OF PARENT/GUARDIAN18

SELF ADMINISTRATION OF MEDICATIONAs parent/guardian of the below identified participant, I verify and attest that my child/ward has the knowledge and skills to safely self-administer medication in a camp setting under adult supervision.

If after administering medication there is an adverse reaction, I understand that Merritt Athletic Club staff will secure from any licensed hospital, physician and/or medical personnel any treatment deemed necessary for immediate care. I agree to be responsible for payment of any and all medical services rendered. I also recognize and acknowledge that there are certain risks of physical injury to participants’ regarding self-administration, or use of medication, and I voluntarily agree to assume the full risk of any and all injuries, damages or loss regardless of severity that my minor child/ward or I may sustain as a result of said self-administration or use of medication. Such risks include, but are not limited to, physical reaction, failing to assess and/or recognize a medical emergency, and failing to recognize the need to summon emergency medical services. I further agree to waive and relinquish all claims I or my minor child/ward may have as a result of or arising out of the self- administration, or use of medication against Merritt Athletic Club, including its officials, agents, volunteers and employees. I further agree to protect, indemnify, save, defend and hold harmless Merritt Athletic club from and against any and all liabilities, obligations, claims, damages, penalties, causes of action, costs and expenses (including reasonable attorney fees) for which Merritt Athletic clubs may become obligated by reason of the possession, self-administration, or use of medication. I further understand that Merritt Athletic Clubs camp medical director reserves the right to deny self-administration of medication. If the child is deemed unable to safely perform these actions, the medical director regarding these issues with self-administration of medication will contact me.


SUNSCREEN APPLICATIONMerritt Athletic Clubs encourages the application of sunscreen daily on all campers prior to the camper attending camp for the day. Merritt Athletic Clubs suggests that all campers bring their own labeled sunscreen to re-apply throughout the day during designated sunscreen application times as well as on an as needed basis. I recognize that Merritt Athletic Clubs will only assist with the application of spray sunscreen if needed by a camper. If assistance is needed, please indicate brand of sunscreen and sign below to authorize application assistance by a Merritt Athletic Clubs employee. I agree to obtain a physicians note for any allergies my child may have to any brand or type of sunscreen. I am aware that although the Office of Environmental Health and Food Protection no longer considers sunscreen a medication requiring a prescriptive order, Merritt Athletic Clubs does require such information if a specific type or brand of sunscreen is required for my child and my child needs assistance with applying the specific sunscreen noted.

Childs Name ______________________________ Brand of Sunscreen ____________________________I give Merritt Athletic Clubs authorization to apply the above noted sunscreen brand to my child if deemed necessary. I will supply a labeled container of sunscreen.


MEDICAL AND EMERGENCY INCIDENTS AUTHORIZATIONIf a medical emergency arises, the Merritt Athletic Clubs staff will first contact 911 if needed, then the staff will attempt to contact the parent/guardian. If the parent or guardian cannot be reached, staff will try to contact emergency contacts listed until someone is reached. If the emergency situation is such that immediate hospital attention is necessary, the staff will accompany the child to the hospital in an ambulance. In the event I or my designees cannot be reached in an emergency, I authorize transportation of my child to a licensed emergency care facility to receive prompt treatment. Furthermore, I authorize the medical personnel at the facility to provide such treatment to my child as is indicated by the nature and extent of his/her injury and that is in accordance with the protocols of standard medical practice. Finally, I accept full financial responsibility for all services involved in the necessary treatment.

PARENT/GUARDIAN SIGNATURE ______________________________

CAMP WAIVER AND RELEASEIn consideration for enrollment, the undersigned, for himself, herself and/or as the parent or guardian of the student named above (individually and collectively the “camper”) assumes the sole risk of injury, accident, death, loss cost or damage to his or her person or property which might arise from the use of Merritt Athletic Clubs services and facilities, or participation in any Merritt Athletic Clubs class or program, including and matter relating to any pre-existing physical condition or impairment. The camper, his or her heirs, personal representatives, executors and assigns do hereby further release and discharge Merritt Athletic Clubs, its instructors, employees, servants and agents from all claims, demands, injuries, damages, actions or causes of action and from all acts of passive negligence on the part of Merritt Athletic Clubs, its servants, instructors, agents or employees. The parent further certifies that child/children is in good physical health and is able to undertake and engage in the physical exercise or Sports & More activities in which he or she chooses to participate, including participation in any Merritt Athletic Clubs class or program.


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DAMAGED PROPERTYIf a child accidentally or deliberately breaks or damages Merritt Athletic Clubs property or any personal property at the site location, the parent/guardian will be held responsible for the replacement cost of the equipment.

______INITIALS OF PARENT/GUARDIAN

PHOTO RELEASEI hereby consent, permit and authorize Merritt Athletic Clubs, LLC and its affiliates, agents, employees, contractors, personnel, and others acting on their behalf (collectively, “Merritt Athletic Clubs”) to use my child/children likeness, voice, and image in drawings, photographs, videotapes, sound recordings, motion pictures or other media materials (collectively referred to as “media materials”) which may be used for promotional purposes, research, publicity or other purposes deemed appropriate by Merritt Athletic Clubs. I understand that my child/children’s photograph or likeness and voice may be copied and distributed by means of various media, including video presentation, simultaneous use television, rebroadcast, radio distribution or retransmission, news bulletins, press releases, billboards or signs, brochures, placement on Merritt Athletic Clubs’ web sites or other web sites, and by other electronic delivery or publications. I acknowledge that Merritt Athletic Clubs has the right to make one or more photographs, audio recordings, videotape or disk presentations, or other electronic reproduction of my child’s image, voice or performance in accordance with this agreement. I waive any right to inspect or approve the finished product or any media materials in which Merritt Athletic Clubs may eventually use my child’s photograph, likeness or voice. I understand that all media materials are the property of the Merritt Athletic Clubs and I relinquish any right, title or interest in or to the media materials or the use made of them by the Merritt Athletic Clubs, including any copyright therein. I understand that my child’s name may or may not be included in whatever credits are associated with the media materials and that my child’s likeness may or may not appear in any media materials. I release from liability the Merritt Athletic Clubs, its principals, successors and assigns from any and all claims, costs, expenses and damages arising out of the making of the media materials and the release of them or any information concerning them. This release is binding upon me and my personal representatives, guardians, heirs, successors, assigns, and other legal representatives. I understand that, although Merritt Athletic Clubs will endeavor to use my child’s photograph, likeness, and voice in accordance with standards of good judgment, Merritt Athletic Clubs cannot warrant or guarantee that any further dissemination of my child’s photograph or likeness will be subject to Merritt Athletic Clubs’ supervision or control. Accordingly, I release Merritt Athletic Clubs from any and all liability related to dissemination of my child’s photograph, likeness or voice, the reproduction, distribution, and display of the photographs in print or an any and all other media and any alteration, distortion or illusionary effect, whether intentional or otherwise, in connection with such use. I also understand that I may not withdraw my permission for the use of any photos, or other likeness at any time in the future.


I have read and fully understand the above waiver and release of all claims and indemnification. If registering on-line or via fax, my on-line or fax signature shall substitute for and have the same legal effect as an original form signature. I understand that failure to adhere to these policies may result in termination from the program. I certify that my child is fully able to participate in this program and is also aware of the policies stated.

PARENT/GUARDIAN SIGNATURE________________________________________

PARENT/GUARDIAN PRINTED NAME______________________________

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REGISTRATION FORMPrimary Parent/Guardian Name:___________________________________ Email:_________________________Address (if different from child’s):_____________________________ City:__________________ State: ____ Zip:______Cell phone: _________________________ Work phone: ________________________

Secondary Parent/Guardian Name:________________________________ Email:_________________________Address (if different from child’s):_____________________________ City:__________________ State: ____ Zip:______Cell phone: _________________________ Work phone: ________________________

Child #1 Name:__________________________________ D.O.B:_______Gender:_____ Grade(Fall 2016):______

Merritt Athletic Clubs Aquatics Department offers daily 30 minute small group swim lessons for all full day non-aquatics camps. Pricing - $60 per week Members and Non Members. Must register 2 weeks prior to camp start date.

Child #1 Swim Lesson Week(s):____________________________________________________________________

Child #2 Swim Lesson Week(s):____________________________________________________________________

CLUB LOCATION CAMP NAME CAMP DATES BEFORE CARE DAYS(PLEASE CIRCLE DAYS NEEDED)

AFTER CARE DAYS(PLEASE CIRCLE DAYS NEEDED)

M T W TH F N/A M T W TH F N/A







Child #2 Name:__________________________________ D.O.B:_______Gender:_____ Grade(Fall 2016):______

CLUB LOCATION CAMP NAME CAMP DATES BEFORE CARE DAYS(PLEASE CIRCLE DAYS NEEDED)

AFTER CARE DAYS(PLEASE CIRCLE DAYS NEEDED)








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EMERGENCY CONTACTCamper 1: Name_____________________________________________DOB:__________Camper 2: Name_____________________________________________DOB:__________

In case of emergency, for the above listed child, please contact the following:Parent/Guardian Name 1_______________________________________ Cell #____________________ Home #__________________ Work #___________________

Parent/Guardian Name 2_______________________________________ Cell #____________________ Home #__________________ Work #___________________

Other Name 1_______________________________________ Cell #____________________ Home #__________________ Work #___________________

Other Name 2 _______________________________________ Cell #____________________ Home #__________________ Work #___________________

The following people are authorized to drop off and/or pick my child up from camp (babysitters,carpools, etc.):Name _______________________________________ Phone__________________________ Name _______________________________________ Phone__________________________Name _______________________________________ Phone__________________________Name _______________________________________ Phone__________________________

The following people are NOT authorized to drop off and/or pick my child up at any time (if applicable)Name _______________________________________ Name _______________________________________Name _______________________________________ Name _______________________________________

CAMPER HEALTH HISTORYChild’s Physician: __________________________________________________Phone: __________________

Are there any health problems including physical, psychiatric, or behavioral problems of which we need to be aware? ___NO ____YES, Explain: _______________________________________________________________________ Are there any medications, dietary restrictions, allergies, or special needs that we need to be aware of to ensure that your child’s camp experience is positive? ___NO ____YES, Explain: _______________________________________________________________________

IMMUNIZATION INFORMATION:For campers who reside within the United States, a United States territory, or the District of Columbia: State/territory in which child resides: _______________________________ Is this child exempt from any immunizations? [ ] NO [ ] YES, List them:______________________________

For campers who reside outside the United States, a United States territory, or the District of Columbia: Country in which child resides:_________________________Attach Department form DHMH-896 (record of vaccination or immunity)

PARENT OR LEGAL GUARDIAN’S SIGNATURE: _______________________________ DATE: ___________

DHMH 4765(1/15)22

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MEDICATION ADMINISTRATION AUTHORIZATIONDEPARTMENT OF HEALTH & MENTAL HYGIENE (DHMH) CENTER FOR HEALTHY HOMES AND COMMUNITY SERVICES (CHHCS)

(410) 767-8417 TOLL FREE 1-877-4MD-DHMH EXT. 8417

I. CAMP OPERATOR

This form must be completed fully in order for youth camp operators and staff members to administer the required medication or for the camper to self administer medication. A new medication administration form must be completed at the beginning of each camp season, for each medication, and each time there is a change in dosage or time of administration of a medication. -Prescription medication must be in a container labeled by the pharmacist or prescriber. -Nonprescription medication must be in the original container with the instructions for use. Nonprescription medication includes vitamins, homeopathic, and herbal medicines. -An adult must bring the medication to the camp and give the medication to an adult staff member.

II. CAMP INFORMATION

YOUTH CAMP NAME

PHYSICAL ADDRESS

CITY STATE ZIPCODE

III. PRESCRIBER’S AUTHORIZATION

CHILD’S NAME DATE OF BIRTH

CONDITION FOR WHICH MEDICATION IS BEING ADMINISTERED: EMERGENCY MEDICATION [ ] YES [ ] NO

MEDICATION NAME DOSE ROUTE

TIME/FREQUENCY OF ADMINISTRATION IF PRN, FREQUENCY

IF PRN, FOR WHAT SYMPTOMS

KNOWN SIDE EFFECTS SPECIFIC TO CHILD

MEDICATION SHALL BE ADMINISTERED (NOT TO EXCEED 1 YEAR)

FROM TO

PRESCRIBER’S NAME/TITLE This space may be used for the Prescriber’s Address Stamp

TELEPHONE FAX

ADDRESS CITY STATE ZIPCODE

PRESCRIBER’S SIGNATURE (Parent cannot sign here) (ORIGINAL SIGNATURE OR SIGNATURE STAMP ONLY)

DATE

IV. PARENT/GUARDIAN AUTHORIZATION

I request the authorized youth camp operator/staff to administer the medication or supervise the camper in self administration if authorized as prescribed by the above prescriber. I certify that I have legal authority to consent to medical treatment for the child named above, including the administration of medication at the facility. I understand that at the end of the authorized period, an adult must pick up the medication, otherwise it will be discarded. I authorize camp personnel to communicate with the prescriber as allowed by HIPAA.

PARENT/GUARDIAN SIGNATURE DATE

HOME PHONE # CELL PHONE # WORK PHONE #

V. AUTHORIZATION FOR SELF ADMINISTRATION AND SELF CARRY

I consent that the child named above is able to self administer the medication listed. I authorize self administration of the above listed medication for the child named above under the supervision of an authorized youth camp operator/staff member. The child named above may self carry emergency medica-tion if indicated below.

PRESCRIBER’S SIGNATURE SELF CARRY EMERGENCY MEDICATION (Check One) [ ] YES [ ] NO [ ] Not emergency medication

DATE

PARENT/GUARDIAN’S SIGNATURE SELF CARRY EMERGENCY MEDICATION (Check One) [ ] YES [ ] NO [ ] Not emergency medication

DATE

DHMH-4758 (01/2015) 23

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EMERGENCY CARE PLAN - ALLERGIES In order for Merritt Athletic Clubs Summer Camp employees to *supervise self administration of medication*, a completed Administration Authorization Form (DHMH 4758) must be on file.

Sign form at the bottom either way. Complete all information for allergies even if medication is not necessary.

Childs Name:______________________________________please check one: __does / __does not have an allergy.

Grade: _____ Age: ______ Date of Birth: ______ Camp Location: ____________

Parent or Guardian Name: ________________________ Cell phone: _____________

Work Phone:______________Home Phone:_______________ Additional Contact number:__________

Address: __________________________________________________________________

TO PROVIDE ASSISTANCE TO THIS CAMPER EXPERIENCING AN ALLERGIC REACTION:Type of allergy: ___________________

Identify triggers which start an allergic reaction:__________________________________________________________________

Possible allergic signs:___________________________________________________________________________________________

Other Considerations: __________________________________________________________________________________________

ACTIONS TO TAKE (Do This)

-Stay calm

-Stay with child

-Ask someone to contact 911 and or parent/guardian

-Are medications on site at Merritt Athletic Clubs Camp location? Yes/no

-Medications on file to treat child: _______________________________________________________________________________

In order for Merritt Athletic Clubs Summer Camp employees to supervise self administration of medication, a completed Medication Administration Authorization Form must be on file.

Other care options: _____________________________________________________________________________________________

CALL 911 IF THE CAMPER HAS:-Difficulty breathing or noisy breathing -A wheeze or persistent cough

-Tightness of chest -Loss of consciousness and/or collapse

-Swelling of tongue, eyes or lips -Vomiting, stomach cramps, or diarrhea

-Swelling or tightness in throat -Blue discoloration of lips or fingernails

-Difficulty talking and/or hoarse voice -Becomes pale or floppy

ADMINISTER CPR IF BREATHING STOPS.CONTINUE UNTIL PARAMEDICS ARRIVE:

I give consent for the Merritt Athletic Clubs staff to take appropriate action for the safety and welfare of my child. I give my consent for the Merritt Athletic Clubs staff to communicate with the authorized health care provider when necessary.

PARENT SIGNATURE:_________________________________ DATE:_______________________

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ALLERGY ACTION PLANIs the child asthmatic? ___ No ___Yes (If Yes = Higher Risk for Severe Reaction)

SYMPTOMS GIVE THIS MEDICATIONThe child has ingested a food allergen or exposed to an allergy trigger: Epinephrine Antihistamine

But is NOT exhibiting or complaining of any symptoms

Mouth: itching, tingling, swelling of lips, tongue or mouth (“mouth feels funny”)

Skin: hives, itchy rash, swelling of the face or extremities

Gut: nausea, abdominal cramps, vomiting, diarrhea

Throat*: difficulty swallowing (“choking feeling”), hoarseness, hacking cough

Lung*: shortness of breath, repetitive coughing, wheezing

Heart*: weak or fast pulse, low blood pressure, fainting, pale, blueness

Other:

If reaction is progressing (several of the above areas affected)

*Potentially life threatening. The severity of symptoms can quickly change.

IMPORTANT: Asthma inhalers and/or antihistamines cannot be depended on to replace epinephrine in anaphylaxis.

MEDICATION DOSEEpinephrine

Antihistamine:

Other:

DOCTORS SIGNATURE:_____________________________________ DATE: ________________

EMERGENCY CALLS-CALL 911 (or Rescue Squad) whenever Epinephrine has been administered. -Call the parent. State that an allergic reaction has been treated and additional epinephrine may be needed-Stay with the childEVEN IF A PARENT/GUARDIAN CANNOT BE REACHED, DO NOT HESITATE TO MEDICATE AND CALL 911

DOCTOR’S NAME:_____________________________ PHONE NUMBER:_______________

HEALTH CARE PROVIDER AND PARENT AUTHORIZATION FOR SELF CARRY / SELF ADMINISTRATIONI authorize Merritt Athletic Clubs Staff to administer the Epinephrine medication only, as indicated. Camper may self carry/ self administer (school age children only) __ yes __no

Merritt Athletic Clubs will:-Reduce Exposure to allergen(s) by: no sharing food, provide a nut free/dairy free table during lunch, express awareness of surroundings that may increase allergen exposure.

-Ensure proper hand washing procedures are followed.

-Observe and monitor child for any signs of allergic reaction(s).

-Ensure that medication is immediately available to administer in case of an allergic reaction (in the camp facility, aquatics area, field area, etc.)

- Ensure that a staff person trained in Medication Administration of Epinephrine accompanies child on any off site activity.

The Parent/Guardian will: ___Ensure the camp facility has the sufficient supply of emergency medication ___Replace medication prior to expiration date ___Monitor any foods provided for the child by the parent/guardian as well as Merritt Athletic Clubs or any partner thereof, and will make sure that substitutions or arrangements with the facility, if needed.

PARENT/GUARDIAN SIGNATURE: _______________________________ DATE: _________________

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ASTHMA ACTION PLANAsthma Severity: __ Exercise Induced __ Intermittent __ Mild Persistent __ Moderate Persistent __ Severe PersistentTriggers: _________________________________________________________________________________________________________

GREEN ZONE: LONG TERM CONTROL MEDICATION - USE DAILY AT HOME UNLESS OTHERWISE INDICATED

MEDICATION DOSE ROUTE FREQUENCY

__Breathing is Good

__No Cough or wheeze

__Can work, exercise, play

__Other:___________

__Peak flow greater than ______ (80% personal best)

__Prior to exercise/Sports & More/physical education (Please list rescue medication)

If using more than twice per week for exercise, notify the medical director and parent/guardian.

YELLOW ZONE: QUICK RELIEF MEDICATIONS - TO BE ADDED TO GREEN ZONE MEDICATIONS FOR SYMPTOMS


__Cough or cold symptoms

__Wheezing

__Tight chest or shortness of breath

__Cough at night

__Other:___________

__Peak flow between ___ and ___ (50%-70% personal best) IF symptoms do not improve in ____ minutes, notify the medical director and parent/guardian. If using more than twice per week, notify the medical director and parent/guardian.

RED ZONE: EMERGENCY MEDICATIONS - TAKE THESE MEDICATIONS AND CALL 911


__ Medication is not helping within 15-20 mins

__ Breathing is hard and fast

__ Nasal flaring or skin retracts between ribs

__ Lips or fingernails blue

__Trouble walking or talking

__Other: _________________________

__ Peak flow less than _____ (50% personal best) CONTACT THE PARENT/GUARDIAN AFTER CALLING 911

HEALTH CARE PROVIDER AND PARENT AUTHORIZATIONI authorize Merritt Athletic Clubs Staff to administer the above medications as indicated. By signing below, I authorize to self-carry/self-administer medication and authorize the child to self-carry/self-administer the medications indicated during any summer camp programs/activities.

Merritt Athletic Clubs will:

-Ensure camper is taking all precautions to decrease risk of asthmatic reaction to daily camp activities.

-Observe and monitor child for any signs of an asthmatic reaction(s).

-Ensure that medication is immediately available to administer in case of an asthmatic reaction (in the camp facility, aquatics area, field area, etc.)-Ensure that a staff person trained in the above listed Medication Administration accompanies child on any off site activity.

The Parent/Guardian will: ___ Ensure the camp facility has the sufficient supply of emergency medication ___ Replace medication prior to expiration date ___ Ensure that Camp Staff is aware of any outside factors that may increase campers symptoms for an asthmatic reaction.Camper may self carry medications: ___ yes ___ no

PRESCRIBER SIGNATURE:__________________________________DATE:____________

PARENT/GUARDIAN SIGNATURE: ______________________________ DATE:___________

REVIEWED BY MERRITT SUMMER CAMPS MEDICAL DIRECTOR,

NAME: ____________________________SIGNATURE:___________________DATE:________ 26

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dear campers and families, - merritt clubs · return them via fax, email or complete them online....

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