CHANDLER SIGNATURE CAMP CHALLENGE | 2019 PARENT … · NO sandals, ﬂ ip ﬂ ops or Crocs. • To reduce the amount of lost and found, please have your child(ren)’s clothing marked

CHANDLER SIGNATURE CAMP CHALLENGE | 2019 PARENT GUIDE

2019

CAMP CHALLENGE is a summer day camp organized by the City of Chandler Therapeutic Recreation program and designed for children, teens and youth, ages 5-21, with developmental disabilities. Activities include arts, crafts, sports, games, cooking,

swimming, special guests, music, talent show, and more.

Dates: Monday, June 3 through Friday, June 28 Camp Location: Sanborn Elementary School700 N Superstition Blvd., Chandler, AZ 85225

Days and Time: Monday-Friday, 8:30 a.m.-3 p.m.

Registration Nights at Chandler Senior CenterRETURNING CAMPERS: March 28

NEW CAMPERS: April 2 & 4 Appointments must be scheduled online at chandleraz.gov/therapeutic.

WHAT TO BRING TO REGISTRATION NIGHT:Complete registration paperwork for DDD services:

• Chandler registration paperwork, • One current 4x6 photograph of your child, • Form of payment (DDD Change in ISP form) and • a copy of your child’s most current ISP.

Using DDD services: Talk to your support coordinators and have them provide you with a Change in ISP form with goals and a copy of your current ISP. Both these documents are required before being accepted into camp.

Complete registration paperwork for private pay services:

• Chandler registration paperwork, • One current 4x6 photograph of your child, • Form of payment (cash, check, debit or credit card).

Residents: $250 • Non-residents: $338

Important Note: Camp Challenge space is limited and is fi lled on a fi rst come, fi rst-served basis. Upon receipt of all paperwork, you will be notifi ed of your child’s acceptance into the program within 7 business days. We do NOT provide 1:1 assistance. Participant must be able to function successfully in a 1:4 or greater ratio.

Incomplete paperwork and mail-in will not be accepted.For any further information, please call (480)782-2709.

CAMPER RALLY NIGHTThursday, May 30 • 6 p.m.

at Chandler Community Center – 125 E. Commonwealth Ave., Room 109

Mayor Kevin Hartke and the Chandler City Council

2019

CHANDLER | SIGNATURE CAMPS

PARENT GUIDE

THERAPEUTIC RECREATION


2019

Dear Parents and Guardians:

Welcome to the City of Chandler’s Camp Challenge! We have worked very hard to create educational, enjoyable and memorable programs while your kids are out of school. To ensure the success of these programs and the safety of our campers, we ask that all parents and campers read through the information provided in this guide.

Though each week of camp and the trips are unique unto themselves, our overriding policies and guidelines are not. In this parent guide you will fi nd a list of Policies and Guidelines that we ask all parents, campers and staff to follow. Please take a few moments to read it over and then sign the Policy Acknowledgement and Emergency Forms in this guide.

If you have any questions please contact the Camp Challenge Program Coordinator. Thank you for your cooperation and we look forward to another fun session of camp!

Sincerely,

Camp Challenge Staff

CAMP CONTACT INFORMATION � Camp Location: Sanborn Elementary School 700 N. Superstition Blvd. | Chandler, AZ 85225 Camp Office: Chandler Community Center 125 E. Commonwealth Ave. | Chandler, AZ 85225 � Mail Stop 501, P.O. Box 4008 Chandler, AZ 85244-4008 � Customer Service Counter | 480-782-2727 Camp Challenge Cell Phone | 480-440-8747 � Fax | 480-782-2734 Collette Prather, Program Coordinator 480-782-2709 | [email protected]

�chandleraz.gov/therapeutic


TABLE OF CONTENTSIntroduction

Welcome LetterLocation and Contact Information

Policies and ProceduresRefunds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1Absences . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1Inclusion and Participation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1Code of Conduct & Safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1Safety Concerns . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1Communication with Parents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1Behavior Policy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2Photographing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2Medication Administration. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2Lost and Found. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2Program Dress Code . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2Participant Drop-off and Pick-up

Drop-off . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2Late Drop-off /Early Pick-up . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2Alternate Pick-ups . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Lunch/Snack . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3Field Trips. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3Transportation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3Swimming . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3Sunscreen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3Donations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3What to bring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Field Trips Camp Field Trips and Permission SlipSmall Group Field Trips and Permission Slip

FormsRegistration FormsEmergency ContactSwimming/Sunscreen Permission SlipMedication FormSchool Contact FormPolicy Acknowledgment

CHANDLER SIGNATURE CAMP CHALLENGE | 2019 PARENT GUIDE 1

POLICIES AND PROCEDURES

**The recreation program is a drop-in program and participants may come and go at their own volition during the session for

which they are registered.**

REFUNDS• If the Recreation Division cancels a session, a full refund or

transfer will be issued. • Program fees paid by credit card, check, or cash will be

refunded within two to four full business weeks after approval by the Program Coordinator.

• Refunds will be made only to the original payee or credit card holder.

• 100% refunds will only be granted if requested 48 hours, or more, in advance of program start. This policy is enforced so that we can plan supplies and activities properly.

ABSENCESRefunds are not available for vacations, special events, short-term illnesses of four days or less, or other personal commitments that prevent attendance. Please call Kris Jacobs on the camp cell phone after 8 a.m. if participant is ill. You may let your counselors know in advance when participant will be gone for vacation.

HEALTHIf your child is experiencing a fever, cough, muscle aches, runny nose or sore throat, be considerate of others and please keep him/her at home on that day. If a participant comes to the program with these symptoms, the parent will be contacted and required to pick up the participant.

INCLUSION AND PARTICIPATIONThe Department welcomes the participation of children and adults, including those with disabilities. A reasonable accommodation should be requested two (2) weeks in advance. Contact Collette Prather at 480-782-2709 via voice or AZ Relay at 711. Staff is not able to provide services of a personal nature, such as assistance in eating, toileting or dressing. Participants are welcome to bring a caregiver or aide, if they need assistance with these activities.

CODE OF CONDUCT AND SAFETYThe City of Chandler Community Services Department strives to maintain an atmosphere of camaraderie, courtesy, and respect. To ensure the safety and enjoyment of everyone in our recreational facilities, classes, programs, and activities, participants are expected to conduct themselves in an appropriate manner, at all times.Appropriate behavior includes the ability and willingness to follow instructions and to interact positively with other individuals. Staff will discuss behaviors of concern with a participant and his/her family, when necessary.Unsafe or unacceptable behavior will not be tolerated from anyone visiting a facility or participating in any City of Chandler class, program, or activity. Any person acting inappropriately may be subject to Progressive Discipline Action Steps, which may include revocation of the privilege of using department facilities or participating in departmental activities, classes, or programs for a period of time (including a permanent ban), as determined by staff , based on the circumstances of a specifi c incident.Please inquire at the front desk to view the Code of Conduct and Safety in its entirety.

SAFETY CONCERNS• Parents/Guardians are responsible for the welfare of their

child(ren) prior to and after the program in which the child is enrolled.

• Participants should not be dropped off before the program start time nor should the parent/guardian leave the participant past the end of the program hours.

COMMUNICATION WITH PARENTS• The program staff is committed to communicating with

parents about their child’s positive and/or negative behaviors.


BEHAVIOR POLICY• Our purpose is to provide recreation for participants

of various ages. Since we’re here to have fun, we take problems seriously.

• We log all behavior incidents, and if incidents are serious and/or frequent, we will talk to the parent/guardian, either on the phone or in person.

• After each incident that warrants parent/guardian contact, we will consider it a “strike.” After a fi rst strike, a Behavior Contract will be established and/or reviewed. After three strikes, participants will be asked to leave the program and will not be given a refund. At the discretion of the program coordinator, campers who are asked to leave the program may not be permitted to enroll in future sessions.

• Incident Report of Child Abuse-Arizona State Law/Code Section 13-3620, 8-201 states mandatory reporting required by a physician, resident, dentist, chiropractor, medical examiner, nurse, psychologist, social worker, school personnel, peace offi cer, parent, counselor, clergy/priest. The Recreation Division will notify the Chandler Police Department Victim Services Unit at 480-782-4535 of all issues relating to the Arizona State Law of Child Abuse.

• This policy is set in place in order to ensure safety and to prevent behavior problems for all participants and staff members. If you have any questions, please speak to camp staff .

PHOTOGRAPHING• Photographs and videotaping of youth participating in

the program is discouraged by parents/guardians, and/or visitors due to the confi dentiality of the child(ren) present.

• Photographs and video footage taken of your child(ren) as a result of participation in activities of the program may be used in promotional materials. Please inform program staff before your child attends, if you do not want your child’s photo or video to be taken.

MEDICATION ADMINISTRATION• Recreation staff and representatives are not trained or

permitted to provide medication administration services to program participants.

• If you require assistance with medication administration during participation in one of our programs, you will need to make arrangements with the Camp Coordinator prior to the start of camp.

• Participants’ self-administration of medications will be permitted only in accordance with an approved in advance Request for Reasonable Accommodation.

• Medications covered by this policy include, but are not limited to, all prescription and over-the-counter drugs, inhalers, and epinephrine auto-injectors (e.g., EpiPens).

• Any questions regarding the administration of medications should be directed to your site’s Program Coordinator.

LOST AND FOUNDLost and found is located outside the cafeteria. Two weeks after the program ends, unclaimed lost and found items will be given to charity. The program is not responsible for any items lost during the program or while on fi eld trips.NO TOYS OR ELECTRONICS PERMITTED IN CAMP!Toys, electronic games and cell phones are distracting to the program. If they need a cell phone, it should remain in a backpack and no one should know they have it. Staff will confi scate items for parent pick-up ONLY!

PROGRAM DRESS CODE• Participants should wear comfortable clothing such as a

t-shirt and jeans. We play active games and explore the outdoors. Your child will get dirty, wet, painted, and/or messy. Do not send them in their best clothes.

• Athletic or soft soled shoes (NON-MARKING with CLOSED TOED, LACED, BUCKLED OR VELCRO CLOSED) are required for all program activities. NO sandals, fl ip fl ops or Crocs.

• To reduce the amount of lost and found, please have your child(ren)’s clothing marked with their name on it.

PARTICIPANT DROP-OFF & PICK-UP • Our signature camps are a drop-in program. Children

may come and go under their own volition.

DROP-OFF• Parents are to walk their children in and out of the building

during drop-off and pick-up.• Staff will have a table with sign in/out forms inside of the

camp facility. Please sign each child in and out properly.

LATE DROP-OFF/EARLY PICK-UP• Please notify the Program Coordinator when you will be

dropping off your camper after the start time or picking up prior to the established pick-up hours.

• Although we try to have someone in the offi ce at all times, occasionally we are away from the sign-in area.

• For late drop-off s you will be asked to remain with your child until the group returns or arrangements can be made to meet up with the group. For early pick-ups there may be a delay.

ALTERNATE PICK-UPS• If someone will be picking up your participant who is not

a parent or legal guardian, we ask that you list that person as an “alternate pick-up” on the Emergency contact form.

• Employees will ask for identifi cation and refuse a pick-up to unauthorized individuals. Please let caregivers know to carry their ID.


LUNCH/SNACK• Please make sure your child(ren) eat a well-balanced meal.

The program does not provide breakfast, lunch, or snack.• Participants must provide their own non-perishable lunch

and snack. Please refer to each site’s daily schedule for lunch and snack times.

• Refrigeration and microwave use is NOT available for individual lunches.

• Please notify staff of any food allergies your child(ren) may have.

• Parent/Guardians are welcome to have lunch with their child(ren).

• Free lunch will be available at Sanborn Elementary this year. Details will be given as they are available.

• Parents of each participant may volunteer to provide a non-perishable snack. A sign-up list will be posted in your child’s classroom. Please bring snacks that are store-bought and unopened. We ask that you do not bring any snacks that have peanuts, peanut butter or nuts. Also please don’t bring foods that have been processed in a plant that processes nuts or contains traces of nuts, tree nuts, etc.

FIELD TRIPS• The City of Chandler would like to have the parents as

informed as possible. If ever a question or problem arises, please feel free to contact or talk to the program coordinator of your site or any of the program staff . We try to improve the program each year using your input.

• Staff is not responsible for the each child’s personal belongings.

• If you elect to not send your child on a fi eld trip you must make arrangements to have them picked up prior to departure of the fi eld trip. NO STAFF will be left behind to watch children who are not attending the fi eld trip or swim day.

• Please send your child to camp with their camp shirt on for all fi eld trips.

TRANSPORTATION• On trips and/or pool days, 14 passenger buses are used to

transport participants to the location.• All drivers have completed defensive driver training with

the City of Chandler.• The buses have lap seat-belts that must be worn by all

passengers.• These buses do not require booster seats for children who

would typically require one in a smaller vehicle.

SWIMMING• Open swim is scheduled for Wednesdays at Hamilton Aquatic

Center from 9:30-11:30 a.m.• We will transport participants from the school to the pool

by school bus and city vans. • If participant is not swimming, please drop off on swim days

after 12 p.m., noon.• Participants will not be allowed to stay behind at the school.• Come to camp with a swimsuit already on.• All participants must bring a swimsuit, towel, and

sunscreen.• All participants will be required to complete a swim test

provided by the aquatic staff prior to swimming at the pool. Participants who do not pass will be restricted to swim in the zero depth area.

• Masks, snorkels, fi ns, water wings, vests, and swim toys are not allowed. Goggles are not required but encouraged.

SUNSCREEN• Please send your child to the program with waterproof

sunscreen (25 SPF or higher), with their name clearly marked on it. The program does not dispense sunscreen due to diff erent needs and allergies.

• Helpful suggestion: Try applying all day waterproof sunscreen on your child(ren) before they leave for the program.

• Our counselors will help participants that cannot apply sunscreen by themselves with a signed approval form.

DONATIONS ALWAYS WELCOME• Items needed include: jugs of water, lemonade mix, small

cups, popcorn, paper towels, garbage bags, fl ushable wipes, Clorox wipes, paper plates, napkins, nail polish, nail polish remover, and cotton balls. Check with your counselors and watch weekly posting for more details.

WHAT TO BRINGPlease bring a box, crate or basket to put lunch and personal belongings in while at camp.

CAMP CHALLENGE | 2019 FORMS

CAMP FIELD TRIPSThe City of Chandler would like to have the parents as informed as possible. If ever a question or problem arises, please feel free to call Collette Prather or talk to any of the program staff. We try to improve the program each year with your input. Below is information parents may need regarding field trips and special events:

DATE & TIME LOCATION DESCRIPTION ADDITIONAL INFO

Weeks 1-4Wednesdays June 5, 12, 19 and 26Depart: 9:30 a.m.Return: noon

Hamilton Aquatic Complex

3838 S. Arizona Ave. Chandler, AZ 85248

We will travel by bus to the pool each week. The pool opens at 10 am. If parents would like to attend, they will need to pay admission at the entrance. Campers will swim from 10-11:30 and we will return to the school for lunch.

Please have the camper come to camp with swimsuit and sunscreen on. Please be sure to send a change of clothes for when we return to camp. Campers with regular seizures should wear a red shirt.

Week 1: Friday, June 7Depart: 9 a.m.Return: 12:30 p.m.

Summer Camp Color Run

Tumbleweed Park745 E. Germann Rd.Chandler, AZ 85286

Campers will run a short route in the park while wearing cool sunglasses and Camp Challenge shirts. We will be covered in color. Parents come cheer on the kids and help throw color. After the run, we will eat and dance.

Pizza lunch will be provided.

Week 2: Thursday, June 20Depart: 10 a.m.Return: 2:45 p.m.

Diamondbacks Baseball

401 E. Jefferson St.Phoenix, AZ 85004

Campers will experience an Arizona Diamondbacks game. Campers will need to bring their own lunch in a clear plastic Ziploc bag.

Campers should wear their Camp Challenge T-shirt. If parents would like to join us, please let us know. Tickets are $15.

Week 3: Ages 6-13.5 Friday, June 21Depart: 9:30 a.m.Return: 1:30 p.m.

Harkins Movie “Toy Story 4”. Please wear your Camp Challenge T-shirt. Admission for campers is provided.


CAMP FIELD TRIPSPERMISSION SLIP In order for the participant(s) listed below to attend field trips scheduled, this form must be signed by a parent or legal guardian of the child(ren).

Also, please indicate which field trips your child(ren) will be attending, by selecting either “Yes” or “No” in the appropriate box.

To ensure the staff-to-participant ratio is met for the field trips, staff will not be left behind at the facility. All participants in attendance that day will attend the field trip or swim trip.

FIELD TRIPS SCHEDULED ARE:

LOCATION DATE ATTENDING?

Hamilton Aquatic Center (Wednesdays) June 5, 12, 19, & 26 Yes No

Color Run (F) June 7 Yes No

Diamondbacks Game (Th) June 20 Yes No

Harkins Movie (F) June 21 Yes No

Participant’s Name: _______________________________________________________________________________________________________________________

I, _______________________________________________________________ , the parent/legal guardian of the above listed participant(s), give permission for my child(ren), listed above, to attend any of the field trips scheduled for the program. I understand that the City of Chandler does not carry accident insurance for these programs. I agree to indemnify and hold harmless the City of Chandler from all losses or injuries sustained during my child’s/youth’s participation. I also give permission for any photo/video taken of my child/participants to be used by the City of Chandler.

Parent/Guardian Signature: _________________________________________________________________ Date: _____________________________


ADDITIONAL PROGRAMS/TRIPS FOR SMALL GROUPSThe City of Chandler would like to have the parents as informed as possible. If ever a question or problem arises, please feel free to call Collette Prather or talk to any of the program staff. We try to improve the program each year with your input. Below is information parents may need regarding field trips and special events offered for our small groups:

DATE & TIME LOCATION DESCRIPTION ADDITIONAL INFO

Week 2: Javelinas & Coyotes GroupsMonday, June 10Depart: 9:30 a.m.Return: 12:30 p.m.

Chandler Fire/Police Station Tour

& Lunch

Campers will go to Chandler Fire/Police Station for a tour. They will eat lunch on the way back.

Campers will need to bring their lunch or at least $10 for lunch. Please wear your Camp Challenge T-shirt.

Week 2: TBA TBA TBA TBA

Week 3: Roadrunners & Rattlers GroupsTuesday, June 18Depart: 9:15 a.m.Return: 1:30 p.m.

Feed My Starving Children & Lunch

Campers will be going to do service at Feed My Starving Children. After working up an appetite, we will go eat lunch before returning to camp. Please bring money for lunch.

Campers should wear their Camp T-shirt to indicate they are with Camp Challenge. Parents/Caregivers are invited to go along. Please let Alycia Glashagel know if you would like to attend. Parents will need to drive separately.

Week 4: Rattlers GroupTuesday, June 25

Community Center Dance

Campers will enjoy a dance and lunch at the Community Center.

Week 4: TBA TBA TBA TBA


SMALL GROUP PROGRAMS/FIELD TRIPSPERMISSION SLIP In order for the participant(s) listed below to attend field trips scheduled, this form must be signed by a parent or legal guardian of the child(ren).

Also, please indicate which field trips your child(ren) will be attending, by selecting either “Yes” or “No” in the appropriate box.

To ensure the staff-to-participant ratio is met for the field trips, staff will not be left behind at the facility. All participants in attendance that day will attend the field trip or swim trip.

FIELD TRIPS SCHEDULED ARE:

LOCATION DATE ATTENDING?

Chandler Fire/Police Station Tour and Lunch (M) June 10 Yes No

TBA TBA Yes No

Feed My Starving Children and Lunch (Tu) June 18 Yes No

Community Center Dance and Lunch (M) June 25 Yes No

Participant’s Name: _______________________________________________________________________________________________________________________

I, _______________________________________________________________ , the parent/legal guardian of the above listed participant(s), give permission for my child(ren), listed above, to attend any of the field trips scheduled for the program. I understand that the City of Chandler does not carry accident insurance for these programs. I agree to indemnify and hold harmless the City of Chandler from all losses or injuries sustained during my child’s/youth’s participation. I also give permission for any photo/video taken of my child/participants to be used by the City of Chandler.

Parent/Guardian Signature: _________________________________________________________________ Date: _____________________________


Please check one: DDD paid client Private pay client

Participant’s Name: _______________________________________________________________________________________________________ (last) (first) (m.i.)

Home Address: ___________________________________________________________________________________________________________ (street) (city) (zip code)

Birth Date: ______________ Age: ______Sex: ______ E-mail address: ___________________________________________T-Shirt size: __

Parent’s Name: ___________________________________ Home Phone: _____________________ Work Phone: ______________________

Emergency Contact (other than parent): ______________________________________________ Phone: ____________________________

The following information is to help staff better understand each participant’s wants and needs. Please be as specific as possible with your answers.

1. Last grade completed: ______ School name: _________________________________ Phone: ________________________________

Teacher who we could contact: _______________________________________________________________________________________

2. What assistance does the participant receive at school? Inclusion class Special Ed class 1:4 ratio Special Ed class 1:2 ratio Special Ed class 1:1 ratio

• Participant must be able to function in a summer camp setting of 1:4 supervision ratio (staff to participant) or greater.

• Camp Challenge does not accommodate for 1:2 or 1:1 supervision ratios.

3. Has the participant ever had a personal classroom aide? Yes No

4. Will your child be attending summer school? Yes No

If yes, what time will they arrive at camp: ___________ What is the last day of summer school? _______________________

5. Will the participant have vacation? Yes No If yes, when? ___________________________________________________

6. Has participant ever been in Camp Challenge before? Yes No If yes, when? ______________________________

7. Does participant read and/or write? Yes No

8. What is the participant’s disability? (Please check all that apply to participant): cerebral palsy MIMD MOMD Down syndrome hearing impaired visually impaired spina bifida learning disabilities burn injury spinal cord injury paralysis AIDS/HIV head injury depression juvenile arthritis fetal alcohol syndrome autism/Asperger’s bi-polar cancer sickle cell anemia diabetes cystic fibrosis amputation seizure disorder ADD ADHD hemophilia communication impairments Other: ______________________________________________________________________________________________________________

9. Does participant have allergies? Yes No

If yes, please list: _____________________________________________________________________________________________________

10. Can participant walk? Yes No If yes, does participant: Need assistance? Use crutches? Use a walker? Walk Independently? If no, does participant: Use a manual wheelchair? Use an electric wheelchair? Propel self in chair?

11. Does participant wear braces or other type of AFO? Yes No

If yes, what type and for what period of time? _______________________________________________________________________

REGISTRATION FORM


12. Does participant have seizures or blackouts? Yes NoIf yes, please describe: _______________________________________________________________________________________________

13. Have you ever known the applicant to: Interact well with others? Never Rarely Occasionally Often Regularly Be cooperative with peers and adults? Never Rarely Occasionally Often Regularly Express his/her needs? Never Rarely Occasionally Often Regularly Exhibit age-appropriate behaviors? Never Rarely Occasionally Often Regularly Hit or strike others? Never Rarely Occasionally Often Regularly Use foul language? Never Rarely Occasionally Often Regularly Exhibit self destructive behavior? Never Rarely Occasionally Often Regularly React aggressively to criticism? Never Rarely Occasionally Often Regularly Comments on the above:_____________________________________________________________________________________________

_______________________________________________________________________________________________________________________

_______________________________________________________________________________________________________________________

14. Does participant display any unusual behaviors? Yes NoIf yes, please describe. What things work at home or school? (Be specific): __________________________________________

_______________________________________________________________________________________________________________________

15. Has the participant ever been removed from a program for any type of behavioral reasons? Yes NoIf yes, please describe? _______________________________________________________________________________________________

_______________________________________________________________________________________________________________________

16. Does the participant need hygiene assistance? Yes NoIf yes, what assistance is needed? ____________________________________________________________________________________

_______________________________________________________________________________________________________________________

17. Does the participant use diapers/pull-ups? Yes No Is the participant potty-trained? Yes No Does the participant need assistance using the bathroom? Yes No If yes, please describe in detail. _____

_______________________________________________________________________________________________________________________

NOTE: Camp Challenge staff will only be able to provide very limited toileting assistance.

18. What adaptive equipment will participant bring to camp? Please describe in detail. ________________________________

_______________________________________________________________________________________________________________________

19. Does participant feed him/herself? Yes No If no, please describe in detail. _____________________________

_______________________________________________________________________________________________________________________

20. Does participant have visual impairments? Yes No If yes, please describe in detail. __________________

_______________________________________________________________________________________________________________________

21. Does participant have hearing impairments? Yes No If yes, please describe in detail. __________________

_______________________________________________________________________________________________________________________

22. Describe any communication difficulties: ____________________________________________________________________________

_______________________________________________________________________________________________________________________

23. Describe how participant participates in small groups: ______________________________________________________________

Large groups: _________________________________________________________________________________________________________

REGISTRATION FORM (continued)


24. Camp activities participant is interested in? (Please check all that apply):

Sports Swimming Community Integration Games Video Games Special Guest Arts Science Water Days Crafts Movies Carnival Cooking Music Therapy On Stage Show Other: _________________________________________________________________________

Please list any other pertinent information that would help our staff in working with the participant. (Be specific, and please attach additional pages(s) if necessary.): __________________________________________________________________________

____________________________________________________________________________________________________________________________

____________________________________________________________________________________________________________________________

____________________________________________________________________________________________________________________________

____________________________________________________________________________________________________________________________

____________________________________________________________________________________________________________________________

____________________________________________________________________________________________________________________________

Please take some time to describe the participant’s likes and dislikes. What activities and environmental stimulation does the individual enjoy and respond positively to? Is there anything that the individual responds negatively to?

Positive response to: Negative response to:

_____________________________________________________________ ____________________________________________________________

_____________________________________________________________ ____________________________________________________________

_____________________________________________________________ ____________________________________________________________

_____________________________________________________________ ____________________________________________________________

_____________________________________________________________ ____________________________________________________________

_____________________________________________________________ ____________________________________________________________

_____________________________________________________________ ____________________________________________________________

_____________________________________________________________ ____________________________________________________________

_____________________________________________________________ ____________________________________________________________

Staff Notes ( to be filled out by camp staff only): ______________________________________________________________________________________

_________________________________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________________________

REGISTRATION FORM (continued)


EMERGENCY CONTACT

I, _______________________________________________________________ , the parent/legal guardian of the participant(s) listed below:

Child’s Name Program child will be participating in

1. ______________________________________________________________________ _________________________________________________________________

2. ______________________________________________________________________ _________________________________________________________________

3. ______________________________________________________________________ _________________________________________________________________

4. ______________________________________________________________________ _________________________________________________________________

give permission for emergency medical service to be administered to my child/participant listed above. I understand that the City of Chandler does not carry accident insurance for these programs. I agree to indemnify and hold harmless the City of Chandler from all losses or injuries sustained during my child’s/youth’s participation. I also give permission for any photo/video taken of my child/participant to be used by the City of Chandler.

Parent/Guardian Signature: ________________________________________________________________________ Date: ________________________________

Parent/Guardian email address:__________________________________________________________________________________________________________

In case of emergency, please contact: (Please print)PARENT/GUARDIAN CONTACT SECONDARY CONTACT

Name: _____________________________________________________________ Name: ____________________________________________________________

Cell Number: ______________________________________________________ Cell Number: _____________________________________________________

Home Number: ___________________________________________________ Home Number: ___________________________________________________

Relationship: ______________________________________________________ Relationship: _____________________________________________________

In case of emergency, please list child’s address: __________________________________________________________________________________

The City of Chandler intends to comply with the Americans with Disabilities Act (ADA). To request a reasonable accommodation, please contact Collette Prather at (480) 782-2709 at least two weeks in advance.

List any physical disabilities/conditions or allergies to food or medications known: ______________________________________________

____________________________________________________________________________________________________________________________________________

____________________________________________________________________________________________________________________________________________

Doctor’s Name: _____________________________________________________________ Phone Number: ____________________________________________

Staff cannot administer any medication. The City of Chandler will not store medication and is not responsible or liable for any medication your child requires.

Alternate Pick-ups: (Please list the names and contact information for people permitted to pick-up your child.)If someone other then myself will be picking my child up from class I will notify staff in writing and that person will be required to show photo ID before my child will be released.

Name Relation to Child Phone Number

1. _______________________________________________________ ________________________ ____________________________________________________

2. _______________________________________________________ ________________________ ____________________________________________________

3. _______________________________________________________ ________________________ ____________________________________________________


I, ___________________________________________________________________ , the parent/legal guardian of

(child’s name) _____________________________________________________________________________________

give permission for a Camp Challenge leader of the same sex as my child to apply sunscreen to my child in the presence of another Camp Challenge leader.

The purpose of sunscreen is for the safety of the participants and encouragement of proper protection from the sun before open swimming and/or any outdoor activity.

Parent/Guardian Signature: _______________________________________________________________________

Date: ______________________________________________________________________________________________

YES! I, __________________________________________________________ , the parent/legal guardian of

(child’s name) _____________________________________________________________________________________

give permission for my child to attend the swimming fi eld trips scheduled for the Camp Challenge Program. I understand that the City of Chandler does not carry accident insurance for these programs. I agree to indemnify and hold harmless the City of Chandler from all losses or injuries sustained during my child’s/youth’s participation. If my child has seizures, I will send a red shirt for him/her to wear in the pool. I understand no child may be left at the school on swim days.

Participant’s swimming ability is: Cannot Swim Beginner (floatation required) Intermediate Advanced


Date: ______________________________________________________________________________________________

OR NO! My child, _________________________________________________________________________________ ,

will NOT swim and I understand that participants will be back at 12 p.m., noon, on swim days and my child may not arrive until after that time.


Date: ______________________________________________________________________________________________

SUNSCREEN PERMISSION SLIP

SWIMMING PERMISSION SLIP

SUNSCREEN/SWIMMING PERMISSION SLIP


CAMP CHALLENGE MEDICATION FORMPlease note: A separate medication sheet must be kept for each medication given to your child during camp hours. Please make copies of this form as necessary and include them with the registration packet. It is the parent’s responsibility to bring the child’s medication to Camp Challenge in the correct quantities/amounts.

As the parent/guardian of participant listed above, I give consent for the Site Supervisor, Program Coordinator, or his/her designee, to oversee that my child/ward receives the medication as listed below:

Medication Name: _______________________________________________________________________________________________________

Dose: ___________________________________________________________________ Time to be given: ______________________ at Camp

Special Instructions: _____________________________________________________________________________________________________

Any side eff ects: _________________________________________________________________________________________________________

Parent/Guardian Signature: ________________________________________________________Date: _______________________________

Please note: Participants are not to carry medications on their person or in their backpack at any time during camp hours, or on any bus ride. The only exceptions to this policy are the following: EPI Pen/Inhaler/Diastat release.

OFFICE USE ONLYParticipant’s Group: _____________________________________________________________________________________________________

Date Initials CommentsJune 4 ___________________________________________________June 5 ___________________________________________________June 6 ___________________________________________________June 7 ___________________________________________________June 8 ___________________________________________________

June 11 __________________________________________________June 12 __________________________________________________June 13 __________________________________________________June 14 __________________________________________________June 15 __________________________________________________

Date Initials CommentsJune 18 __________________________________________________June 19 __________________________________________________June 20 __________________________________________________June 21 __________________________________________________June 22 __________________________________________________

June 25 __________________________________________________June 26 __________________________________________________June 27 __________________________________________________June 28 __________________________________________________

Signature of staff administering medication: ___________________________________________________________________________

Staff title: _______________________________________________________________________________________________________________

A=participant absent R=refused to take medication X=no program today 0=no medication sent to program

NOTE: Please duplicate this sheet for each medication taken at camp.

CAMP PARTICIPANT’S NAME: _______________________________________________________________Will the participant take medication while at camp? Yes No

If yes, please complete the following and note that a Request for Reasonable Accommodation form is also required.

NOTE: Recreation staff and representatives are not trained or permitted to provide medication administration services to program participants. If you require assistance with medication administration during participation in one of our programs, you will need to make arrangements to have a caregiver provide such services for you. Participants’ self-administration of medications will be permitted only in accordance with an approved in advance Request for Reasonable Accommodation. Medications covered by this policy include, but are not limited to, all prescription and over-the-counter drugs, inhalers, and epinephrine auto-injectors (e.g., EpiPens). Any questions regarding the administration of medications should be directed to the program coordinator.


SCHOOL CONTACT FORM (If Applicable)PARENTS: To ensure the participant has an optimum camp experience, please fill out the following.

I give my permission for City of Chandler Camp Challenge staff to (check all that apply):

______________ Visit with my child’s teacher by phone

______________ Observe my child at school

School: ______________________________________________________________________________________________________

Teacher’s Name: _____________________________________________ Phone Number: _____________________________

Camp Challenge does not provide enhanced ratio programs; participant must be able to function successfully in at least a 1:4 ratio during all structured and less structured activities.

Parent/Guardian Signature: _________________________________________________ Date: __________________________

CAMP PARTICIPANT’S NAME: _______________________________________________________________


PARENTS: Please read the attached information regarding our Camp Challenge policies. When you have read them, please sign this acknowledgement sheet.

I, __________________________________________________ , the parent/legal guardian of the participant(s) listed above have read and understand the Parent Guide, Drop-off/Pick-up policy, Behavior policy and the Refund policy. I have also filled out the registration packet as COMPLETELY as possible and to the best of my knowledge.

All the staff members at Camp Challenge may rely on the information contained herein to make a decision as to whether or not this applicant may safely participate at Camp Challenge. The City of Chandler reserves the right, in its absolute discretion, to terminate this program, or anyone’s participation in the program, at any time, for any reason, including but not limited to any participant’s failure to comply with any staff or program coordinator’s directives.

I give permission for emergency medical service to be administered to my child/participant listed above. I understand that the City of Chandler does not carry accident insurance for these programs. I agree to indemnify and hold harmless the City of Chandler from all losses or injuries sustained during my child’s/youth’s participation. I also give permission for any photo/video taken of my child/participant to be used by the City of Chandler.

Parent/Guardian Signature: _________________________________________________ Date: __________________________

POLICY ACKNOWLEDGEMENT

CAMP PARTICIPANT’S NAME: _______________________________________________________________

Documents

CHANDLER SIGNATURE CAMP CHALLENGE | 2019 PARENT … · NO sandals, ﬂ ip ﬂ ops or Crocs. • To reduce the amount of lost and found, please have your child(ren)’s clothing marked