The Anthony Rizzo Family Foundation
presents
Gilda’s Club Chicago’s Teen Camp 2017
This camp is offered free of charge for teens (13-19 years old) living with a
cancer diagnosis, who have a family member or friend living with a cancer
diagnosis or have lost a loved one to cancer.
Make new friends, bring your
old ones, and participate in
awesome activities in the
Clubhouse and around
Chicago, including the Adler
Planetarium, The Second City,
Wrigley Field and more!
Teens must register for the entire
week of camp – strict limit of 40
participants in order of completed
registrations received.
To register for camp, please complete
this entire packet (5 pages) including:
- Camper registration form
- Publicity release
E-Mail: [email protected]
Fax:
312.464.1487
In Person:
Gilda’s Club Chicago
Allison Brown, Noogieland Coordinator
537 N. Wells St
Chicago, IL 60654
Questions? Please contact Allison Brown, LCSW, Noogieland Coordinator at 312.464.9900 ext 116
Teen Camp 2017 Agenda
Monday, July 24
9:00-9:30
Check in
9:30-10:30
Mixer Games
10:30-11:30
Drum Circle with Old Town School of Folk Music
11:30-11:45
Walk to Gino’s East
11:45-12:45
Lunch at Gino’s East
12:45-1:00
Walk back to Gilda’s Club Chicago (GCC)
1:00-2:00
Writing Workshop with Nora
2:00-3:00
Tai Chi with Deb
Tuesday, July 25 (Late Day – we return to GCC by 4:00pm)
9:00-9:30
Check in
9:30-9:45
Sparkle Time
9:45-10:15
Bus Ride to Wrigley Field
10:15-3:30
Lunch and Chicago Cubs vs. Chicago White Sox
3:30-4:00
Bus ride back to GCC
Wednesday, July 26
9:00-9:30
Check in
9:30-11:00
Second City @ GCC
11:00-12:00
Yoga with Jenny
12:00-12:30
Walk to Dave & Buster’s
12:30-2:30
Dave & Buster’s – Eat and Play
2:30–3:00
Walk back to GCC
Thursday, July 27
9:00- 9:30
Check in
9:30-9:45
Bus ride to Adler Planetarium
10:00-12:30
Adler Planetarium and Planet 9 show
12:30-12:45
Bus Ride back to GCC
12:45-1:45
Lunch
1:45-2:00
Sparkle Time
2:00-3:00
Iron Chef Cooking Activity
Friday, July 28
9:00-9:30
Check in
9:30-10:30
Art
10:00-11:30
Anti-Cruelty Society – Educational Program and Tour (Dogs and Cats)
11:30-12:15
Lunch
12:15-12:30
Walk to Jesse White Community Center
12:30-2:00
Soccer with Chicago Red Stars
2:00-2:15
Walk Back to GCC
2:15-3:00
Art, Sparkle Time, Goodie Bags and Farewells
Camper Registration Form
Teen’s Name: __________________________________________________________________
Teen’s Address: ___________________________City: __________________
Zip Code: _____________
Teen’s Telephone Number: (h) __________________ (c) ___________________
Teen’s Email Address: _________________________________________________________________
Teen’s Date of Birth: _________________ Gender: _______
Parent/Legal Guardian(s) Name: ___________________________________________________
Parent/Legal Guardian(s) Email Address:
___________________________________________________
Emergency Contact: ____________________________________________________________
If not parent, relationship to teen: ___________________________________________________
Emergency Contact Number: (h) ___________________ (c) ___________________
Teen’s T-shirt Size: _______
Teen’s relationship to the person with cancer _______________________
Please list any allergies/medical conditions: (including animals(cats/dogs), asthma, diabetes, cancer, bee
sting allergy, etc)
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________
My teen has the following dietary restrictions: (vegetarian, lactose intolerant, peanut free, Kosher
I give permission for my teen ___________________________ to attend the Gilda’s Club
Chicago’s Teen Camp July 24-July 28.
I have reviewed the agenda and am aware of the activities that my teen will be participating in
throughout the week. I understand that Sparkle Time is an opportunity for the teens to share
their cancer experience with each other at designated times each day of camp. If you have any
questions regarding Sparkle Time please contact Noogieland Coordinator, Allison Brown,
LCSW . I understand that camp takes place at Gilda’s Club Chicago, located at 537 N. Wells
Street, Chicago, IL 60654. I understand my teen will be riding a school bus to off-site locations
including: Adler Planetarium, and Wrigley Field. I understand that on Monday, July 24th my teen
will be walking a total distance of 0.2 miles (.1 miles both directions) to and from Gino’s East. I
understand that on Wednesday, July 26 th my teen will be walking a total distance of 1.6 miles (.8
miles both directions) to and from Dave and Buster’s Chicago, I understand that on Friday, July
28th my teen will be walking a total distance of 1.2 miles (.6 miles both directions). I also
understand that on Tuesday, July 25th the camp day will end LATE at 4:00pm, instead of
3:00pm.
Camp t-shirts will be distributed on the first day – they MUST be worn on offsite
“community days” to participate, these include: Tuesday (7/25), Wednesday (7/26),
Thursday (7/29), Friday (7/28).
Please check one of the following:
I will pick my teen up from Gilda’s Club Chicago at the end of camp each day.
My teen will be taken home by ______________ (adult’s name) at the end of
camp each day.
I give my permission for my teen to take public transportation (el, bus) or walk
home at the end of camp each day.
Supervision for teens on Tuesday, July 25 ends when the Gilda’s Club Chicago’s (GCC) Teen
Camp group leaves Wrigley Field at 3:30pm and returns to GCC at 4:00pm. With permission
below, your teen can stay at Wrigley Field after the GCC group leaves, to continue watching the
game. Teens are then on their own to leave the game at their discretion by public transportation
or getting picked up by a friend or family member. GCC is no longer liable for their safety if they
have permission to remain at the game.
I give my permission for my teen to stay at Wrigley Field after GCC summer camp
has left at 3:30pm. My teen has permission to take public transportation (el, bus),
walk home or get picked up by a friend or family member from Wrigley Field.
___________________________________________________
Signature of Parent/Guardian and Date
___________________________________________________
Relationship to Teen
___________________________________________________
Print Name of Parent/Guardian
Lunch Choices
Please indicate your teen’s preference for lunch:
July 24th: Gino’s East (thin crust pizza)
Select only one option:
Cheese
Pepperoni
Sausage
July 25th: Wrigley Field Concession Stand
There will be a variety of food available – each teen will receive $10 in Cubs Cash
July 26th: Dave & Buster’s
There will be a buffet of food available:
Crispy Chicken bites with Chipotle Honey Sauce, Burgers, Veggie Lawnmower Salad,
Cavatappi Pasta with Marinara, French Fries and Assorted Cookies and Brownies
July 27th: Subway
Select only one option (sandwich or salad):
Cold Cut Combo
Italian BMT
Roast Beef
Spicy Italian
Subway Club
Tuna
Turkey Breast
Turkey and Ham
Vegetarian Delight
July 28h: Potbelly
Ham
Pizza
Publicity Release for Gilda’s Club Chicago
I, the undersigned hereby grant Gilda’s Club Chicago the right, license and privilege to
use my child’s name, likeness, photograph, voice, biography and video likeness in such
a manner as Gilda’s Club Chicago deems appropriate in order to promote, advertise,
and publicize Gilda’s Club Chicago and its charitable activities.
_____________________________________________
Signature of Parent
_____________
Date
PLEASE NOTE: IF YOU WANT TO LIMIT OR RESTRICT GILDA’S CLUB CHICAGO’S
RIGHT OF PUBLICITY IN ANY WAY YOU MUST PLACE YOUR INITIALS ON THE
SPACE PROVIDED BELOW AND STATE THE SPECIFIC LIMITATION OR
RESTRICTION YOU DESIRE
The publicity is limited in the following respects:
_______Initials