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Oso Valley Service Unit presents Girl
Scout® Day Camp 2017
“Under the Sea”
July 10 – July 14, 2017
9:00 a.m. to 2:00 p.m.
Laguna Niguel Regional Park
Your girls will have fun while they learning about what lies beneath the waves. Activities will be based on
the various species of ocean life. The week will be packed full of unique crafts, interesting learning
activities, games and a camp provided lunch on Friday. Join us for a great underwater adventure….
REGISTRATION FEES FOR DAY CAMP JULY 10 - 17, 2017:
Campers and Adult Voluteers
#Registered
Fee
Girl Scout Campers (registered Girl Scouts)
__________
x $80 each =$ ________
•
Total
Non-Registered Girl Scout Campers & GEMS must register first through GSCOC website to attend
“GEM’s” Program Aides, Grades 7-12 (registered Girl Scouts)
__________
x $30 each = $ ________
Pixie Campers (children 3-5 yrs. old of Adult Volunteer)
_
Boy Campers (sons of Adult Volunteer, 5-11 years old)
__________
x $30 each = $ ________
__________
x $30 each = $ ________
Extra Camper/GEM T-Shirt
__________
x $10 each = $ ________
T-Shirt for Adult Volunteer (Required for adults working less than 5 days)
____________
x $10 each = $ ________
Total Due by May 17, 2017
$ _______
•
Adult Volunteers who work 5 days receive a FREE t-shirt and have one girl camper attend FREE!
•
Parents: Please submit your Registration and Health History Forms with payment to your TROOP
LEADER , check payable to your troop
•
Leaders: Please submit all registrations together with a double- signature troop check, payable to
“Oso Valley Day Camp” by May 17th, 2017
•
Parents: If your troop leader has NOT made this registration process available to you through your troop,
you may register individually. Please make checks payable to “Oso Valley Day Camp” and submit by May
17, 2017 to: Oso Valley Day Camp 26681 Baronet, Mission Viejo, CA 92692
Oso Valley Service Unit- All-Volunteer Day Camp 2017
Registration Information for
“Under the Sea” Day Camp
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Camp is open to any girl, entering Kindergarten-6th grade in September.
Boy Camp (5-11 year old boys) and Pixie Camp (3-5 year olds) will be available only for the children of Adult
Volunteers only on their volunteer day(s). Insurance requires that parent be at camp during the time their child is
in boy or pixie camp.
Registrations should be made through your troop. Parents please make check payable to their troop and then the
troop will write ONE TROOP CHECK to Oso Valley DayCamp. All camp registrations & payments due May
17th, 2017, at the registration address listed below. Camp will be filled according to postmarks and dates received.
Fee includes: T-shirt, hat, patch, Friday’s all-camp lunch, and camp gifts & activities. All adult volunteers must
wear a camp T-shirt, which will be provided free of charge to adults working 5 days. Adults working less than 5
days need to order a T-shirt for $10.
Participants bring lunches / water Mon-Thurs. Don’t miss our Grand Finale luncheon on Friday where campers will
enjoy a feast provided by DayCamp and enjoy wonderful last day special activities.
Adult Volunteers
Enjoy Day Camp for FREE! Adult volunteers who work 5 days may have one Girl Scout camper attend for
FREE! We must have adult/girl ratios of 1:6 for Daisies, 1:6 for Brownies, and 1:16 for Juniors at Day Camp. If
we do not meet our adult ratios, we will be forced to reduce our camper numbers. Troops can either have one
adult volunteer for 5 days or have several different adults co-volunteer on different days. However, troops
that are having several different adults working MUST specify who and on what days these adults will be
attending camp at the time of registration. All Volunteers are required to be registered and background screened by
GSOC to work with children. Please see DayCamp Director for paperwork. Volunteers who work 5 days will
receive a free camp T-shirt and all adult volunteers are REQUIRED to wear a camp T-shirt. Training will be
provided to all adult volunteers and is mandatory for Unit Leaders. This is a great opportunity to help without a
long term commitment. The girls really need your support! Do it for the girls!
GEMS (GIRLS WITH EXTRA MATURITY, ENTERING GRADES 7-12)
Share experience and knowledge with younger Girl Scouts! As GEM, you can help younger children with crafts, songs and
games while earning IPs, leadership/service hours, and having fun too! Our camp cannot sparkle without our GEMs!
Boy Camp / Pixie Camp
Children of Adult volunteers have a chance to share our wonderful Day Camp experience. Boy Camp (5-11 year
olds) and Pixie Camp (3-5 year olds – if not toilet trained, diapers must be changed by parent) will be on the park
site during camp hours. At the semi structured camp they will enjoy crafts, games, play and story time. Boy
Camp will have their own activities, hikes and age appropriate crafts. Sack lunches and water need to be
provided by the parent, except on Friday when the whole camp will enjoy lunch and program together.
Transportation
Parents transport their camper(s) to/from Day Camp. Carpooling is strongly encouraged. Vehicles parked for
the duration of DayCamp must display a parking pass. Vehicles dropping off campers will be required to
display a Entry Pass provided to you. Vehicles with these passes will enter for FREE only 15 minutes before
and after the drop/pick up times. If you enter the park at any other time, there is a fee per vehicle per entry
collected by the park. Please do NOT honk at the ranger, or try to “run the gate” when the arm is up. Girl
Scout manners are expected when dealing with the Park Employees and Rangers at all times.
Day Camp Director & Registration
Maggie Sepulveda, DayCamp Director
26681 Baronet., Mission Viejo, CA 92692
[email protected]
(949) 462-4054 text or cell
Dee Dee Keuning, Day Camp Assistant Director
[email protected]
(949) 351-6131
Tara Houck- Lehr, Camp Registrar
[email protected]
(949) 395-6457
*We are sorry, but Saddleback 6 Day Camp cannot be responsible for lost items. Please label all personal items.
For camp use ONLY
Placement _________
COMMUNITY DAY CAMP REGISTRATION FORM
Child
Name of Day Camp:
Shirt size __________
Location:
Camper’s Name ____________________________________Age at Camp_______________
Date of Birth__________________ Grade in Fall ___________ Current School _____________________
Parent/ Guardian Name ____________________________ Day Phone _____________Cell____________
Age
Parent/ Guardian Name ____________________________ Day Phone _____________Cell____________
Address ____________________________________ City _____________________ Zip ___________
Email Address ____________________________________Home Phone _________________________
Is camper a registered Girl Scout?
YES Current Troop #: ________
NO
(If no, please register as a Girl Scout member online at www.GirlScoutsOC.org/join and attach the Membership Order Receipt to this form)
You must register as a Girl Scout member prior to Day Camp registration.
Girl Scout Level:
T-shirt size:
Daisy (k-1)
Child’s small
Adult small
Brownie (2-3)
Junior (4-5)
Child’s medium
Adult medium
Cadette (6-8)
Child’s large
Adult large
Senior/Amb (9-12)
Pixies
Child’s XL
Adult XL
If possible I would like my camper to be with her friend(s) __________________ and/or __________________
(Placement of campers is at the camp’s discretion)
Name & Troop #
Name & Troop #
In case parent/guardian cannot be reached in an emergency, who should be notified?
(NOTE: This must be a local person over 18 and not working at day camp who can pick up camper if needed.)
Name _______________________________________ Relationship ____________________________
Day Phone ________________________ Alternate Phone/Cell _______________________________
----------------------------------------------------------------------------------------------------------------------------Is there anyone who CANNOT pick up your child from Day Camp? YES
NO
If yes, name (s) ______________________________________________________________________
Does camper have any physical, mental, or medical condition or disability that might affect her involvement in any day camp
activities? YES NO
If YES, please describe how the condition or disability might affect her involvement and what could be done to enhance her
participation.
__________________________________________________________________________________
1
I give permission for my camper to be photographed and permit Girl Scouts of Orange County to use the photographs in print,
internet, video and electronic marketing and promotional materials. YES NO
I have read the information and give my permission for my child to attend and participate in all Girl Scouts of Orange County day
camp activities.
Signature of Parent or Guardian __________________________________________________________ Date _________
I would like to help at my daughter’s day camp: YES NO
(If YES please request an Adult Volunteer Application)
Camp use ONLY:
GSUSA fee ______
Camp fee ______
Health History ______
Med release ______
For camp use ONLY
Placement _________
COMMUNITY DAY CAMP REGISTRATION FORM
Shirt size __________
Adult
Name of Day Camp: ____________________________ Location: _________________
Volunteer’s Name ____________________________________________________________________
Day Phone _________________ Evening Phone _________________ Cell Phone ___________________
Best time to call _____________
Age
Address ____________________________________ City _____________________ Zip ___________
Email Address _______________________________________________________________________
T-shirt size:
Adult small
Adult 2XL
Are you a registered Girl Scout?
Adult medium
Adult 3XL
Adult large
Adult 4XL
Adult XL
YES Current Troop #: ________ Membership ID#:__________________
NO
(If no, please register as a Girl Scout member online at www.GirlScoutsOC.org/join and attach the Membership Order Receipt to this form)
You must register as a Girl Scout member prior to Day Camp registration.
Girl Scout Adult Volunteer Experience: (please list your two most recent Girl Scout volunteer experiences)
Position
Year(s)
Council
City/ State
Were you a Girl Scout as a child?
Have you worked at this camp before?
YES
YES
NO
NO If yes, how many summers? ___________
Skill Inventory:
Are you a registered nurse?
Are you certified in First Aid?
Are you certified in CPR?
Are you a certified Lifeguard?
YES
YES
YES
YES
NO
NO
NO
NO
Required: Emergency Contact
Name _______________________________________ Relationship ____________________________
Day Phone ________________________
Alternate Phone/ cell _______________________________
I give my permission to be photographed and permit Girl Scouts of Orange County to use the photographs in print, internet, video
and electronic marketing and promotional materials. YES NO
My signature below acknowledges that the information, I have provided on this form is true and accurate.
I have read the information and I understand that I am registering to attend and participate in Girl Scouts of Orange County day
camp activities.
Signature ____________________________________________________________________ Date _____________
( Please complete an Adult Volunteer Application if you are a new volunteer. www.girlscoutsoc.org)
Over
Volunteer’s Name: __________________________________________________________________
Type of position preferred:
st
Indicate position preference.. (List 1 through last choice. Every effort will be made to place you in one of your first 3 choices.)
__ Daisy (k-1) __Brownie (2-3) __Junior (4-5) __Cadette (6-8) __Pixie (pre-k) __Boy unit
__ Craft Station
__ Program Station
__ Songs/ Games Station
__ My daughter’s unit
Please list skills you are willing to share:
________________________________________________________________________________
______________________________________________________________________________
Availability:
Indicate days and times you are available to volunteer at Day Camp.
_______________________________________________________________________________________________
Days Available:
Monday
Tuesday
Wednesday
Thursday
Friday
(Please circle)
Times Available:
List any children who will be attending day camp:
Name
Age
Girl/Boy
Registered Girl Scout
Troop
Do you know of any reason why you would not be able to perform the essential functions of the job for
which you are applying for with or without reasonable accommodations? YES
NO
If yes, what accommodations might be necessary?
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
Camp use ONLY:
GSUSA fee ______
Vol. App. ______
Health History ______
Troop #
Child Health History
Participant Name
Last
First
Birth Date
Middle Initial
Age
Custodial Parent/Guardian Name
Home Address
Phone Number
Number & Street
City
State
Zip
Business Address
Area Code/Number
Phone Number
Number & Street
City
State
Zip
Area Code/Number
If above contact is not available in an emergency, notify:
Name
Relationship
Address
Phone Number
Number & Street
City
State
Zip
Name of family physician or Christian Science Practitioner
Area Code/Number
Phone Number
Area Code/Number
Do you carry family medical/hospital insurance?
Yes
No
Carrier Name
Policy/Group Number
Carrier Address
Phone Number
Number & Street
City
State
Zip
Health History Information. If you check any of the boxes below, please explain below.
Yes
No
Allergies
11 German Measles
1
Hay Fever
12 Mumps
2
Poison Oak, etc.
General Information
3
Insect Sting (i.e. bee, mosquito)
13 Had any recent injury, illness
4
Penicillin
or infectious disease?
5
Asthma
14 Have a chronic or reoccurring
6
Animals
illness/condition?
7
Food
15 Have frequent headaches?
8
Drugs
16 Wear corrective eyewear?
Diseases
17 Have a personal assistance
9
Chicken Pox
device (e.g. wheelchair, brace,
10 Measles
prosthetic device)?
Please explain any “Yes”, noting the number of the question:
Area Code/Number
Yes
No
Yes
No
18
19
Have diabetes?
Have a problem
w/sleepwalking?
20 Have an eating
disorder?
21 Have epilepsy?
Special Needs
22 Developmental Disability?
23 Hearing Impairment?
24 Visual Impairment?
25 Learning Disability?
26 Physical Impairment?
List any restrictions in activities:
This health history is complete and accurate. My child has permission to engage in all activities, except as noted by me.
Signature of Parent/Guardian
Date
I (we) the undersigned parent, parents or legal guardian of
, a minor, do herby authorize consent to any x-ray
examination, anesthetic, medical or surgical diagnosis rendered under the general or special supervision of any member of the medical staff and emergency room staff
licensed under the provision of the Medicine Practice on the staff of any acute general hospital holding a current license to operate a hospital from the State of California
Department of Public Health. It is understood that this authorization is given in advance if any specific diagnosis, treatment, or hospital care being required but is given to
provide authority and power to render or which the aforementioned physician in exercise of his/her judgment may deem advisable.
It is understood that effort shall be made to contact the undersigned prior to rendering treatment to the patient but that any of the above treatments will not be withheld if the
undersigned cannot be reached. I will not hold liable the Girl Scout Council of Orange County, its officers or leaders for medical aid rendered at the hospital or first aid
rendered at the event and will reimburse the Girl Scout Council of Orange County for medical or other expenses incurred in the care of my child.
This authorization is given pursuant to Section-6910 of the Civil Code of California.
I will permit photographs of my daughter taken at this event to be used for publicity by authorization of the designated members of the Council.
Medication must be accompanied by written instructions from the parent or physician and in their original containers.
Parent/Guardian’s Signature
This consent shall remain effective for one year from this date:
Phone
Date
,20
Girl Scouts of Orange County ♦ 9500 Toledo Way, #100 ♦ Irvine, CA 92618 ♦ www.GirlScoutsOC.org
949.461.8800 ♦ 800.979.9444 ♦ Español 949.461.8894 ♦ Tiếng Việt 949.461.8895
Adult Health History
We appreciate your time to complete this record as it will help to make camp a healthy and positive experience for
everyone. Information on this form is gathered to assist us in identifying appropriate care in the event of an emergency.
Please fill in all information or write N/A for non-applicable. Please use and attach additional sheets if necessary.
Name
Date of Birth
Last
First
Middle Initial
Age
mm/dd/year
Emergency Contacts – We contact in the order listed. If you are covered under a parent/guardian’s insurance, you must
include them as a contact.
1
Name
Relationship
Address w/city & state
Phone
Name
Relationship
Address w/city & state
Phone
Name
Relationship
Address w/city & state
Phone
2
3
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
General questions: (explain any “Yes” responses in the space provided below.)
Yes No
Had any recent injury, illness or infectious
20 Ever had nosebleeds?
disease?
21 Ever had problems with joints (e.g. knee, ankles)?
Have a chronic or recurring illness/condition?
22 Have any skin problems (e.g. itching, rash,
Ever been hospitalized?
acne)?
Ever had surgery?
23 Have diabetes?
Have frequent headaches?
24 Have asthma?
Ever had a head injury?
25 Had mononucleosis in the past 12 months?
Ever been knocked unconscious?
26 Have problems with diarrhea/constipation?
Ever had frequent ear infections?
27 Wear glasses, contacts or protective eye wear?
Have an eating disorder?
28 Have any special dietary needs/issues?
Ever passed out during or after exercise?
29 Have an orthodontic appliance being brought
Ever been dizzy during or after exercise?
to camp?
Have a personal assistance device(e.g.
Ever had emotional difficulties for which
30 wheelchair,
professional help was sought?
brace, prosthetic device)?
Allergies. List all known on a separate sheet if
Ever had high blood pressure?
Ever had chest pain during or
needed. Describe symptoms, reactions and
after exercise?
management or treatment for each.
Have problems sleepwalking?
31 Do you have any medication allergies?
Ever had seizures?
32 Do you have any food allergies?
Do you take medication?
33 Do you have any other allergies (including bee
Ever been diagnosed with a heart murmur?
stings, hay fever, animal dander, etc…)?
Ever had back problems?
Please explain any “Yes” response, noting the number of the questions.
This Health History is complete and accurate.
Participant Signature
Date
Girl Scouts of Orange County ♦ 9500 Toledo Way, #100 ♦ Irvine, CA 92618 ♦ www.GirlScoutsOC.org
949.461.8800 ♦ 800.979.9444 ♦ Español 949.461.8894 ♦ Tiếng Việt 949.461.8895
Yes
No
COMMUNITY DAY CAMP
Medication Release Form
*This form MUST be turned in with all youth participant Registration Forms*
Name of Day Camp: __________________
Camp Dates: ____________________
Child’s Name __________________________________________________________
I request that my child _____________________________________________of troop # ___________
(name)
be given ____________________________________________________ by the camp health supervisor.
(medication)
Age
Medication
Time
Dose
Repeated at what interval
Physician prescribing medication _______________________________________________________
Phone # of physician (_______)_________________________________________________________
In light of the correlation between Reye's Syndrome and aspirin indigestion, no aspirin or aspirin products may be
administered at camp. If it is medically necessary for your child to receive aspirin, a physician's authorization
must accompany the medication.
Please list any allergies:
___________________________________________________________________________________________________
__________________________________________________________________________________
My child is NOT taking any medication
PLEASE NOTE – WE CANNOT KEEP OVER THE COUNTER MEDICATION AT CAMP TO DISPENSE. IF YOU FEEL YOUR CHILD WILL
NEED MEDICATION OF THIS NATURE, PLEASE PROVIDE THE TYPE OF MEDICATION IN ITS ORIGINAL BOTTLE IN A BAG WITH
THE CAMPER’S NAME ON IT ALONG WITH THIS FORM GIVING AUTHORIZAITION TO ADMINISTER.
Signature of Parent or legal Guardian _____________________________________________________ Date _________
Phone _____________________________________________
“Under the Sea”
Camp!
Oso Valley Day
Camp 2017
Logo Design Contest
This is your chance to design the artwork to be featured on the
2017 Oso Valley Day Camp patch and T-shirts.
Name:_____________________ Troop #______ Level_____________
Submit entries: Maggie “Ms. Aloha” Sepulveda, 26681 Baronet,
Mission Viejo, CA 92620 by 4/19/2017. For questions, please contact
Maggie Sepulveda at [email protected]
Rules:
1. Contest is open to All Girl Scouts.
2. You may choose either template shape for your design
3. Please use the phrases “Under the Sea” and
“Oso Valley Day Camp 2017” in your design.
4. Use only COLORED PENCILS to color your design.
*Limit your colors to a total of seven
5. Simple designs transfer best to both patches and t-shirts.