SUMMER DAY CAMP
FOR TEENS Ages 12-16!
Cordova Recreation and Park District
2197 Chase Dr. • Rancho Cordova, CA • 95670
(916) 369-9844
FAX (916) 369-9870
Day Camp Recreation Coordinator
Angie Stolze
[email protected]
(916) 369-9844 ext. 13
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XX
The H.Y.D.E Out!
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TEEN L.E.A.D.
OFFERS 8 WEEKS
OF SUMMER
ADVENTURE!
Camp Hours:
Monday-Friday
8am-5pm
Dates
Field Trip
Theme
Getting to know ME!
Week One
June 13-17
$125
 Jelly Belly Factor (Tues)
 Studio Movie Grill (Thurs)
Week Two
June 20-24
$125
 Diamond Billiards
 Sunsplash
Week Three
 Wackford Water Park (Tues)
Got H20?
Build
a
water
park that recycles
 Wake Island (Thurs)
Explore personal strengths,
talents, creativity and build
confidence through interactive
games and activities
It’s Summer Time
Build a boat
Fee: $125/week
June 27 – July 1
$125
Field trip day!
Camper t-shirt
required.
Fee: $10/shirt
To register visit
or call:
water
Week Four
July 5-8
$125
 Foot Golf (Wednesday)
 Rafting (Thursday)
Week Five
July 11-15
$125
 6 Flags (Tues)
 John’s Incredible Pizza (Thurs)
Week Six
July 18-22
$125
 Feed Sacramento (Tues)
 Oak Park Garden work
Cooperative Learning
Co-op activities
Engineers
Work together to research, design
and build an amusement park
www.crpd.com
Cordova
Community
Center
(916) 362-1841
(Thurs)
Week Seven
July 25-29
$125
 K1 Speed (Tues)
 Auto Museum (Thurs)
Week Eight
August 1-5
$125
 Scandia (Tues)
 Nimbus Lake (Wed)
(916) 369-9844 • FAX (916) 362-9602
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Volunteering
Find a cause in which we could
make a difference.
Viable Vehicles
Understand alternative power
source for vehicles
Teen Choice
Teens will choose the theme
and activities for the week
Thank you for enrolling your child in the Teens in the L.E.A.D Summer Day Camp program. This program was
created with a focus on Leadership, Experiences, Adventure and Development with the intent to promote
healthy physical activity, appropriate social interaction, skills in independence and leadership. During program
hours many of the discussion topics are geared towards common teen issues and ways to deal with them such
as bullying, image, respect, entering the workforce as well as explore creativity. We hope that any child who
participates in our program will have gained knowledge, confidence, leadership skills and memorable
moments of n adventured filled summer. For further information about the contents of Teens in the L.E.A.D
contact program coordinator: Angie Stolze at (916) 369-9844 ext. 13 or at [email protected] or the Day Camp
Director, Tammy White at [email protected].
Registration Information
Please familiarize yourself with this packet and return the following THREE FORMS before leaving your child
with us on the first day of camp.
□
□
□
Camper Information Form
Waiver Form
Bike Agreement
Return these THREE forms to: CRPD, 2197 Chase Drive, Rancho Cordova, CA 95670, Attn: Tammy White. Or
email [email protected]. We must receive this paperwork before your child is left with camp staff. You
need only complete and return this paperwork once per summer.
• You may register one week at a time and you may register for as many sessions as you desire. PLEASE
REGISTER YOUR CHILD NO LATER THAN THE WEDNESDAY BEFORE THE START OF THE FOLLOWING WEEK
FOR EACH CAMP SESSION. Your Child’s space in the camp is not secure until payment, in full, is received.
Camp Spaces are limited to 32 participants each week.
• Children must be registered, and all paperwork completed, before the child is left in our care. If you do
not turn in your child’s paperwork before the start of camp, please allow extra time for yourself on their first
day as you will be asked to complete it on-site. YOU MAY NOT LEAVE YOUR CHILD WITH US UNLESS THIS
PAPERWORK IS FILLED OUT.
Refund Policy
• Cancellation prior to the start of the session. If you cancel 2 weeks prior to the start of the session you will
receive a full refund. Cancelations 1 week prior to the start of the session will result in a 50% refund.
PLEASE NOTE: Refunds will NOT be given for missed days or for suspension.
By returning the information forms included in this packet, you are acknowledging you have received and
read this packet. You are also acknowledging the following policies:
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Important Information
•
•
•
•
•
These camp programs are recreation programs run by the Cordova Recreation & Park District. Our
staff is trained exclusively for these programs. We are not a licensed child care facility or a day care
program.
Program hours are 8 am-5 pm. Staff is not on duty until 7:45 am. Do not drop off your child prior to
7:45 am. No one is available to supervise.
Please Note: Toys and electronics are not allowed at camp. We are not responsible for lost,
damaged or stolen items.
Cell phones are not allowed except on field trips. If a cell phone is a neccessity, we will lock up the
cellphones in a closet and return an hour before the end of camp. On field trip days, cell phones will
be permitted as a way to stay in touch with staff, to check in and tell time or take pictures. Staff
members have access to the district cell phone and office phones if parental contact is mandatory.
Teens in the L.E.A.D. Summer Day Camp is located in the HYDE Out, CRPD’s teen center. Gamimg
console systems are available for use in the Hyde Out at allotted times. Bringing games from home is
allowed with permission from both parents and camp staff. ONLY GAMES WITH THE FOLLOWING
RATINGS WILL BE PERMITTED: E, E10+, and T. Please make sure items from home are labeled with
your name.
• Be aware that photos may be taken of this program for publication in our activity guide, Facebook Page,
and other promotional use. Please note on your child’s information form if you object to your child’s
photo being used.
Things to bring to Camp
□ Shoes – VERY IMPORTANT. All participants must be wearing closed toed shoes to ride bicycles and
participate in camp activities. Sandals and flip flops may be worn during pool time.
□ Backpack – VERY IMPORTANT. We will be riding bicycles on the American River Trail as often as the
weather permits. It is important to bring a backpack to camp everyday to carry all of his/her items.
□ Snack - Send a snack with a drink each day.
□ Lunch - Send a lunch with a drink each day.
□ Swimsuit – Please bring a swimwear to camp every day.
□ Towel – Your child will need a towel for water game activities.
□ Sunscreen - Send sunscreen every day and remind your child to use it.
□ Water - Send a large container of water each day. Drinking fountains are available for refills.
Drop-Off/Pick Up Location
Drop off & Pick Up Location: Drop off and pick up your child at the Hagan Community Center building #2, The
Hyde Out. You or someone on your child’s authorized pick up list must check out your child each day. Your
child needs your permission to check him/herself out. (If you give your child permission to check out, check
out time will be 5 pm unless you call to notify staff that your teen need to leave earlier).
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Early Pick up - Teen LEAD’s daily schedule changes depending on the days activities. Often times the teens
and leaders will be off site on bike rides and they are required to stay together as a group. Off site pick up is
not allowed, if a teen rides a bicycle to a destination, then they need to ride it back to the returning location.
If an early pick up is needed, speak with the site supervisor about that days schedule.
IMPORTANT RULES:
FOLLOW ALL BICYCLE SAFETY RULES. ALL PARTICIPANTS MUST SIGN A BICYCLE RULES AGREEMENT FORM
INCLUDED IN THIS PACKET TO ENSURE HE/SHE UNDERSTANDS THESE RULES.
Program Rules:
1.
2.
3.
4.
5.
6.
7.
Follow directions; listen to, respect, and cooperate with others.
Sign bicycle agreement and follow ALL bicycle rules
Respect the teen center equipment and treat the bicycles with care.
Do not throw things or use physical agression with other participants
Do not use profanity or foul language
Get permission to leave activity area
Must wear shoes to camp everyday and bring backpack with EVERYTHING ON THE CHECKLIST
Behavioral Policies: Inappropriate behavior will be addressed promptly. The situation will be discussed by the
staff and the participant(s) involved. The parent(s) of the child(ren) may be contacted. The following format
is used:
1st offense
2nd offense
3rd offense
Warning (parent contact)
Removal from activity (Parent contact)
Parent contacted and speak with Recreation Coordinator
Possible consequences include a time out from group activities, loss of some pool time, loss of special
activities, suspension from field trip. Further offenses may result in the child being sent home, suspended for
one or more full days of camp. If the behavior is a danger to himself or others, or is interfering with the
program, you will be asked to pick him/her up from camp immediately. NO REFUNDS will be issued for
behavioral incidents.
Physical aggression or violence is addressed as follows:
1st offense
2nd offense
3rd offense
Removal from activity, speak to Program Supervisor, parents will be called. If the
he/she is uncooperative, violent, or disrespectful of staff, he/she will be sent home.
Suspended from the field trip, may also be suspended additional full days of camp
Permanent removal from program
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Field Trips:
• All participants are REQUIRED to wear a Teens in the L.E.A.D T-shirt on field trip days. Camper Tshirts can be purchased in the Office for $10 each. If your teen forgets his/her camp shirt we will have
loaner shirts available at a rental fee of $2.00
• If your son/daughter doesn’t want to go on the field trip, we have no alternative care and there are no
refunds for those who do not attend the trip.
• All field trips leave promptly so it is important that you arrive NO LATER THAN 8:00AM ON FIELD
TRIP DAYS. Teens will be attending field trips on FCUSD busses or Vans. We do not hold the
busses/vans for children who are late. Those who miss the bus will not be able to attend the field trip.
There are no refunds for those who miss the bus on field trip days. All campers attending the field trip
must ride the bus/van. Parents may not transport their son/daughter to attend the field trip, unless
previously cleared with the Day camp Director and Coordinator under extrenuating circumstances.
• You will receive a reminder a few days before the trip informing you of details such as departure time,
items you will need to bring, return time, etc. Spending money is optional.
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Day Camp Frequently Asked Questions
• Do you take registration on line for this program?
Yes, you may register online for the program of 8 am- 5pm. The resgistration online does not take care of the
forms that must be present on the first day. Online registration is just for payment. Please remember to send
the forms with your teen on the first day of camp or leave in the front office.
• “What do they do all day?”
9:00-10:00
10-10:15
10:15 11:15
Thursday
Arrival
Friday
Arrival
Daily agenda
(announcements/reminders)
(announcements/reminders)
bike ride
Snack
bike ride
Snack
bike ride
Snack
1:00-3:00
3:00-3:30
3:30-4:00
4:00 -5:00
time to wind down
12:00-12:30
12:30 -1:00
Wednesday
Arrival
Daily agenda
(announcements/reminders)
outdoor game
Introduction to weekly
theme & activities
Lunch
Free time
work on themed
activity
Snack
Free time
11:15-12:00
Tuesday
Arrival
outdoor game
Introduction to weekly
theme & activities
Lunch
Free time
FIELD TRIP
NORMALLY
8:30-9
Monday
Arrival
Daily agenda
FIELD TRIP
NORMALLY
8-8:30
work on themed activity
Snack
Free time
wind down
time to wind down
outdoor game
Introduction to weekly
theme & activities
Lunch
Free time
work on themed activity
Snack
Free time
wind down
time to wind down
• “How many teens are in the program each week?”
Program space is limited to 30 participants per week. Summer of 2015 Teens in the L.E.A.D. averaged 28
campers per week.
• “What are the staff qualifications and how are they trained?”
Staff are certified in CPR, 1st Aid and Basic Water Safety, must pass a background check, and are trained in
games, leadership and how to work with youth/teens. Staff are hired based on their experience with ages 1116 and are at least 18 years or older.
• “Is there a refrigerator where I can keep their lunch/medicine, etc.?”
A refridgerator is available in the Hyde Out, but it is not recommended to rely on it. There are times the camp
is not at the facility ans need to bring their lunch with them. We recommend an insulated lunch box with an
ice pack, if needed.
• “Should I call if my son/daughter will be late or absent?”
YES, we will need to know because the camp leaves for bike rides in the morning. Please call the camp site
supervisor, Tammy White, at (916) 538-0804
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TEENS IN THE L.E.A.D. Summer Day Camp Program
Leadership , Education, Adventure, Development
Child’s Information
Child’s Name: _________________________________ Birth Date: ________________________________
Age: __________ Sex: _________ Home Phone: ________________________Work Phone:_____________________
Address: _______________________________ City:_____________________________ Zip: ____________
Child lives with:  Both Parents  Mother  Father  Other: _________________________________
• How did you hear about our program? ______________________________________________
• Is there someone we can thank for referring you? (Name)_______________________________
Parent/Guardian Information
Name: _______________________ Work/Cell Phone: ___________________ Relationship: ________________
Name: _______________________ Work/Cell Phone: ___________________ Relationship: ________________
MY SON/DAUGHTER MAY SIGN HIM/HER SELF OUT EVERY DAY: Circle
YES
or
NO
Names of other persons who have permission to pick up your child
Name: ________________________
Name: ________________________
Name: ________________________
Phone: ___________________ Relationship: ___________________
Phone: ___________________ Relationship: ___________________
Phone: ___________________ Relationship: ___________________
• Is there anyone who is NEVER to pick up your child? ______________________________________________
• Is there any other information we should know about your child? (Special concerns or fears) ________________
_________________________________________________________________________________________
• Medical Information
Any allergies (food, drugs, insects)?: _______________________________________________________________
Medical concerns or activity restrictions? _________________________________________________________
Current medications and dosage ________________________________________________________________
• Complete the following only if your child is to take medication at camp
The child named above will be taking medication while at camp. CRPD staff has my permission to counsel camp staff
regarding the possible effects of the medication on my child. I will not hold Cordova Recreation and Park District or its
employees responsible if my child refuses to take the medication.
Parent’s Signature_____________________________ Parent’s Name (print) ____________________________
A.) Medication name _______________________ Reason for medication_______________________________
Dosage__________ Time to be taken ____________ If “as needed”: how often may it be taken?____________
Side effects _________________________________ Signs of over dosage ______________________________
B.) Medication name _______________________ Reason for medication_______________________________
Dosage__________ Time to be taken ____________ If “as needed”: how often may it be taken?____________
Side effects _________________________________ Signs of over dosage ______________________________
Please contact us if your child requires special accommodations to fully enjoy our Day Camp Program.
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Cordova Recreation and Park District • Day Camp Program Waiver
Class: Day Camp
Dates: 6/13-8/5/16
Location: Hagan Park/Cordova Community Center
Times: 8 AM - 5 PM
Days: Monday - Friday
Instructor: Staff
The Cordova Recreation and Park District's Day Camp program is based in Hagan Community Park. Planned activities make extensive use of the ball
fields, courts, buildings, picnic areas, open spaces, and petting barn. Wildlife does flourish in the vicinity of Hagan Park. Gophers, poisonous and
non-poisonous snakes, and skunks have all been encountered by park users. Bee stings do occur, however infrequently.
Arts and Crafts activities involve paints, pastes, glues, paper, scissors, crayons, other basic materials, and items found by participants.
Active games are conducted on turf, asphalt, concrete, and unimproved exterior surfaces, while indoor activities of active and passive types are
held on tiled and hardwood floors. Games engaged in by participants may involve balls, bats, frisbees, and hula hoops; they may require running,
skipping, sliding, and jumping.
Quite often there are other activities taking place in the surrounding areas during the conduct of Day Camp. Some of these activities are
sponsored by the Park District, some by other agencies, and many are unscheduled and spontaneous use of the area by groups and individuals.
District maintenance activities such as mowing, watering, trimming, repairing, and cleaning are ongoing.
Parents of children who take medication during camp assume all responsibility and risk of that medication. District will not be held
responsible for injuries or problems that occur due to the use of medication. District is not responsible for medication which is lost, stolen, or
traded by children. Problems may include: overdose, child refusing to take medication, or injuries to a child who receives medication prescribed to
another child. District staff will not administer medication or assist child in taking medication. District will not be held responsible if child forgets or
refuses to take medication.
Please be advised that the District places the highest priority on the safety of your child. Staffis well trained and staff-participant ratios
are lower than many comparable programs. However, with activities taking place out-of-doors, over many acres of park space, accidents and
injuries are possible, although serious injuries are exceedingly rare. Day Camp participants are subject to the usual assortment of abrasions, cuts,
and sprains that active children experience.
Agreement, Waiver, and Release - General
In consideration of being permitted by Cordova Recreation and Park District to participate in this class, I hereby waive, release, and
discharge all claims for damages for personal injury, death, or property damage which I may have or which may hereafter accrue as a result of my
participation in said activity. This release is intended to discharge in advance the above district, other participants, instructors, officials, sponsors,
advertisers, owners and lessees of the premises used to conduct the event and each of them, their officers, directors, agents, all of which are
referred to as "Releasees", from all liability to the undersigned, my/our personal representatives, assigns, heirs, and next of kin for any and all
claims, demands, losses, or damages on account of injury, including but not limited to death or damage to property, caused or alleged to be caused
in whole or in part by the negligence of the "Releasees" or otherwise.
I fully understand and acknowledge that: (a) There are risks and dangers associated with participation in classes, including but not limited
to those of bodily injury, partial and/or total disability, paralysis and death; (b) The social and economic losses and/or damages, which could result
from those risks and damages could be severe; (c) These risks and dangers may be caused by the negligence of participants or the negligence of
others, including but not limited to the "Releasees" named above; (d) There may be other risks unknown to us or not reasonably foreseeable at this
time.
I further accept and assume such risks and responsibility for the losses and/or damages following such injury, disability, paralysis or death,
however caused and whether caused in whole or in part by the negligence of the "Releasees" named above.
As parent(s) and/or legal guardian(s), I consent to instruct the minor participating in any district class to inspect the facilities and equipment to be
used, or I will inspect said facility and equipment myself, and if he or she believes anything is unsafe, the participant or parent/legal guardian should
immediately advise the instructor of such condition and refuse to participate until the faulty condition is corrected. Participant should be fully
instructed by parent(s) and/or legal guardian(s) and encouraged to adhere to any class rules and common courtesy.
I agree that this Waiver and Release Agreement covers each and every activity sponsored by the above district including class make-ups and
extensions and the "Releasees" are released as to each and every activity and event for the duration of the program.
PARENTAL CONSENT: I hereby consent that my son/daughter participate in the above activity, and I hereby execute the above Agreement, Waiver,
and Release on his/her behalf. I state that said minor is physically able to participate in said activity. I hereby agree to indemnify and hold persons
and entities mentioned above free and harmless from any loss, liability, damage, cost, or expense which they may incur as a result of the death or
any injury or property damage that said minor may sustain while participating in said activity. I have carefully read the above agreement,
waiver, and release, and fully understands its contents. I am aware that this is a release of liability and a contract between myself
and the above District, and I sign it of my free will.
SIGNATURE_______________________________________ PRINT NAME _____________________________
NAME OF PARTICIPANT __________________________________________________ DATE ____________
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Teens in the L.E.A.D
AGREEMENT FOR USE OF MOUNTAIN BIKE
&
RELEASE AND WAIVER OF LIABILITY
Cordova Recreation & Parks District owns a number of mountain bikes and accessories. To ensure that such
equipment is used properly, and to ensure that the individual using the equipment (“the RIDER”) behaves
responsibly and has the best possible experience, CRPD requires that the Rider and the Rider’s parents or
other legal guardian (if the Rider is under 18) read and sign this agreement, which defines the Rider’s
obligations in exchange for using the Mountain Bike.
Rider’s Name:
Date:
Name of Parent/Guardian:
Phone no.
Address:
Zip:
Parent Email:
Rider’s Age:
Helmet/bike
number:
Visual Inspection:
PLEASE READ CAREFULLY BEFORE SIGNING.
THIS IS A RELEASE OF LIABILITY AND WAIVER OF CERTAIN LEGAL RIGHTS!
AGREEMENT FOR USE OF BIKE
The Rider agrees to ride safely and with consideration for all other users of the trail. The Bike shall be at the
sole risk of the renter for the RENTAL PERIOD. The mountain bike shall be returned undamaged, in good order
and in road worthy condition to the satisfaction of CRPD, fail wear and tear expected. Rider will read and
follow all the signs.
1. EXERCISE CAUTION! While riding you may encounter many RISKS AND HAZARDS, including but not
limited to other bikes and joggers, loose gravel and dirt, wet surfaces, bumps, forest growth, wild life,
rocks. Trails maybe steep and narrow; ride within your own ability. You must regulate your speed to
avoid or negotiate obstacles.
2. I UNDERSTAND THAT FALLS AND COLLISIONS WHICH MAY CAUSE SERIOUS INJURY CAN
OCCUR REGARDLESS OF SKILL LEVEL. In consideration of participating in the above named Activity. I
ASSUME ALL RISKS OF AND RESPONSIBILTY FOR PROPERTY DAMAGE AND INJURY. To myself or to
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others which may be associated with and/or result from my activities in the premises, including, but
not limited to, any biking related activities.
3. I HEREBY FULLY RELEASE, INDEMNIFY AND HOLD HARMLESS, CRPD Teen LEAD, it representatives,
agents, affiliates, officers, directors, and employees (hereafter collectively CRPD) of and from any and
all liability, claim, demands, and causes of action whatsoever for any loss, damage, injury, illness or
harm of any kind and nature arising from or related in any way to my activities on the premises,
including mountain biking.
4. I understand that HELMETS ARE REQUIRED while biking with Teen LEAD and I agree that I will wear a
helmet at all times. I also understand, however that wearing a helmet does NOT guarantee my safety.
5. I have carefully read this Agreement, have not relied on any verbal representations to me, if any, and
understand that this is a release of liability that will legally prevent me from recovering in any lawsuit
or in connection with any other legal claim damages in the event of any injury to me. I nevertheless
enter into this Agreement freely and voluntarily and agree that is binding upon me, assigns and legal
representatives.
6. I Agree that I (or if applicable, my child) will be the only person using the equipment identified during
the rental duration, and I accept the Bike “AS IS”. I further accept full responsibility for the care of the
equipment while it is in my (or if applicable my child’s) possession.
I accept responsibility for replacement of the equipment at full value if it is not returned to the rental
Shop. I acknowledge my obligation to return the equipment by the agreed time and
AGREE TO PAY FOR ANY REPAIRS IN THE EVENT THE EQUIPMENT IS DAMAGED BEYOND
NORMAL WEAR AND TEAR
All Riders under the age of 18 years are required to have a parent or Legal guardian read and also sign
this release. The parent or legal guardian and the Rider have read and understood and agree to
comply with the release. By signing this document, the parent or legal guardian agrees to each of the
provisions above. By signing below, the rider agrees to all the provisions above:
I agree to terms of this agreement and waiver.
Date:
Signature of Rider:
I agree to terms of this agreement and waiver.
Date:
Signature of Parent/Guardian:
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