8.B. PRSR 03-13-2002 ITEM 18.B.
• Staff Report
Recreation Department
March 2002
March-April Programming
For the same time frame in 2001,we brought in$34,804 for Elk River programming.
This year we have brought it over$60,000. This includes arena programming. Much of
this is due to non-resident registration fees. Our programs are doing well and we are very
busy with registrations. We are busier than we had imagined we'd be at this time.
Programming for Summer
We are programming for summer and the brochure goes to the printer on March 13`h.
Our programs include playground programs,t-ball,tennis,tumbling, adult fitness,
entertainment in the park and much more. Some of our new programs include
kickboxing, an afternoon playground program and entertainment in the park geared more
for adults. We will not be doing summer strength and speed or the football camp this
summer as the high school coaches will be doing them on their own.
Lions Park Center
We are moved and operating out of Lions Park Center. Response has been very positive
about the new facility and we love it. We are working out some of the last minute details
• and look forward to landscaping and completion of the project this spring. We have
reserved 498 hours of use so far in the new facility for a variety of programs including
rec programs to senior dance classes to support group meetings, brownie troops, Chamber
luncheons, Operation ER meetings, and a wedding. While most of the use has been for
local non-profit groups, we are seeing some uses coming through that include a fee,
which is needed to cover the operational expenses.
Staff
We are now officially at full staff in our office. Lana started on March 6th and we are
now working on staffing summer programs. We will need to hire staff for our joint
programming with the YMCA as well as our various programs. We will be running an
ad in the newspaper and hope to have staffing completed by mid-April.
Warming House Summary
Lions
Open—36 days
Total Number of Users—approximately 1,100
Average Users Per Day—approximately 31
Handke
Open—36 days
Total Number of Users—approximately 1,400
• Average Users Per Day—approximately 40
Table of Contents Summer opportunities
v School Age
,Summer['owes • • • •• • • • • • • •
Summer Uproar
Family Nights
Y Day Camp Provided by the YMCA in collaboration with the
Day Camp Programs City of Elk River Recreation Department
Horse Camp Programs
Y Lead
Specialty Camps
Family Might
Before Atter Care
Bus Slop Locations
• School Age Care • Day Camp Manitou
Y Summer Opportunities
Program Description
Registration Form Dear Families,
Health History Form
Every day is a new adventure at YMCA camping and summer
programs. Kids grow in many ways. They grow in confidence, develop
new skills, and learn what it means to be a good friend.
The YMCA of Metropolitan Minneapolis offers a wide range of summer
YMCA Mission programs for all kids ranging in age from pre-kindergarten through high
school. Your child will be involved in fun activities that may include:
The mission of the YMCA swimming, arts &crafts, sports, studying the environment, canoeing,
is to develop the total person- field trips, and more. Most importantly, your child will be in a safe,
spirit, mind, and body- friendly environment where the YMCA's core values of caring, honesty,
through character respect and responsibility are an integral part of the curriculum.
development programs
that build strong kids, We choose our staff based on their experience and sensitivity to
strong families, children's needs. They will inspire your child and create opportunities
strong communities. for them to learn and explore the world around them.
Exciting, new programs offered for the Elk River area this summer
include:
• Day Camp Manitou • Summer Power
Financial Assistance
The YMCA welcomes all who • Summer Uproar
wish to participate, and
annually raises funds All programs are currently being sponsored by the Northwest YMCA.
though our Y Partners Sessions have limited enrollment and fill on a first-come, first-served
campaign to help make that basis. We recommend that you register early. Please take a few
possible. Please let us know moments to read through this brochure. Feel free to contact us at 763-
if we may serve you or your 535-4800 with any questions you may have. The YMCA looks forward to
family in this way. being a wonderful part of your child's summer.
Sincerely,
Chad Lanners, Director
Y SUMMER POWER Y SUMMER UPROAR
Opr children entering grades 1-6 in fall 2002 For children entering grades 7-8 in fall 2002
FEE: $129/WEEK• $28/DAY FOR PARTIAL WEEKS FEE: $140/WEEK • $29/DAY FOR PARTIAL WEEKS
(3-DAY MINIMUM - MUST BE THE SAME 3 DAYS EACH (3-DAY MINIMUM-MUST BE THE SAME 3 DAYS EACH
WEEK) WEEK)
Dates: June 10-August 30, 2002 Dates: June 10-August 30, 2002
Location: 50th Main Street Location: 50th Main Street
(Emporium Building) (Emporium Building)
Elk River Elk River
Summer Power is uniquely designed for children Summer Uproar is a challenging, exciting and highly
who are entering 1st through 6th grade. In Y Summer active program for youth who are entering grades
Power we will take wonderful adventures exploring 7 and 8. The Summer Uproar participants are
weekly themes through creative activities. Each involved in the planning of many of the summer's
week is filled with multiple field trips including activities. We will show your child the Twin Cities
adventurous outings, YMCA tours and programs and surrounding areas through weekly field trips,
and camp exploring. Your child's week will consist community service projects and a variety of other
of cooking, crafts, group games, theme activities, activities that build self-confidence, self-esteem
water fun and celebrations. YMCA programs are and leadership skills. Activities will include exciting
developed to work with the four Core Values of things such as swimming, outdoor challenges,
Caring, Honesty, Respect and Responsibility while sports, movies, and waterparks.
promoting safety, learning and fun. 10 Person Minimum
00 Person Minimum
Themes SUMMER POWER and SUMMER UPROAR times are:
Each week Summer Power will be celebrating
activities based on the following themes. The week Drop off: 6:00-9:00 a.m.
will end with an exciting Fun Friday event. Program Day: 9:00-4:00 p.m.
Pick Up: 4:00-6:00 p.m.
Week 1 Carnival Week Week 7 Career Craze
Week 2 Time Warp Week 8 Around the World
Week 3 Crazy Days Week 9 outer space Please arrange your schedules accordingly, as all
Week 4 Camp Mania Week 10 Amazing Animals children will be out of the building and on the go
Week 5 Catch a Wave Week 11 Summer Games from 9 a.m. to 4 p.m. Emergency pick-ups must be
Week 6 Science Sensation Week 12 Film Festival arranged through the program coordinator.
YMCA Each participant should bring a lunch with
SUMMER POWER/SUMMER UPROAR beverage, 2 snacks and a swimsuit and towel each
111 collaboration With the day.
lil of Elk River Recreation Department
FAMILY NIGHTS
•
Meet the staff •Free Food •Games
•Learn about the programs •1 In!!
Summer Power and Summer Uproar
June 5`"an t August r program fees include all transportation
and field trip costs.
Lions Park
6.30-8:00 p.m.
Y CAMP—A NATURAL PART OF GROWING UP Horse Camp Programs
Say Camp Manitou is an ideal outdoor 1, 2 and 3 Week Sessions
arning environment located outside All Sessions have limited enrollment
Monticello, Minnesota. With 1,200 beautiful
acres of and, Manitou offers horseback riding, YMCA Camp Manitou offers a progressive riding
canoeing on Long Lake, swimming beaches program based on your child's age and ability.
on Bertram Lake, and miles of hiking trails. Professionals assess your child's horse aptitude and
Among other facilities, we have an outdoor an appropriate horse is chosen to fit their needs.
amphitheater and an arts and crafts building, (Horses are carefully chosen for sound
which, along with several shelters, serve as our temperament.) Campers must wear their own
rainy day locations. We offer all the traditional leather shoes or boots and long pants. Camp
camping activities such as swimming, hiking, provides helmets that must be worn.
outdoor skills, archery and more. For kids with
special interests, consider our specialty sessions NOTE: For many campers, repeating levels will
for fishing, golf, waterskiing, sports and benefit their full accomplishment of skills and
horseback riding concepts,which will better increase their abilities.
IMPORTANT: Not all instruction is done on
horseback. An important part of horsemanship is
2002 Camp Programs at Manitou working with a horse on the ground. With safety in
mind, the wrangler determines all riding time with
Day Camp programs have structured events each consideration for weather conditions.
day for your child. Each camper should bring a
lunch every day. Milk will be provided.
Colts
1 Week Sessions
41111av Camp Programs For youth entering grades 2-7 in fall 2002
Fee: $192
Wee Backpackers For children in grades 2-7 with little or no
1 Week Sessions independent horseback riding experience, Colts is
Children Ages 4 and 5 in fall 2002 a great place for those with a desire to learn about
Fee: $160 horses to start. Instruction is for five hours a week
Wee Backpackers is an introductory outdoor camp and includes basic riding skills and horse safety
experience for preschoolers who are in their first lessons. Campers participate in traditional camp
camping experience. Each group is under the activities when not in the horse area.
watchful eye of experienced staff as they spend
time playing, discovering nature, and meeting new
friends. Wee Backpackers will enjoy swimming, Buckaroos
songs, games, frequent rest periods, arts and crafts, 1 Week Sessions
and more. For youth entering grades 3-8 in fall 2002
Fee: $235
Buckaroos is a one-week program for campers who
Bay Camp have previously completed the Colts camp, or who
1 Week Sessions have previous riding experience. There are ten
Children entering grades 1-7 in fall 2002 hours per week of instruction that includes saddling
Fee: $155 skills, continuation of posture and riding skills as well
The heart of the Manitou experience! Small, close- as introduction to trotting. Campers participate in
knit groups of campers explore the outdoors and traditional camp activities when not in the horse
create summer fun! Children of similar age are area.
rouped together with some flexibility so that each
amper has the chance to share, create
adventures and make new friends. Activities
include: Cooperative group games, canoeing,
swimming, hiking, theme activities,singing, archery, Strong Kids,Strong Families,Strong Communities
nature study, low ropes course, and values learning.
CIRCLE Y YLEAD
2 Week Sessions
or youth entering grades 3-8 in fall 2002
ee: $390 Leaders-In-Training
Previous Buckaroos experience is required to attend 3 Week Session
this camp. In Circle Y, campers receive instruction Youth ages 11-14 in fall 2002
including: introduction to basic horse care, control Fee: $275
at a trot and introduction to cantering. Campers Is your teenager a future YMCA counselor? This
spend ten hours a week on horse instruction and three-week program provides experiences created
they participate in traditional camp activities when specifically for teens. The program focuses on
not in the horse area. (Heeled boots with smooth developing skills that every future counselor needs.
bottoms are required for riders who wish to use Sophisticated group games and other methods are
stirrups) used to build self-confidence and leadership
abilities. During the third week, all participants have
the opportunity to "shadow" a senior staff person
ENGLISH RIDING for several days as they interact with the younger
1 Week Sessions campers. Limited enrollment.
For youth entering grades 2-7 in fall 2002
Fee: $235
Learn the basics of riding in an English saddle. SPECIALTY CAMPS
Learn the basics of English riding and beginning IF THERE ARE FEWER THAN SIX REGISTRANTS PER
dressage. There are approximately ten hours of SESSION,THAT SESSION WILL BE CANCELLED
instruction a week. Campers will participate in
traditional camp activities when not in the horse
area. (Heeled boots with smooth bottoms are Golf Camp
required for riders who wish to use stirrups.) 1 Week Sessions
For youth entering grades 4-8 in fall 2002
111 ranglers Fee: $180
Golf Camp is a great introduction to the game of
3 Week Sessions golf, and is also for those players who are working
For youth entering grades 4-8 in fall 2002 to improve their skills. Campers receive 4-1/2 days of
Fee: $540 instruction and practce. On Fridays, campers will
Previous Circle Y experience required to attend play a round of golf at a local course. Campers will
Wranglers. This program for the serous camper and participate in traditional camp activities when not
horse enthusiast is three consecutive weeks. golfing. Campers will need to bring their own clubs.
Activities include ringwork (involving advanced
riding skills and cantering) as well as trail work.
Wranglers will receive 10 hours of instruction a week Sports Mania
and will participate in traditional camp activities. 1 Week Sessions
(Heeled boots with smooth bottoms are required for For youth entering grades-4 in fall 2002
riders who wish to use stirrups) Fee: $165
Campers learn about and play a different sport
Broncos everyday. The focus will be on having fun, learning
skills, and building confidence.The balance of time
3 Week Sessions is spent participating in traditional camp activities.
For youth entering grades 6-9 in fall 2002
Fee: $540
This horse camp for the older experienced camper
who loves to ride! Previous Wrangler experience is
required. Broncos is an extension of Wranglers,with
similar instruction and a focus on advanced trail
rides. Instruction will include hands-on horse care.
*here is a minimum 10 hours per week of instruction.
(Heeled boots with smooth bottoms are required for
riders who wish to use stirrups)
Asking Camp Transportation Information
1 Week Sessions As arranged-Through your registration
.or youth entering grades 4-8 in fall 2002 Transportation is provided each day to and from
ee: $170 camp. Approximate departure is between 8-9 a.m.
Who wants to be an awesome angler? The lakes of with an approximate return between 4-5 p.m. Exact
Camp Manitou hold Northerns, Bass, Crappies, pick up times will accompany the information sent
Bluegills, and many other types of fish. Campers to you after receiving your registration
practice skills and have fun. Fish are caught on a
catch-and-release basis. Campers must bring their Please note these important bits of information:
own fishing poles. Bait will be provided. The
balance of time is spent participating in traditional • Camp buses stop only at designated bus stops.
camp activities. Children are to be dropped off and picked-up
at one location only, please!
Waterski Camp • Please be sure to indicate your child's pick-
1 Week Sessions up/drop-off site on the registration form.
For youth entering grades 4-8 in fall 2002
Fee: $235 • Traffic congestion and road construction will
If you have always wanted to try waterskiing- slightly affect actual times of pick-up and drop-
here's your chance. Groups will send half of each off.
day either skiing or tubng. The remainder of each
day will be spent doing traditional day camp • Important: bus sites are not supervised before
activities. All equipment will be provided. Limited pick-up or after drop-off times.
enrollment.
• Children not picked up within 5 minutes of the
scheduled drop off time by an adult will be
CAMP MANITOU brought back to the Northwest YMCA in New
•amlIy Nights Hope.
Evening Event: 6:00-7:30 p.m. on Thursdays
June 6, and 27, July 18 and August 8
Mark your calendar! We want you to personally Elk River/ Monticello/Buffalo
meet counselors and tour Camp Manitou. Enjoy Big Lake/Rogers
dinner served by the Y Service Club, followed by Lincoln Elementary Pinewood Elementary
camp activities and fun. Participants from the Big Lake Elementary Discovery Elementary
Rogers Elementary
horse programs perform a horse show too! Family Osseo/Maple
Night is a chance for campers to showcase what
accomplished. Parents and Grove/Champlin
they've learned and accom
p St.Michael/Albertville Osseo Junior High
guardians are strongly encouraged to attend. This St.Michael Elementary Cedar Island Elementary
is also a great opportunity for upcoming campers Albertville Primary Rice Lake Elementary
to visit the camp and take a tour. Weaver Lake Elementary
Brooklyn Park/Brooklyn Basswood Elementary
Center
Before and After Care Park Center Senior High
$25 PER WEEK PER CHILD Golden Valley
Bring your Manitou camper to the Elk River YMCA Plymouth Sandburg Middle School
satellite site (Emporium Building) where Zachary Lane Park
experienced staff members provide and supervise Beautiful Savior Lutheran
activities. Campers can be dropped-off before Church New Hope
camp, between 6:00 and 8:00 a.m. They can be Northwest YMCA
picked up after the camp day between 4:30 and Robbinsdale/Crystal Sonnesyn Elementary
6:00 p.m. Late fees will be assessed after 6:10 p.m. Lakeview Elementary Meadow Lake Elementary
Wvailable all sessions. Indicate on the registration
orm if you would like this service.
Oeadership/Safety
taff are selected n the basis of responsibility, maturity,
energy and sensitivity. They are the heart of the program
and their leadership is vital to each child's positive
experience. Counselors work in small groups and are
positive role models to the children.
The safety of each participant is our primary concern. All it's FREE!
counselors receive 40 hours of specialized training.
Swimming activities are supervised by certified lifeguards.
All other high risk activities will be supervised by trained
professionals. Ilk RiverResourceRecovery
Commitment/Accessibility faciiitypresents
The YMCA is committed to the policy that all persons shall
have equal access to its programs,facilities and
enjoyment without regard to race,ability, creed, national
origin and sex. The YMCA will accommodate special EARTH DAY
needs into existing programs,to the extent that financial
and physical resources permit. So we may provide a
positive experience, please contact the YMCA about
any accommodations needed for participation.
Saturday,April 27t
Register Early 10;00 a.m. - 4:00 p.m.
We encourage you to sign up as early as possible to get
aour first choice of sessions. In order for us to staff
occordingly,you must register no later than Wednesday
of the week preceding your session choice OR A$15.00 • Learn more about YMCA
ADMINISTRATIVE CHARGE WILL BE ADDED to your fee.
summer programs offered in
Open Participation Elk River.
In the operation of the Summer Camps Food Service
Program, no child,as defined by the program
regulations,will be discriminated against because of
race,sex, color, national origin,age or handicap. Any • Take part in fun activities, great
person who believes that has been discriminated against
n any USDA related activity should write to the Secretary games
of Agriculture, Washington DC 20250.
Child Care Assistance Authorizations ♦ Register to winafreeweekat
A current "Authorization of Service" must be on file with
the County and the YMCA. Registrations will not be camp orSummerPower!
processed until this information is received.
Financial Assistance
The YMCA is driven by community need,guided by
community volunteers and open to all. Subject to
available resources, no person is denied participation in a
YMCA program solely by reason of financial inability to
pay the fee. Call the Northwest YMCA at 763-535-4800 for
a Campersh fameive
. ounty assistance ip application.for child careFor , please ilies who contact rec your
count y worker to receive authorization before
registering. The YMCA s a nonprofit, charitable and
United Way affiliated agency. We build strong kids,strong families,strong communities
Summer Power / Summer Uproar Registration - Elk River
June 10-14 June 12-21 June.2418 July 1737 '„:nIlilYlill ::July 15-19 '- 114,406 July 29-Au&2 '''Aug 5-9:!!;!!1;: Aug 12-1A! Aug 19-23 Aug 26-30•
Week I Week,2 ,„Week 3' Weelt„4,:',,,'.;::::Wiek4 Week 6 Week?. Week$ ''Week 9 ,Week Mk , Week II Week I 2
lkummer Power
0$129 0$129 0 $129 0$78* 0$129 0 $129 El $129 0 $129 0 $129 0$129 0$129 0 $129
r. 1-6 in fall'02
Summer Uproar
[3$140 0$140 0$140 0$84* 0$140 0 $140 0 $140 0 $140 0$140 0$140 0 $140 0 $140
Gr. 7-8 in fall'02
*NO CAMP,SUMMER POWER OR SUMMER UPROAR JULY 4&5
Day Camp Registration: - Camp Manitou
Day Camp Program -041044!-- Ilme'tm,!,,-, loomm,-,::::--,-, July 1-3* Jail 0-12 —July 15-19 July 22-24;:','!,:July 29-Aug rriii44!-9 ,A_u(12:16,."}' ,'A,P,&49:23 , Aug 26-30
Week I Weelei''''' WeekTr'''''''':,Week 4''.. Week 5 Week.6 , Week 1 ---'':, ,:Veek 4 11100 Week 10 , Week:,P -Wet 12,2sww.
Wee Backpackers P'4'449i 7,1
0 $160 0$160 0$160 0$96 0$160 0$160 0$160 0$160 0 $160 0 $160 0 $160
(Peanuts)Ages 4-5
Day Camp(Explorers) i__, $155 ri$155 0$155 0$93 0$155 0$155 Ej$155 0$155 0 $155 0 $155 0 $155
Gr. 1-7 in fall'02 1--1 $'" "
Sports Mania
0 $165 0$165 0$165 El$99 0$165 0$165 0$165 0$165 0 $165 1:1 $165 0$165
Gr.2-4 in fall '02 . 44trffqc,,, 'Fishing
Camp
0$170 0$170 0$102 0$170 0$170 0$110 0$170 0 $170 0 $170 0 $170
Gr.4-8 in fall'02 0$110
Waterski Camp Pr:filo
0$235 0$235 0$141 Ej$235 0$235 0$235 0$235 0 $235 0 $235 0 $235 aitetiq
Gr.4-8 in fall'02 0$235
IFAIM,
Golf Camp ri win /-1$180 0$180 0$108 0$180 0$180 0 $180 El$180 El $180 0 $180 0 $180 Ifszti:;::
Gr.4-8 in fall'02 1-1''" 1-"J
r"7""11M17;.•;• R1 i 1 VFFril;ilic77137771,3r4:7517ISWATP ,zawinaw, - Auggi:Q 1_,t,„
Manitou Mania
All Ages ',,,,,,,,,SoWit'th,4141.4at241:filw, ;,,,,,A.M)liAilZ.LUiiiiiii4 :14,5i4,'; Likt.i1Z,Z,,t; -44a-,as,..a,ltsi:.*5kAa,...t&L.Ni.,,,,a,,,Vatri.t,L;int,,v,
Colts(Buckaroos)
Gr. 2-1 in fall'02 El$192 El$192 El $192 0$116 0$192 0 $192 0 $192 0 $192 0$192 0 $192 0 $192
, 15;:Vr1-1 :11
Buckaroos(Circle 1) r_i t 1-1$235 0 $235 0$188 0$235 0 $235 0$235 0 $235 0 $235 0$235 0$235
Gr.3-8 in fall'02 1-1$23' 1--1'
•!;',•gk.. ''' '-' r':::::::4C4::.
English Riding „i;k6i1 ,, ; ,,";1;:l i—i$235 04!, :',,':":1 0$235 ';':''.-:'-''4,4 D$235
Gr.2-7 in fall'02 ° $235 1,1' 11.4;;;,,,, D$235 ' 0 ' ';',k` 1=1 $235 'itlz,"1 ” 'W'' '4
Circle Y(Adv Circle Y) r..„ Continues 2 weeks 2 0 .s.. Continues 2 0$390 wCoenetiks'nues 2 0$390 wCoenetksinues 2
weeks ,_,ri$312
iipt.3-8 in fall'02 I—I $390 437V weeks
ranglers Camp Continues Continues Continues Continues Continues Continues Continues Continues
Gr.3-8 in fall'02 0 $540 3 weeks 3 weeks 0 68 3 weeks 3 weeks $540 3 weeks 3 weeks 0 $540 3 weeks 3 weeks
Broncos Camp Continues Continues Continues Continues Continues Continues Continues Continues
Gr.6-9 in fall'02 0 $540 3 weeks 3 weeks 0 68 3 weeks 3 weeks 0$548 3 weeks 3 weeks 1-1 $540 3 weeks 3 weeks
Leaders-in-Training Not Not Not Continues Continues , Continues Continues Not Not Not
(C1T)Ages 11-14 Offered Offered Offered 0$239 3 weeks 3 weeks 1-1$21$ 3 weeks 3 weeks Offered Offered Offered
Before&After Care-
at YMCA Satellite 1-152'c
0$25 0$25 0$15* 0$25 0$25 0525 0525 0$25 0$25 0$25 0$25
Before&After Care-
at Camp 0$25 0$25 0525 0$15* 0$25 0525 0$25 0525 0525 0$25 0$25 0$25
*NO CAMP,SUMMER POWER OR SUMMER UPROAR JULY 4&5
0
[ _ _„„,.._
YMCA Emergency& Health Information
• Please complete both sides and return to:
Elk River Recreation Department • 1104 Lions Park Drive• Elk River, MN 55330
PLEASE USE ONE FORM PER CHILD AND PRINT NEATLY
Child's Name(please print) ❑ Female ❑ Male
Home phone( ) E-Mail
Address City State Zip
Birthdate / / Grade in Fall 2002 School in Fall 2002
Parent/Guardian Home phone( )
Work Phone( ) Cell phone/Pager( )
Parent/Guardian Home phone( )
Work Phone( ) Cell phone/Pager( )
Child Resides with ❑ Mother ❑ Father ❑ Both ❑ Other
How did you hear about us? ❑School ❑ Word of mouth ❑ Brochure: _received in mail_received at school_picked up at YMCA
Are you a YMCA member? ❑ Yes(Member# ) ❑ No
I would like YMCA programming updates forwarded to me via e-mail ❑ Yes ❑ No
EMERGENCY CONTACTS AND PICK UP AUTHORIZATION Has child has any of the following,and if so,please explain:
The following people should be contacted in case of ❑ Operations or serious injuries
emergency,only if parent or guardian cannot be reached AND (date/s)
are authorized to pick up the child: ❑ Chronic or recurring illnesses
1.Name
Relationship to child ❑ Allergies or Asthma
IllkPhone:Day( ) Evening( ) ❑ Dietary restriction(s)
.Name ❑ Special Needs
Relationship to child Is the child taking any medications? ❑ Yes ❑ No
Phone:Day(_) Evening(_) If yes,what kind and why?
3.Name
Relationship to child
Phone:Day(_) Evening( ) If medication needs to be administered during the program,a
4.Name Medication Permission Form must be completed. Call the YMCA
Relationship to child for this form or pick it up at your site.
Phone:Day(_) Evening(_)
Status of child's vision,hearing,and speech
Family Doctor
Phone( ) Please comment on your child's swimming ability
Family Dentist
Phone( )
Do you carry medical/hospital insurance? ❑ Yes ❑ No Does your child have a communicable disease or condition
Carrier which may prove to be a risk to others? ❑ Yes ❑ No
Policy/Group# If yes,please comment:
REQUIRED: Month,date and year of most recent immunizations: Other significant information about your child's behavior that
DPT Polio would be helpful to know:
Measles Mumps
Rubella HIB
Photographic Release
I hereby release all pictures of my child taken by the YMCA for promotional purposes and programming materials including the YMCA
website ❑ Yes ❑ No Initials
Medical Records Release
I agree to the release of any records necessary for treatment,referral billing or insurance purposes. The YMCA receives medical information on
campers/participants that may need to be shared with medical providers ❑ Yes ❑ No Initials
earent/Guardian's Authorization
n the event that my child needs immediate medical attention for injuries received while participating in a YMCA program,I authorize the YMCA staff to give
my child reasonable first aid,and to transport my child to a health care facility for emergency services as needed. My child has permission to be transported
by the YMCA to and from field trips. I authorize YMCA staff to administer syrup of ipecac when instructed to do so by a poison control center.I hereby
acknowledge that the YMCA will assume that either parent of the child may pick up the child at any time during the program unless there is pertinent court
documentation on file at the ymca that indicates otherwise.
Parent/Guardian Signature Date
ELK RIVER YMCASUMMER PROGRAM REGISTRATION FORM
,1
• Please refer to Registration Process boxes for detailed Participant Infermatien
registration information. I Child's Name
I.One child per Registration form.Please make copies for Parent/Guardian Name
additional children. Billing Address
2.Review session and bus schedule.Completely fill out the City/State/Zip
Registration form and the Health History form. ' Home Phone
3. Return completed registration form and non-refundable Date of Birth
deposit for each session or full payment to: This will be my child's year at Camp Manitou/YMCA Summer Power
Elk River Recreation Department Please pair my child with(limit two; must be registered for same program and session)
1104 Lions Park Drive,Elk River, MN 55330
or fax to:163-274-1842
(must include credit card information) Payment information
This is a (check one) 0 Deposit 0 Full Payment 0 Amount $
4.A confirmation letter will be sent to you within two
weeks.You will be billed for the remaining balance,which 0 Check Enclosed 0 Credit Card: Visa _MC _Discover _Am. Ex. ,
must be paid 1 week prior to the start of the session. = Name on Card
s
Card Number Exp. Date
Bus Information (Camp Manitou Only)
Bus Location I agree to pay above
Total amount according
$25/Week YMCA Before&After Care: 50th Main Street i to card issuer agreement X
F Yes F No Em orium Building)( P g) Please include appropriate NON-REFUNDABLE deposit per session per registration.$25 for Summer Power and Summer Uproar Programs
$25/Week YMCA Before&After Care at Camp Manitou l and$50 for Day Camp Manitou
F Yes F No
IP
•