Adventure Day Camp | Town of Walworth, NY

Adventure Day Camp

Parent Information Packet - Summer 2024

Walworth Recreation Department (315) 986-1400 (Option 7)

Greetings Adventure Day Camp families! Enclosed please nd information regarding camp activities and required

paperwork for participation. Please carefully review this information and complete the Medical Form, Immunization

Record, Approved Pick Up Form, and Camp Rules & Behavior Guidelines Form for all participants registered under

your name. All forms must be returned and completed prior to participants rst week of camp.

ADVENTURE DAY CAMP SCHEDULE - SUMMER 2024

ARRIVAL & DISMISSAL

With a large volume of campers arriving and departing during Standard Hours, adhering to arrival times and

arriving promptly for pick-up greatly assists our sta. Should you need to pick up a camper(s) early on any

specic day please alert camp sta in advance.

Walworth Recreation reserves the right to terminate participation without refund should campers

consistently fail to follow and/or take advantage of arrival/departure windows.

MONDAY, MONDAY, 7/87/8

THROUGHTHROUGH

FRIDAY, 7/12FRIDAY, 7/12

Zoo ExplorersZoo Explorers

Field Trip:

Seneca Park Zoo

2222 St. Paul St | Rochester

MONDAY, MONDAY, 7/157/15

THROUGHTHROUGH

FRIDAY, 7/19FRIDAY, 7/19

Wizards Wizards

& Magic& Magic

Special Daily Guest:

Rich The Magic Man

MONDAY, MONDAY, 7/227/22

THROUGHTHROUGH

FRIDAY, 7/26FRIDAY, 7/26

BeachBeach

Field Trip:

Roseland Water Park

250 Eastern Blvd | Canandaigua

MONDAY, MONDAY, 7/297/29

THROUGHTHROUGH

FRIDAY, 8/2FRIDAY, 8/2

Survivor Survivor

ChallengeChallenge

Field Trip:

YMCA Camp Arrowhead

20 Arrowhead Rd | Pittsford

MONDAY, MONDAY, 8/58/5

THROUGHTHROUGH

FRIDAY, 8/9FRIDAY, 8/9

CarnivalCarnival

Field Trip:

Roc City Circus

1344 University Ave | Rochester

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TOWN OF WALWORTH | WWW.TOWNOFWALWORTHNY.GOV | 315-986-1400

Standard

Hours:

9:00am9:00am

-- TO --

3:00pm3:00pm

Extended

Wrap-Around

Hours:

8:00am8:00am

-- TO --

5:00pm5:00pm

Adventure Day Camp

Parent Information Packet - Summer 2024

Walworth Recreation Department (315) 986-1400 (Option 7)

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CARPOOLING

Many families establish carpool arrangements at the beginning of summer. To grant permission for another driver

outside the parent(s)/guardian(s) listed on camp registration forms to pick up your camper(s) you must submit an

Approved Pick Up Form with your camp paperwork prior to the rst week of camp your camper(s) are scheduled

to attend.

Any changes to these approved additional pick-up permissions must be completed in writing and in advance for

sta to grant camper(s) release.

PERSONAL ELECTRONIC DEVICES

Adventure Day Camps operate primarily as an electronic free zone. Cell phones, tablets, and/or game consoles

must be stored in campers’ bags during standard camp hours (9:00am-3:00pm). Electronic devices can be used

by those utilizing Wrap-Around services during those hours ONLY. Counselors may also choose to allow campers

to use electronic devices during lunch as well. In the event of an emergency or extenuating circumstance

campers may be granted access to devices for communication purposes. Please Note: Walworth Recreation

is not responsible for any damaged, lost, or stolen items.

MEDICATIONS

All campers must take all prescription medications at home prior to arriving at camp. The administration of

prescription medication is prohibited during camp hours. EpiPens or Inhalers are the only exception to this rule.

All campers must complete the Medical Form and Immunization Form. Campers are restricted from camp

until this form has been completed and submitted to Walworth Recreation. FORMS MUST BE RECEIVED

PRIOR TO YOUR FIRST WEEK OF CAMP to ensure participation.

DRESSED FOR FUN

We encourage you to send your child to camp in clothes suitable for outdoor activity, active play, arts and crafts,

and fun without worries of them remaining pristine. It’s helpful to mark your child’s name on clothing (especially

any loose items). PLEASE BRING A WATER BOTTLE AND SNEAKERS EACH DAY OF CAMP. Hats are also

recommended for sunny days.

A swimsuit and towel are required for Beach Week and on certain days during Survivor Week. Camp sta will

alert campers and guardians of any specic items of clothing and/or additional supplies should they be necessary

for activities or any camp events outside the normal daily routine.

LUNCHES & SNACKS

Please provide a bag lunch, drink, and snack during each day of camp unless otherwise noted on detailed camp

schedules. A microwave and fridge are available when on site for use each week of camp.

Adventure Day Camp

Parent Information Packet - Summer 2024

Walworth Recreation Department (315) 986-1400 (Option 7)

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SNOW CONE WEDNESDAYS

Sugary Delights visit with their snow cone truck each Wednesday following lunch. Campers have the option

to purchase a small size snow cone for around $3.50. This cost IS NOT COVERED in the camp registration

and comes at an additional cost to each camper. Please remember to send cash with your camper(s) each

Wednesday should you wish to participate.

ADVENTURE DAY CAMP BEHAVIOR POLICY

We expect campers to act respectfully at all times when they are on our property or participating in our programs.

Campers are to behave in a mature, responsible way and respect the rights and dignity of others.

Campers should talk to a counselor or any Walworth Recreation sta member if they are uncomfortable

with any experiences or need assistance while at camp at any point.

A signed Rules & Behavior Guidelines Form must be returned prior to the rst week of camp acknowledging these

rules and expectations for all campers.

Walworth Recreation strives to oer the best camp experience possible through

active, fun, organized activities, and ensuring campers’ safety by overseeing

multiple small groups of participants as they enjoy events throughout the day.

Should you have questions or concerns at any point please don’t

hesitate to contact the Recreation Department or alert camp sta.

Thank you for registering for Summer Adventure Day Camp - we

look forward to a wonderful summer full of fun!

Jl Hannd Wwor RecJl Hannd Wwor Rec

Jill Hannold Town of Walworth

Director - Summer Adventure Day Camp Department of Recreation

Adventure Day Camp

Summer 2024

Walworth Recreation Department (315) 986-1400 (Option 7)

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Adventure Day Adventure Day

Camp FormsCamp Forms

Please return all forms Please return all forms with a with a

black circle/white dot to the black circle/white dot to the

Recreation Department prior to your Recreation Department prior to your

first scheduled week of camp.first scheduled week of camp.

Adventure Day Camp

Medical Form

Walworth Recreation Department (315) 986-1400 (Option 7)

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MUST BE COMPLETED BY PARENT/GUARDIAN & RETURNED

PRIOR TO CAMPERS FIRST WEEK OF CAMP

Please Indicate Any/All Weeks Camper is Registered for Adventure Day Camp:

Zoo Explorers Wizards & Magic Beach Survivor Challenge Carnival

GENERAL INFORMATION

Child’s Name: ________________________________________________________________________________

DOB: ____/____/____ Gender: M F Grade (Fall 2024): _______ Age (Entering Camp): ________

Parent/Guardian Name: ______________________________________ Best Phone #: _____________________

Address: _________________________________________________ Zip Code: ________________________

Email Address: ________________________________________________________________________________

Emergency Contact Information (If Above Is Not Available in an Emergency):

Name: ____________________________ Relationship: __________ Best Phone #: _____________________

Address: _________________________________________________ Zip Code: ________________________

ALLERGIES

No known allergies

This camper is allergic to the following: Food Medicine Environmental (Bees, etc.)

(Please describe allergy and reaction below)

_________________________________________________________________________

Additional Sensitivities/Reactions:

_________________________________________________________________________

Does Child Have Past or Current Experience with Any of the Following (Check for YES)?

Hospitalization Motion Sickness

Surgery Speech Impairment

Recurrent/Chronic Illnesses Hearing Impairment

Recent Injury Sun Sensitivity

Asthma/Wheezing/Shortness of Breath Diarrhea/Constipation

Diabetes ADHD

Seizures Other Behavior Disorder

Headaches or Migraines

Females Only:

Glasses or Contacts Menstruation

If no; Have They Been Told About It?

Yes No

If YES, Please Explain Below:

______________________________________________________________________________________________

Please List Any Current Medications Below:

______________________________________________________________________________________________

Primary Care Physician: ______________________________________ Best Phone #: _____________________

Dentist/Orthodontist: ________________________________________ Best Phone #: _____________________

Is this camper covered by Medical/Hospitalization Insurance? Yes No

Carrier: __________________________________________ Policy Number: _____________________________

PARENT/GUARDIAN EMERGENCY AUTHORIZATION

To the best of my knowledge the information provided on this health form is correct and this camper has permission to engage in all

camp activities, unless as noted by me. THIS CAMPER ALSO HAS PERMISSION FOR USE OF SUNSCREEN AND/OR BUG SPRAY:

________ (INITIAL). I hereby give permission to the medical personnel selected by camp sta to treat my child for all illness/injury.

In the event I cannot be reached in an emergency, I give permission to the physician to hospitalize, to secure proper treatment for, and

order injection, anesthesia, or surgery for this child as medically appropriate.

Adventure Day Camp

Medical Form

Walworth Recreation Department (315) 986-1400 (Option 7)

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Parent/Guardian Signature: _______________________________ Date: ____/____/____

Adventure Day Camp

Immunization Record

Walworth Recreation Department (315) 986-1400 (Option 7)

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Please provide the month/year for each immunization. Copies of immunization forms from your health-care provider

or state or local government are also acceptable. Please attach all records to this form. Immunization records are

required for your child to attend camp.

ATTACHING IMMUNIZATION RECORDS FROM YOUR PEDIATRICIAN FULFILLS FORM REQUIREMENTS.

Child’s Name: __________________________________________________________ DOB: ____/____/____

Immunization

Date of Basic

Immunization

Date of Last Booster

Physician Signature: ____________________________________ Date: ____/____/____

Diptheria, Tenanus, Pertussis

(DTap) or (TdaP)

Mumps, Measles, Rubella

(MMR)

Poliomyelitis (IPV)

Haemophilus Influenza

Type B

Hepatitis B

Varicella

(Chicken Pox)

Most Recent

Tuberculin Test

Other (Specify):

________________

____/____/____ ____/____/____

Town of Walworth

Approved Pick Up Form

Walworth Recreation Department (315) 986-1400 (Option 7)

The following form must be completed and submitted in advance should you wish to have your camper(s) picked up

by anyone outside the parent(s)/guardian(s) listed on the initial camp registration form. Any changes to documented

additional pick-up permissions must be completed in writing and in advance for sta to grant camper(s) release.

Additional forms will be available at the Recreation Oces or from the Camp Director throughout camp should you

need to update forms.

ADDITIONAL PICK-UP FORM

Child’s Name: ________________________________________________________________________________

Additional person(s) granted permission to pick up my camper(s) from camp:

Name: ____________________________ Relationship: __________ Best Phone #: _____________________

If carpooling with another camper, please provide the specic schedule by which alternate individuals will

pick up your camper(s) from camp:

Monday Name: ____________________________

Tuesday Name: ____________________________

Wednesday Name: ____________________________

Thursday Name: ____________________________

Friday Name: ____________________________

DO NOT RELEASE TO:

If you have concerns over a specic individual(s) attempting to pick up your camper(s) from camp

please list them below:

I DO NOT AUTHORIZE THE RELEASE OF MY CAMPER(S) TO THE FOLLOWING INDIVIDUALS:

Name: ____________________________ Relationship: __________

Parent/Guardian Signature: ___________________________________________________ Date: ____/____/____

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Town of Walworth

Camp Rules & Behavior Guidelines

Walworth Recreation Department (315) 986-1400 (Option 7)

Walworth Recreation aspires for all campers to enjoy a safe, enjoyable experience while attending our Adventure

Day Camp Weeks. We expect all campers to follow camp rules and guidelines.

Camp sta will reinforce appropriate behavior through positive reinforcement and redirection. Rules and expectations

for all campers will be reviewed at the beginning of each week of camp. We expect campers to act responsibly and

respectfully at all times - whether on our property or o-site as a guest at a third-party site.

Campers should talk to a counselor or any Walworth Recreation sta member if they are uncomfortable with

any experiences or need assistance while at camp at any point.

A signed Rules & Behavior Guidelines Form must be returned prior to the rst week of camp acknowledging these

rules and expectations for all campers.

CAMP RULES & BEHAVIOR GUIDELINES

1. Always follow camp rules as presented and displayed by sta.

2. Consistently demonstrate respect for all campers, sta, equipment, and property.

3. Keep hands and feet to yourself (unless part of a sta-led activity).

4. Always remain with assigned sta members during camp and other scheduled activities. Campers may not

return to the lodge, move to another activity, or transition to another area on or o-site without a sta member

present or verbal consent.

5. Use appropriate language - No cursing, vulgar, or inappropriate language.

6. Uphold camp rules and expectations when o-site (such as while on eld trips and/or on the bus).

7. Facilitate a safe and clean camp site by keeping your area tidy, returning items to their assigned spaces

when not in use, and assisting others in clearing areas after use, play, activities, or the conclusion of the day.

8. ABSOLUTELY NO BULLYING OF ANY KIND IS TOLERATED AT CAMP. Immediately let a sta member

know should you witness or be subject to any form of bullying, discussion, or activity that leaves you feeling

unsafe or uncomfortable in any manner.

9. Be safe, have fun, and be kind to one another!

BEHAVIOR MANAGEMENT POLICY

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Verbal

Warning

& Redirection

Temporary

Removal

from

Activity

1st Parent

Contact

Notied at pick up

or by phone of rule

violation.

Incident report led.

2nd Parent

Contact

Parent/Guardian

contacted for

immediate pick up

Camper(s)

suspended from

camp for remainder

of day.

Incident report led.

Dismissal

Camper(s)

immediately

removed from

camp for remainder

of week (and

possibly longer).

Town of Walworth

Camp Rules & Behavior Guidelines

Walworth Recreation Department (315) 986-1400 (Option 7)

Incident reports document all behavior violations. Should a report be led against a camper(s), parents/guardians

are notied of said report during pick up or by phone.

The Camp Director, in coordination with Recreation Sta, reserves the right to make decisions regarding

current and future participation in the Adventure Day Camp Program based on the Behavior Management

Policy outlined on page 9.

Violations of Camp Rules & Guidelines are taken seriously and our priority remains cultivating a safe, enjoyable

environment for all campers and sta.

Please let us know if there is anything we should know about your child that will assist camp sta in

providing the most positive camp experience possible:

___________________________________________________________________________

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I HAVE READ, ACKNOWLEDGE, & AGREE TO SUPPORT THE RULES & BEHAVIOR GUIDELINES AND

BEHAVIOR MANAGEMENT POLICY FOR WALWORTH RECREATION ADVENTURE DAY CAMPS

Parent/Guardian Signature: ___________________________________________________ Date: ____/____/____