Summer camp

2 0 1 9 A free summer camp for

Hartford’s kids ages 5-12

Camp life is the best life!

2019 Camp Season

Camp Opening Day: Monday, June 24, 2019

Camp Closing Day: Friday, August 2, 2019

Parents’ Day: Saturday, June 22, 2019

Registrations are due no later than

Friday, June 28, 2019 Spaces are limited-enrollment is based on a

first-come, first-serve basis

For additional information

Mily Navedo,

Administrative Service Manager

860 244 2835 ext. 1004

All information will be kept confidential. Rules for acceptance and participation in the program are the same for

all campers, ages 5-12, without regard to race, creed, color, national origin, sex, ancestry, sexual orientation,

gender identity or expression or disability. One registration form is required for each camper, and all enclosed

documents must be completed and signed by a parent or guardian in order to be considered.

Welcome To Camp Courant!

Dear Parents/Guardians,

The warm summer days at Hartford’s Camp Courant are filled with moments of excitement, fun, friendship, and self-confidence. As the oldest and largest FREE summer day camp in the nation, Hartford’s Camp Courant provides a safe, exciting and educational environment in which Hartford’s youth, ages five (5) through 12, participate in active learning opportunities and fun activities focused on positive youth development and healthy lifestyle choices. Campers become part of a historic camp community that continues to grow and evolve, but has also stood the test of time for 125 years. Welcome to the Camp Courant family. 2019 is going to be the summer of a lifetime. Stan Glowiak, Camp Director Registration information Parents’ Day: Saturday, June 22, 2019 Camp Opening Day: Monday, June 24, 2019 Camp Closing Day: Friday, August 2, 2019 Last Day To Register: Friday, June 28, 2019 Camp will be closed on Thursday, July 4th for the holiday Parents’ Day information will be sent with confirmation letter There are no fees to attend Camp Courant. All programs are offered FREE of charge; The first 700 registrants will be considered, and will be accepted on a first-come, first-served basis. The remaining applicants will be placed on a wait list. If spaces open up, registrants on the wait list, in the order registrations were received, will be notified by letter that he/she may attend; All registrants will receive a green confirmation letter in the mail confirming camper start date; Due to limited spaces, Camp Courant has a strict three day, unexcused absence policy. If your camper misses more than three days without approval, your camper will be removed from the registration list. Please contact the office if your camper is unable to attend Camp; Please indicate on the registration form if your camper is required to attend summer school. Once summer school begins, your camper will be removed from the registration list; Camper registration must be dropped off or mailed to:

Hartford’s Camp Courant

285 Broad Street, Hartford CT 06115

Registrations may be dropped off at the Broad Street entrance between 8:30 a.m. and 2:00 p.m. After 2:00 p.m., please use the Flower Street entrance.

Meals & Personal Belongings Hartford’s Camp Courant is not responsible for personal belongings, and we highly encourage campers to leave anything of value at home; We suggest your camper wear closed–toed shoes, and bring a bathing suit and towel. If your camper does not have either, each will be provided; Camp Courant provides free breakfast and lunch, but each camper is welcome to bring their own food (microwave and refrigeration not available). Camp Hours & Transportation The standard Camp day runs from 8:30 a.m. to 3:30 p.m. daily. Campers must be at their designated bus stop no later than 8:30 a.m. Drop off is between 3:00-3:30 p.m.; In order to ensure the safety of our campers, we do not allow drop-off at the campsite. If your camper misses the bus, he/she cannot attend Camp that day; Available bus stops are listed on the registration and are monitored by Camp Courant counselors; Campers must use the same bus stop every day; Camp is open rain or shine! In the event of cancellation or emergency, you will receive notification via email, text and phone. Field Trips Hartford’s Camp Courant arranges off-site field trips for campers, and arranges all transportation to and from the campsite. Parents will be notified of field trips in advance, and will be required to sign a permission slip for each trip. Insulin-dependent campers cannot participate in off-site field trips without a certified nurse in attendance. Swimming Hartford’s Camp Courant will offer swimming lessons to the first 200 campers registered;

The lessons will take place during the normal Camp day and are taught by licensed lifeguards and instructors;

Registration is required for this program and campers are accepted into the program on a first-come, first-served basis. Dental & Vision Screenings Camp Courant offers free dental and vision screenings to campers over the course of the season. Should you choose for your camper to receive a free dental or vision screening, you will receive a notification by mail of any referral and will retain the right to refuse any referral.

Hartford’s Camp Courant 2019 Registration Form (page 1)

Part 1: Personal Information (At least one phone number is required; please notify office of any changes)

___________________________________________________________________________________________________________________

Parent/Guardian Last Name Parent/Guardian First Name Relationship to Camper

_____________________________________________________________________________________________________________________________________________ Home Phone Work Phone Cell Phone Email

___________________________________________________________________________________________________________________

Parent/Guardian Last Name Parent/Guardian First Name Relationship to Camper

_____________________________________________________________________________________________________________________________________________ Home Phone Work Phone Cell Phone Email

Part 2: Camper Information (One registration form is required for each camper)

___________________________________________________________________________________________________________________

Camper Last Name Camper First Name Nickname

Gender: Male Female Chooses to Identify As________________________________________ Birth Date_______________________

_____________________________________________________________________________________________________________________________________________ Home Address Hartford, CT Zip Code

_____________________________________________________________________________________________________________________________________________ School Name Grade Completed In June

Is your child attending summer school this year? YES NO If YES, Start Date_____________

Camper Ethnicity (Choose One)

African American/Caribbean American

American Indian/Alaska Native

Asian/Pacific Islander

Caucasian Hispanic/Latino(a)

Multi Racial (two or more)

Camper Family (Choose One)

Two Birth/Adoptive Parents

Step & Birth Parent

Single Parent-Female

Single Parent-Male Grandparent

Relative/Guardian

Dept. of Children & Families Foster Parent

On Own

Joint Custody

Choose Not To answer/other____________________

Free/Federal Reduced Lunch

Does your camper qualify?

YES NO Choose Not to Answer

In an effort to obtain grants and keep Camp Courant FREE, we report on the following below:

Responses are for reporting purposes only, and do not determine enrollment

Hartford’s Camp Courant 2019 Registration Form (page 2)

Part 1: Personal Information

Part 3: Emergency Information (At least one phone number is required; please notify office of any changes)

___________________________________________________________________________________________________________________

Emergency Contact Last Name Emergency Contact First Name Relationship to Camper

_____________________________________________________________________________________________________________________________________________

Home Phone Work Phone Cell Phone Email

Can your camper be released from Camp to this person in the event of emergency or illness? YES NO

Can your child be released to anyone from Camp other than the emergency contact? YES NO

If YES, please print full name and relationship:____________________________________________________________________________

Part 4: Transportation Information (Please select ONE-changes will not be accepted)

North End-Hartford

Mary Shepard Place and Pavilion Street

Corner of Clark Street and Elmer Street

Corner of Garden Street and Cleveland Avenue

Global Communications-Edwards Street

Achievement First-Blue Hills Avenue Annie Fisher School-Plainfield Street

Corner of Palm Street and Andover Street

South End-Hartford

Hartford Public High School-Forest Street

Kennelly School-Cheshire Street

Bulkeley High School-Elliott Street

Baby Pope Park-Putnam and Russ Streets Moylan School-Ledger and Catherine Streets

Betances STEM-Bodwell Street

Is your camper allowed to walk home without an adult? YES NO (If NO, please complete below)

_____________________________________________________________________________________________________________________________________________ Last Name First Name Relationship Phone

____________________________________________________________________________________________________________________________________________ Last Name First Name Relationship Phone

_____________________________________________________________________________________________________________________________________________ Last Name First Name Relationship Phone

Part 5: Medical History

Connecticut State Law requires each camper to have a physical examination and current immunization record signed by his/her physician. Campers are required to have had a physical examination within the last three years of arrival at Camp. In addition to completing pages 1 and 2 of the registration form, please submit the following:

Camper Health Record-page 3 (to be completed by parent/guardian)

Authorization for the Administration of Medications and/or Blood Glucose Test-page 4 (to be completed by physician, if applicable). All medications signed for must come with the camper on his/her first day.

Physical examination and current immunization record within the last three years (please obtain a copy from camper physician and include with completed registration form). If your child has a care plan at school, please attach with the physical.

Hartford’s Camp Courant 2019 Registration Form (page 3)

Part 6: Camper Health Record (Please put N/A if question(s) not applicable)

___________________________________________________________________________________________________________________ Primary Care Physician Name and/or Clinic Phone _____________________________________________________________________________________________________________________________________________ Address City State Zip Code

Does your camper have health insurance? YES NO HUSKY (For HUSKY information, 1-877-HUSKY)

_________________________________________________________________________________________________________________________________ Insurance Company/Managed Care Plan (include secondary if applicable) Insurance, HUSKY, or Medicaid Client ID

Camper Name:________________________________________________________ Date of Last Physical Exam:____________________

Health History and Chronic Illness (Check All That Apply): Hay Fever Insect Sting Ivy Poisoning Chicken Pox Measles German Measles Mumps Whooping Cough Ear Aches/Infection Sinus Throat Heart Stomach Diabetes Menstrual Rheumatic Fever Seizure/Epilepsy Asthma Behavior Sickle Cell Ear Tubes Other_____________________________________________________________________________ Other Past Illnesses/Explanation:__________________________________________________________________________________________ _________________________________________________________________________________________________________________________________ Allergies (Drugs, Foods, etc…):_____________________________________________________________________________________________ Medical/Religious Dietary Restrictions:____________________________________________________________________________________ Physical Restrictions:________________________________________________________________________________________________________ Operations or Serious Injuries (Dates)/Hospitalization (Dates)_________________________________________________________ _________________________________________________________________________________________________________________________________ Appliance Worn (Glasses, Contacts, etc…)_________________________________________________________________________________ Current Medications:_________________________________________________________________________________________________________

Can Camper self-administer medication? (please read prescription policy in ‘Standard Release Form’) YES NO

YES NO If you checked ’YES’ above, please have your camper’s physician complete ‘Authorization for the Administration of Medications and/or Blood Glucose Test’ form on the next page.

Is your camper exempt from immunizations based on religious or medical reasons? YES NO

Part 8: Physician and Insurance Contact Information

Part 7: Non-Prescription Medications and First Aid

The Nurse on staff at Hartford’s Camp Courant has a list of non-prescription medications and treatments to be used for routine medical situations that commonly occur at Camp. They include, but are not limited to: insect bites and stings, headaches, stomachaches, sprains and strains, fever, minor cuts and bruises and other similar conditions. State licensing regulations require permission to administer non-prescription medications and topical treatments to include: over the counter pain relievers, antibacterial/antiseptic ointments, creams or wipes, calamine lotion, cortisone solution, Band-Aids, adhesive tape and sterile dressings, ice packs, petroleum jelly and sterile eye wash. Epi-pens (in case of allergic reactions) will only be administered by trained Camp Staff over the age of 18.

In the event of an emergency, we will administer First-Aid treatment and take the camper to the hospital/dentist.

Hartford’s Camp Courant 2019 Registration Form (page 4)

Part 9: Authorization for the Administration of Medications and/or Blood Glucose Test

Connecticut State Law requires a physician’s or dentist’s written order and parent/guardian’s authorization for a nurse to administer medications and/or Blood Glucose Tests in a youth camp setting. All medications signed for must come with campers on his/her first day and must be in pharmacy-prepared containers and labeled with the name of the camper, strength, dosage, frequency, physician or dentist name, and the date of the original prescription. Over the counter medications and Blood Glucose Tests must be in the original container, unopened, and labeled with the camper’s name. All medications may be picked up August 5th-9th between 8:00 a.m. and 3:00 p.m. Medications not picked up will be destroyed.

To Be Completed By Camper Physician (If Applicable)

Camper Name:__________________________________________________ Physician Name:______________________________________

Relevant Side Effects/Management:________________________________________________________________________________________ Allergy/Food Interactions with Medication:_______________________________________________________________________________ Please List All Controlled Medications:_____________________________________________________________________________________ Can the Camper Self-Administer Medication? (camper may not self-administer Blood Glucose Test) YES NO

Restrictions/Additional Comments:________________________________________________________________________________________

_________________________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________________ Parent Name Parent Signature Parent Contact #

_________________________________________________________________________________________________________________________________Physician Signature Date License # _____________________________________________________________________________________________________________________________________________ Address City State Zip Code

Medication Condition Dose Frequency Method of Administration

Hartford’s Camp Courant Standard Release Form

I hereby request that my child be enrolled as a camper at Camp Courant, Inc. As an enrolled camper, I give permission for my child to voluntarily participate in Camp activities, which I have familiarized myself with, including, but not limited to, sports, physical fitness, arts & crafts, swimming, nature walks, table games and recreational activities (except those noted on the ‘Camper Health Record’ and ‘Authorization for the Administration of Medications and/or Blood Glucose Test’ forms). I understand Camp Courant, Inc. is responsible for my child only during the regular Camp day, which includes transportation to and from Camp.

I certify that the information listed on the ‘Camper Health Record’ and ‘Authorization for the Administration of Medications and/or Blood Glucose Test’ forms are accurate, and my child has no undisclosed medical or other condition(s) that might affect his or her ability to participate in the activities above. I affirm that I have identified any/all medical restrictions my child may have. I understand all medications must be in pharmacy-prepared containers and labeled with the name of the camper, strength, dosage, frequency, physician or dentist name, and the date of the original prescription. Over the counter medications and Blood Glucose Tests must be in the original container, unopened, and labeled with the camper’s name.

I further understand and recognize that certain hazards and dangers are inherent in the events and programs offered to campers at Camp Courant, Inc. These potentially hazardous and dangerous activities include, but are not limited to sports, physical fitness activities, horseback riding, swimming, and the low ropes course, among others. I understand Camp Courant, Inc. has taken safety measures to minimize the risk of injury to Camp participants, but cannot ensure campers will be free from accidents or injuries. During activities at Camp, concussions may result from a fall or from campers colliding with each other, the ground, or with obstacles.

With a full understanding of the above-mentioned risks, I agree to release and hold harmless Camp Courant, Inc. and its agents, officers, employees, representatives, from any and all liability, claims, suits, demands, judgments, costs, interests and expenses (including attorney’s fees and costs) for any other loss, damage or injury, including those caused by negligence, that may occur during my child’s participation at Camp, including participation in any activities, programs, events, vision and dental screenings, transportation or field trips.

I agree that I have thoroughly read the entire registration package, and reviewed all rules, regulations and procedures with my child.

I understand that prevention and health awareness programs, including discussions about Acquired Immune Deficiency Syndrome (AIDS), will be part of the curriculum for the 9-12 year olds.

I also agree that all photographs, videos, negatives, prints, paintings, drawings, sketches, reproductions and likenesses of any kind made of the child while at Camp are and shall remain the property of Camp Courant, Inc., its successors, and assigns. I give my irrevocable consent that said works, or any part thereof, may be published, displayed, reproduced, and circulated in any form by Camp Courant, Inc. or anyone else authorized by Camp Courant, Inc. with or without the child’s name, for commercial purposes or otherwise, including advertisement in any media, and with or without any testimonial copy of other form of advertising or display.

In addition, I understand that Camp Courant, Inc. offers field trip opportunities, Swimming 101 and free dental and vision screenings. Camp Courant will also administer non-prescription medications and first aid with my permission.

•I authorize my child to participate in Swimming 101 YES NO

•I authorize my child to receive a free vision screening YES NO

•I authorize my child to receive a free dental screening YES NO

•I authorize the Camp Courant nurse to administer non-prescription medications YES NO

•I authorize the Camp Courant nurse to administer prescription medications and/or blood glucose test YES NO

(if applicable)

•I authorize first-aid treatment (treatment will be administered in event of an emergency) YES NO

Checklist

In order for my child to be considered for admission to Hartford’s Camp Courant this summer, I have completed and attached the following information:

Personal and Camper Information Form (with at least one phone number) Emergency Contact Information Form (with at least one phone number) Transportation Information Form Camper Health Record and Physician Information Form Authorization for the Administration of Medications and/or Blood Glucose Test Form, signed by physician (if applicable) Copy Care Plan (if applicable), Camper Physical and Immunization Record (physical must be dated within three years of camper start date)

_____________________________________________________________________________________________________________________________________________ Camper Name Parent Name Parent Signature Date

2018 Camp Season highlights