RECREATION LEADER IN TRAININGWHAT DO I NEED FOR CAMP?Guide for Campers and Parents

SNEAKERS SNACK

WATER SUNSCREEN

BATHING SUIT/TOWEL A POSITIVE ATTITUDE!

MANCHESTER RECREATION DIVISIONDepartment of Leisure, Family and Recreation

REGISTRATION PACKETTOWN OF MANCHESTER

RLTRecreation Leader in Training

For ages 14 & 15

RECREATION LEADER IN TRAINING REGISTRATION FORM

Child’s Name: ________________________________________________ Sex ______ Date of Birth ___/____/______

School ______________________ Grade ____ Home Phone ______________ Email _______________________

Address (Street, Town, State, Zip Code)___________________________________________________________________

STEP TWO: PARENT/GUARDIAN INFORMATION

Last, First, MI

Primary Parent/Guardian Name __________________________ Phone Number(s) _____________(c) _____________ ___(w)

Secondary Parent/Guardian Name ________________________ Phone Number(s) _____________(c) ________________ (w)

Emergency Contact Name ______________________________ Phone Number(s) _____________(c)_________________(h)

Please List Names and Phone Numbers of Additional Persons Authorized to Pick-Up Child (MUST BE AT LEAST 15 YEARS OLD):________________________________________________________________________________________________

STEPS THREE: REGISTRATION INFORMATION

STEP ONE: PARTICIPANT INFORMATION

STEPS FOUR, FIVE, SIX: HEALTH HISTORY

DATE OF LAST TETANUS SHOT: ____/____/______4: IMMUNIZATIONS

5: MEDICATIONSDoes your child take any medications?____yes____no

Please List____________________________________

Will your child take any medications during camp hours? (In-

cludes inhalers, aspirin, etc.)____yes____no

Please List____________________________________

6: HEALTH INFORMATIONPlease list any allergies, restrictions, family, social or emotional con-cerns you feel camp staff should be aware of, along with any other ad-ditional concerns:

________________________________________________

________________________________________________

________________________________________________

This health history is correct so far as I know. The person named above has permission to participate in all camp activities except as noted by the examining physician or myself. If I can’t be reached inan emergency, I hereby give permission to the physician selected by the camp director to hospitalize, secure, give proper medical treatment and order injection, anesthesia for surgery for the personnamed above. The Town of Manchester is not responsible for any condition or situation of which they are not informed. I give permission for my child to be transported via bus to and from special eventand rainy day activities as required. Additionally, I the undersigned do hereby waiver and hold harmless the Town of Manchester, its employees and agent, from any personal or property damage I or anychild may incur while participating in this activity. I understand the Town of Manchester does not provide accident or health insurance. I also give permission to the Town of Manchester, associatedTown Departments, and local news media to take pictures of and/or film my child during camp activities. I understand that these entities may include these pictorial and/or film images of my child intheir public service announcements, publications, or on their websites.

STEP EIGHT: PARENT OR GUARDIAN AUTHORIZATION (REQUIRED FOR ALL PERSONS UNDER 18)

8. SIGNATURE:___________________________________DATE:______________

Manchester Recreation Division

RECREATION LEADER IN TRAININGInformation and Frequently Asked Questions

STEP SEVEN: FINANCIAL ASSISTANCE

7: Financial Assistance I am requesting financial assistance and have attached my Financial Assistance Form.I do not need financial assistance.

REGISTRATION PROCEDURES All registration forms POSTMARKED MARCH 31 or earlier will be randomly selected and processed beginning in April. Any youth not selectedfor the RLT program and indicated on their form they would like to be enrolled in a Teen Camp Site will be placed in the Camp registration lot-tery box.

WHAT TO INCLUDE WITH REGISTRATION: A completed registration form for each child, including: health information, tetanus shot date, and insurance information.•Select which program your child will attend the 2nd week of the RLT program (Ropes Course or Lifeguard).•Indicate which weeks your child will attend the RLT program by checking appropriate box (first 3 weeks are mandatory).•Check the correct box if your child would like to be enrolled in a Teen Camp Site if they are not chosen for the RLT program.•$65 Fee Per Child Per Week for weeks 1 - 6, (minimum enrollment of 5 weeks)•Make checks and money orders payable to: “Town of Manchester”•Mail to: RLT PROGRAM, Recreation Division, 41 Center Street, PO Box 191, Manchester, CT 06045-0191•Confirmations will be mailed at the end of April 2017. Space is limited.•

PROGRAMMINGWEEK 1 (June 26 to June 30)Leadership Training - Workshops include but are not lim-ited to sessions on communication skills, human diversity,emergency procedures, job interviewing skills and role play-ing.(Held at Nathan Hale Activity Center, 160 Spruce Street)

WEEK 2 (July 3 to July 7)A choice must be made between these two program offerings:Ropes Course Training - Includes physical and mentalchallenges, teaches team work and trust building, includes lowand high ropes elements. Facilitators are certified instructors. (Held at the Manchester Ropes Course, Hillstown Road).

OR

American Red Cross Lifeguard Training - Provides skilland knowledge needed to prevent and respond to aquaticemergencies. Facilitators are certified instructors. (Held at the Globe Hollow Pool, Spring Street).

WEEK 3 (July 10 to July 14) Certification courses American Red Cross first aid and CPR for the professional res-cuer, blood borne pathogens and community water safety.(Held at Nathan Hale Activity Center, 160 Spruce Street)

WEEKS 4—6 (July 17 to Aug. 4) (held at sites TBA)Youth Camp/Aquatic Experience - Includes severalweeks of hands on training at Youth Camp or Aquatic sites, in-cludes journaling experiences, assisting counselors or guardsat planning, implementation and supervision of activities.(Transportation to these sites is NOT provided).

*Mandatory attendance and participation from June 26 to July 14 (weeks 1 through 3) AND at least two (2) other weeks between July 17 to August 4.

DROP OFF AND PICK UP PROCEDURESAll youth are to be escorted by a parent or responsible adult tothe designated site and signed in (9:00 AM) and signed out (3:00PM) with the RLT staff daily. (Biker/Walker forms are available).

BEHAVIOR MANAGEMENTOur goal is to provide a safe and nurturing environment for allour participants. We believe that the youth enrolled in this pro-gram are to be treated as responsible young adults. We respect ayouth’s individual needs and interests and will work with youand your youth to help develop the skills he or she needs to feelconfident in themselves and in their growing abilities.

This is a Summer Recreation Leader In Training program and itis our policy not to discourage participation due to any disabilitywhether it be social, emotional, or physical. However, we will nottolerate behavior which threatens the physical and emotionalsafety of all participants and sacrifices the quality of the pro-gram.

MEDICATION ADMINISTRATIONYou must indicate on your registration form if your child re-quires medication at his/her RLT site. This includes inhalers andepipens. You will receive an Authorization for Medications Ad-ministration form in the mail when your registration is con-firmed. This form must be completed by a physician andreturned at least two weeks prior to the start of the program.

LUNCH is not provided, youth must bring their own food anddrink.

For more information contactCalvin Harris (860) 647-3088

Weeks: 6 weeks, June 26 to August 4, 2017* *Mandatory attendance from June 26 to July 14 AND at least two (2) other weeks between July 17 to August 4.

WEEK 2 (July 3 to July 7) A choice must be made between these two program offerings, PLEASE CHECK A BOX:

Ropes Course Training - Includes physical and mental challenges, teaches team work and trust building, includes low and highropes elements. Facilitators are certified instructors. OR

American Red Cross Lifeguard Training - provides skill and knowledge needed to prevent and respond to aquatic emergencies.Facilitators are certified instructors.

Week 1 (6/26-6/30) MANDATORY ATTENDANCENo camp held July 4

Week 2 (7/3-7/7) MANDATORY ATTENDANCE

Week 3 (7/10-7/14) MANDATORY ATTENDANCE

Week 4 (7/17 - 7/21) RECOMMENDED

Week 5 (7/24 - 7/28) RECOMMENDED

Week 6 (7/31 - 8/4) RECOMMENDED

Select a session by placing an (x) in the box.Participant MUST attend the first 3 weeks and at least two (2) other weeks between July 17 to August 4.

X

XX

COST: $65 per week for weeks 1- 6, (minimum registration of 5 weeks).

SITE: Each week the participants meet at various sites (confirmation packet will contain additional site information).

HOURS: 9:00 AM to 3:00 PM

WEEKS: 6 weeks, June 26 to August 4, 2017 *Mandatory attendance from June 26 to July 14 AND at least two (2) other weeks between July 17 to August 4.

No transportation is provided. Each participant is responsible for providing transportation to and from any of the sites.

PLEASE CHECK HERE if you would like an opportunity to attend a regular Recreation Summer Day Camp, if you are Not Selectedfor the RLT program (Community Y Teen Camp)