Beruflich Dokumente
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Our Story
As told by parents and caregivers of our campers . . .
Camp Pow Wow has been a lifesaver for our family. My son looks forward to coming all year round! It is impossible for her to express her feelings all the time, but we can tell by her smile that she couldnt be happier! Andrew is happier after camp. He is not as upset over little things and it is easier to get him to do things for himself. Kristy has been attending camp for 40 years and loves it more than any other activity. Its better than Christmas for her! It gives Jared the opportunity to meet new friends and socialize, grow, and gain independence. She was so PROUD! Overnight with bonfire and dancing made her feel like a regular kid! Overnighting was a huge opportunity for herand the first time we were alone in our house overnight in 18 years! Hes already asking to do it again next yearthis from a kid who never wants to participate! Its the only time that we dont have to struggle in the morning to get out of the house! Derek loved being with kids his own age and this camp allowed for him that important experience that all kids need and deserve. He is learning to trust more people to help him. Hes okay with most situations in new places because of his Camp Pow Wow experiences his level of independence has blossomed from being at camp! Summers are usually very stressful for myself and his two sisters. Having him at a camp where there was a schedule, and then getting to be home with the girls was really great for all of us. Loved how he was able to bring fishing gear and worms and spend time doing his very favorite activity!
Schedules Matter
!
RESIDEntIal Camp SamplE SChEDulE
7:30 8:00 9:00 9:30 10:30 12:00 12:45 1:30 3:00 4:00 5:00 6:00 7:30 8:15 9:00 Reveille Breakfast French toast, cereal, fruit, milk, juice Opening Circle Arts & Crafts -Make Bird Feeders Fishing Lunch Deli sandwiches, chips, carrots, apples, pudding, juice Rest Swimming Special Guest Lannon Fire Department Free Play Dinner Barbeque chicken, mashed potatoes, beans, fruit salad, corn bread, cookies, juice Evening Activity Capture the Flag Shower Hour Campfire Bedtime 2
A typical day at ARCh Camp Pow Wow provides a safe and comfortable routine through rotations to different activities (art, music, recreation, and life experiences) along with the thrill of meeting special guests and visitors that change from week to week. Here is an example of what your camper would enjoy on a day filled with fun in the sun!
Tell me More
Who can attend camp?
ARCh Camp Pow Wow accepts all campers, regardless of their label of disability. Childrens sessions are for campers age 5-21 Adult sessions are for campers who are 22 and older
how can my camper participate in the Day Camp program when I work from 8:30 a.m. to 5:30 p.m. every day?
Campers may sign up for the Extended Respite option and be dropped off at camp as early as 8:00 a.m., and picked up as late as 6:00 p.m. during day camp weeks. Campers who utilize part, but not all of the Extended Respite hours may still be eligible for partial camp bus transportation. Please contact the ARCh office at (262) 542-9811 to discuss your schedule. The fee for the Extended Respite option is $150 per session, in addition to the regular camp fees.
does my camper have to stay the entire time if I sign up for the extended respite program?
No! If you are signed up for Extended Respite, you may drop off your camper anytime after 8:00 a.m., and pick them up anytime before 6:00 p.m. However, if you are picking up your camper early, we ask that you please notify the camp office at the beginning of the day so that your camper will be ready for you when you arrive. Otherwise, they may be on a hike, swimming at the beach, fishing at the pier, etc.
What will campers in Extended Respite do with their extra time in camp?
Campers participating in Extended Respite will still enjoy all of the activities of the typical camp day with everyone else, but they will have additional supervised activities before and after camp. They might go for a hike, make an art project, go for a swim, go fishing, play a game of kickball, make cookies, or do any number of fun camp activities. Additionally, ARCh Camp Pow Wow will provide a daily snack for Extended Respite participants, shortly after the typical camp day ends at 3:00 p.m.
If
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More
. . . Tell me More!
in platform tents and participate in all of the usual camp activities during the day crafts, fishing, games, music, and of course, plenty of swimming at the nearby beach! This allows for a more rustic camp experience and more individualized attention. Of course, our campers have full access to our air conditioned lodge, complete with modern bathrooms, showers, and a full kitchen. No transportation is provided for residential camp. The camper-to-staff ratio is 2:1 during residential camp.
Who can I talk to if I have more questions about aRCh Camp pow Wow?
Please contact the ARCh office for more information. Call 262-542-9811 -or- e-mail archcamppowwow@ameritech.net
adult Sessions
junE 17 - 21 SESSION 1 DAy CAmP midsummer nights Dream
A camp by any other name would smell as sweet! The curtain goes up on a true theatrical adventure as you travel back to the Renaissance this week to experience a little piece of Shakespeares world. Its up to you to pick your role king, queen, jester, or knight all are welcome at ARCh Camp Pow Wow! Act quickly, but be sure to leave your tights at home. After all, you dont want to make a scene!
COlOR WaR!
1, 2, 3, 4, We want color war! 5, 6, 7, 8, What is it gonna take? No Color War protests needed here. Camp will be split into two teams as campers and counselors alike compete in a fiveday adventure to win points. Campers will earn points for participating in a variety of activities including a kayak race, tie dye contest, all-camp musical chairs, and everybodys favorite, All Pow Wows Children. Then, get ready on Thursday night for the 3rd annual ARCh Camp Pow Wow SMores Cook-off, followed by Fridays events the pie toss, and the song competition at closing circle. Spirit and pride are all around as you compete for the title of 2013 ARCh Camp Pow Wow Color War Champions!
children's Sessions
junE 24 - 28 SESSION 2 RESIDENTIAL CAmP Sherlock holmes & the Case of the Curious Camper Caper
Whodunnit? Elementary, my dear Watson! Join us in this fun and exciting week of cases, clues, mysteries, and magnifying glasses. Campers will spend their week playing detective, finding clues, and solving the biggest mystery of the summer Who was the criminal mastermind behind the Curious Camper Caper? Just dont be fooled by any red herrings! You will spend your nights in a unique platform tent after a fun-filled day of swimming, fishing, art projects, sports, picnics, and much more! Enjoy a week-long overnight camping experience from Monday through Friday featuring a 2:1 staff ratio. You wont want to miss it!
COlOR WaR!
1, 2, 3, 4, We want color war! 5, 6, 7, 8, What is it gonna take? No Color War protests needed here. Camp will be split into two teams as campers and counselors alike compete in a five-day adventure to win points. Campers will earn points for participating in a variety activities including a kayak race, tie dye contest, all-camp musical chairs, and everybodys favorite, All Pow Wows Children. Then, get ready on Thursday night for the 3rd annual ARCh Camp Pow Wow SMores Cook-off, followed by Fridays events the pie toss, and the song competition at closing circle. Spirit and pride are all around as you compete for the title of 2013 ARCh Camp Pow Wow Color War Champions!
Its easy! Simply complete the camp registration forms, pages 10-18, along with a $50 per session deposit, and return to the ARCh office by Friday, March 29th. Registrations received after this date will be assessed a $25 per session late fee. Dont forget to include the deposit of $50 per session to hold your spot(s). registration deposits are not refundable. Once your registration is received, you will receive a confirmation along with your camp invoice. Full payment of all fees and completed Health Examination Form are due by Friday, April 19th. Please make sure to register early to ensure you can attend all the sessions you want! Camp is in high demand; therefore, no camper will be permitted to attend camp until ALL FEES AND COMPLETED FORMS HAVE BEEN RECEIVED BY ARCh. Once all forms are submitted, you will receive a packing list, bus schedule and other important information to help make your time at camp successful and unforgettable!
www.waukeshaarch.org
RETuRN FORmS AND DEPOSITS TO:
ARCh 419 Frederick Street Waukesha, WI 53186
DEaDlInE FOR:
MARCH
29
DEaDlInE FOR:
APRIL
19
JUNE
STARTS!!!
17 16
JULY
vISITORS NIgHT
Please join the fun!
Give a Campership
impact a life . . . Sponsor a campership!
Many children and adults with disabilities lack the financial resources to attend camp. Children may come from homes undergoing financial stress. Adults working in sheltered employment often earn just $60 per month. You can make a dream come true by sponsoring a campership! Your gift in any amount will help to make camp possible for someone who, without your help, could not participate. A gift of $350 provides one week of camp for a delighted camper, but any amount makes an impact! If you would like to help a deserving individual have an unforgettable experience, please indicate your sponsorship of a campership on pages 16 - 17. on behalf of many grateful children and adults, thank you for your kindness!
Please submit your written request by mail to: ARCh, 419 Frederick Street, Waukesha, WI 53186 or via e-mail to archoffice@ameritech.net
Campership applications are due Friday, march 29th NO EXCEPTIONS.
The Campership Committee will announce campership award decisions on or before Friday, April 12th.
Welcome to the
family
When you register for camp, you become a member of ARCh and gain access to services like these: aRCh for paREntS: Advocacy Information and resources on medical care,
benefits, transportation, housing, etc. along with emotional support and self-advocacy training. Advocacy services include support for IEP meetings, staffings, and 504 meetings.
We are here to serve our members, so please let us know what you need and how we can help! Contact us by phone (262) 542- 9811 or e-mail archoffice@ameritech.net
aRCh for yOung aDultS (ages 13-21): Teen Time Service projects and community outings
for teens with and without disabilities to build friendships and social skills.
aRCh for aDultS (age 18+): Thursday Night Socials Twice-monthly dances for approximately
150 energetic participants.
Camper Information
Last Name:_________________________________________ First Name:__________________________________ Address:_______________________________________________________________________________________ City:_______________________________________________ State:____________ T-shirt size: (Please Circle One) Youth: Adult: 6/8 S 10/12 M 14/16 L 18/20 XL XXL Zip: _____________________ Date of Birth:_______________________________________ Attended CPW before? ____YES ____NO
2ND CONTACT: Name:____________________________________ Relationship: _____________________________ Phone Number: ____________________________ Alternate Phone Number: _____________________________
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Bus transportation
DEaDlInE tO REtuRn: FRIDay, maRCh 29, 2013
BuS tRanSpORtatIOn IS pROvIDED FOR Day Camp Only
NO transportation provided for Residential Camp.
Extended Respite participants should contact the ARCh office for transportation information - (262) 542-9811.
bus Transportation to ARCh Camp Pow Wow DEaDlInE tO REtuRn: FRIDay, maRCh 29, 2013
The final bus schedule will be mailed prior to your camper attending camp.
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All about ME
PAgE 1 OF 2
Seizure Disorders:
____ Does Not Apply ____ Nocturnal ____ Psychomotor ____ Non-convulsive (Petit mal) ____ Tonic/Clonic (Grand mal) ____ Mixed
mobility:
(indicate all that apply to the camper) ____ Ambulatory ____ Walker/crutches ____ Stroller ____ Cane ____ Braces ____ Prosthesis ____ Manual Wheelchair ____ Power Wheelchair Additional Comments: ____________________
Seizure Frequency: ______________ Length of seizure: _____________ Date of last seizure: ______________ How are seizures handled at home? _____________________________ __________________________________________________________ __________________________________________________________
Eating:
Normal appetite: Diet: ____Standard
____G-tube ____Large ____Medium ____Small ____Chopped Food ____Blended/pureed Other: ______________________________
___________________________________
Is camper able to indicate the amount of food and liquid intake he/she needs? ____ Yes ____ No Eating accommodations: ____ Needs total assistance ____ Straw ____ Clothing protector ____ Adaptive utensils Special Instructions (attach separate paper if necessary): ____________ Camper able to feed self with: ____ No help ____ Some assistance
___________________________________________________ ___________________________________________________
SPECIAL DIETS: Menu will be sent to all campers prior to attending camp. G-TUBES: We can usually accommodate a G-tube schedule. Please attach the feeding schedule so we can contact you with
any questions prior to attending camp. Please call ARCh at 262-542-9811 with any further questions. ContinueD on PAge 13
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More
Toileting: Please bring all needed supplies/equipment, (e.g. briefs, wipes, etc.) to each camp session.
Is camper independent in toileting? Does camper wear disposable briefs?
Personal Hygiene: Please complete this chart by writing an X and comment where appropriate.
TOTAL ASSISTANCE Dressing Undressing Showering Washing face/hands Brushing hair Brushing teeth Menstrual Care SOME HELP SUPERVISE REMINDERS INDEPENDENT
Communication:
____ Verbal ____ Non-verbal ____ Sign-language ____ Gestures
Does the camper understand/respond to questions? Does the camper communicate his/her needs and wants? Does the camper read/write? ____ Yes ____ No
____ No ____ No
behavior: *If the camper has a behavior plan or IEP available, please include a copy.
If the camper becomes upset, you may see (mark all that apply): ____Verbally Aggressive Behaviors ____Physically Aggressive Behaviors ____Shouting ____Swearing ____Self-Abusive Behaviors ____Tendency to Withdraw When upset, the best ways to calm or soothe the camper are: __________________ ____________________________________________________________________ ____________________________________________________________________ What motivates the camper? ____________________________________________ ____________________________________________________________________ ____________________________________________________________________
Please provide additional instructions or explanations for our aquatic services staff:
___________________________________________________________ ___________________________________________________________
Additional Information: Please describe any likes, dislikes, fears or habits that you think would be helpful for the Camp Pow Wow staff to know. (If there is not enough room, please attach separate paper and return with this form.) ___________________
_______________________________________________________________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________
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Wisconsin State Law requires all campers to have an annual physical exam.
Parent/guardian Section:
Campers Name: __________________________________________________ Date of Birth: ______/______/______ Health Insurance Provider: ________________________________________________________________________ Health Insurance Number: ________________________________________________________________________ Name of Insured: ___________________________________ Relationship to Camper: ________________________
In the event of a medical emergency, when it is not possible to contact the parent or guardian, I grant the Association for the Rights of Citizens with handicaps (ARCh) permission to contact appropriate medical personnel and authorize medical service or emergency treatment to the camper named above.
The remainder of this form must be completed by a licensed medical physician, PA or RN. To be filled out by Health Care Professional:
Examined on: ________________ Medical Diagnosis: _________________________________________________ Gender: _________ Age: ___________ Weight: __________ Height: ___________ BP: _____________________
Is the following normal?(YES or NO). if nO, please explain: 1. Ears:____________________________________ 2. Nose: ___________________________________ 3. Throat: _________________________________ 4. Skin: ___________________________________ 5. Eyes: ___________________________________ 6. Scalp: __________________________________ 7. Heart: __________________________________ Is there a history of (YES or NO). if yeS, please explain: 1. Asthma: _________________________________ 2. Hernia: _________________________________ 3. Enuresis: ________________________________ 4. Recent Fevers: ___________________________ 5. Recent weight loss: _______________________ 6. Kidney Disease: ___________________________ 7. Diabetes: _______________________________ if yeS to diabetes, please indicate frequency of blood glucose checks and any needed snacks according to blood sugar levels: __________________________ __________________________________________ __________________________________________ 8. 9. 10. 11. 12. 13. 14. 8. 9. 10. 11. 12. 13. Lungs: _____________________________________ Extremities: __________________________________ Glands: _____________________________________ Abdomen: __________________________________ Varicosities: __________________________________ Genitalia: ___________________________________ Neurological: ________________________________ Stomach Disorder: ____________________________ Heart Disease: _______________________________ Frequent Colds: ______________________________ Hay Fever: __________________________________ Hepatitis: ___________________________________ Other bodily fluid precautions, specify: ____________ ___________________________________________
Does camper require G-tube feedings?________ If yes, please indicate product, amount and frequency: ____________________ ________________________________________________________________________________________________________ ________________________________________________________________________________________________________ sEE NExt PAgE
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Wisconsin State Law requires all campers to have an annual physical exam.
hEalth FORmS DuE By: apRIl 19, 2013 PAgE 2 OF 2 hEalth FORmS DuE By: apRIl 19, 2013
If yes, type? _________________________________________________________________________________________ Frequency: ___________________________________________________ Last Seizure: __________________________ Treatment: __________________________________________________________________________________________
Does this person have allergies? ____ Yes ____ No If yes, what type? _______________________________________ __________________________________________ _______________________________________ __________________________________________ _______________________________________ __________________________________________ Please list any medications camper is currently taking:
MEDICATION DOSAGE TIME OF DELIVERY REASON FOR MEDICATION SIDE EFFECTS TO WATCH FOR
Please note: ONLY medication on this list will be administered to camper at Camp Pow Wow, so please take time to properly complete. Any changes in medications between the time of this physical and when the camper attends camp, must be authorized again by signature of a licensed medical physician, PA, or RN.
Permission to give camper over-the-counter medication: ____ Yes ____ No Diet Restrictions: _____________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________
Has the camper been immunized against the following: (provide most recent dates if possible)
___ Polio: _____________ ___ Mumps: ___________ ___ Rubella: ___________ ___ Measles: ______________ ___ Hepatitis B: ____________ ___ Tetanus:_______________
_____________________________________________________________________
(PLEASE PRINT) Name & Credential of Medical Professional
Signature of Medical Professional
X_____________________________________________________________ 15
SESSION
AmOuNT DuE
junE 17 - 21 SESSION 1
DAy CAmP midsummer nights Dream 9:00 a.m 3:00 p.m.
Extended Hours 8 a.m. - 6 p.m.
$350
$150
$_________ $_________
july 15 - 19 SESSION 4
DAy CAmP Color War 9:00 a.m 3:00 p.m.
*THURSDAY OVERNIGHTnO ADDiTiOnAL ChArGe ____ Yes ____ No
Extended Hours 8 a.m. - 6 p.m. ____ Yes ____ No
$350
$150
$_________ $_________
july 29 - auguSt 2 SESSION 6 RESIDENTIAL CAmP Folktales and Fables 9:00 a.m. Monday 3:00 p.m. Friday
$700
$_________
total $__________
Third party cost(s) if applicable. (see Payment options on page 18 ) LATE FEE for registrations reCeiveD After MArCh 29, 2013 - ADD $25 per session
* DAy CAmP REmINDER: NO transportation provided on Thursday afternoons & Friday mornings.
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SESSION
AmOuNT DuE
junE 24 - 28 SESSION 2 RESIDENTIAL CAmP Sherlock holmes and the Case of the Curious Camper Caper 9:00 a.m. MONDAY 3:00 p.m. FRIDAY july 8 - 12 SESSION 3 DAy CAmP Once upon a time DAy CAmP 9:00 a.m 3:00 p.m.
Extended Hours 8 a.m. - 6 p.m.
$700
$_________
$350
$150
$350
$150
auguSt 5 - 9 SESSION 7 DAy CAmP Superheroes: From Ordinary to Extraordinary 9:00 a.m 3:00 p.m.
*THURSDAY OVERNIGHTnO ADDiTiOnAL ChArGe ____ Yes ____ No
Extended Hours 8 a.m. - 6 p.m. ____ Yes ____ No
$350
$150
auguSt 12 - 16 SESSION 8 DAy CAmP Color War 9:00 a.m 3:00 p.m.
Extended Hours 8 a.m. - 6 p.m.
$350
____ Yes ____ No
$150
total $__________
Third party cost(s) if applicable. (see Payment options on page 18 ) LATE FEE for registrations reCeiveD After MArCh 29, 2013 - ADD $25 per session
paymEnt DuE In Full by FRIDay, apRIl 19, 2013 $__________ * DAy CAmP REmINDER: NO transportation provided on Thursday afternoons & Friday mornings.
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Payment Options
1) Check or Money Order Enclosed (made payable to ARCh):
Check #_______________________ Amount: $________________________
Cardholder Name: ______________________________________________________ Account Number:____________________________________ Exp. Date: __________ Security code (3 digits on back of credit card): _________________________________ Amount to bill to credit card: $_____________________________________________ Cardholder Signature:____________________________________________________
3) Third Party Pay: If camp is being paid through county funds (family services, autism waiver programs, etc.) or by another third party, the full cost of camp will be invoiced to the payer. Full cost of Residential Camp is $800 per camper Full cost of Day Camp is $450 per camper Full cost of Extended Respite is $150 per camper (Day Camp ONLY) Third Party Payer Contact Information:
Name: ______________________________________ Agency: __________________________________________ Address: _______________________________________________________________________________________ City:________________________________________ State: ___________________ Zip: ______________________ Phone: __________________ Fax:________________ E-mail: ____________________________________________
DEaDlInE tO REtuRn payment Options & Consent Form: FRIDay, maRCh 29, 2013
Consent
Parent/guardian Consent
I understand that I am liable for all camp fees, including any fees billed to a third party listed above, in the event that the third party does not pay. I also understand I am liable for camp fees whether or not the camper attends. I give permission for the camper named on page 10 to attend ARCh Camp Pow Wow and to participate in all activities. I give ARCh Camp Pow Wow permission to use photographs of this camper in ARCh publicity and promotions. I give ARCh Camp Pow Wow permission to transport the camper before, during, and after camp activities. I give ARCh Camp Pow Wow permission to provide routine health care, administer medications, and seek emergency medical treatment.
I agree to relieve ARCh Camp Pow Wow and its personnel from any liability in connection with any ARCh Camp Pow Wow activity. Print name of Parent/Guardian: _________________________________________________ * Signature of Parent/Guardian: _________________________________________________ *We will only accept the signature of Parent/Guardian Date: _________________________________________________ Contact information for Parent/Guardian if not included on page 10: Phone: __________________________ Email: ______________________________________
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Our mission: . . . to empower children and adults with disabilities to reach their full potential, and to increase prevention and awareness in the community.
014 2
looking ahead!
Next year we will be celebrating
55th summer
of friends, laughter & fun in the sun! We cant wait to celebrate with you!
STAY TUNED FOR MORE INFORMATION!