SUMMER

DAY CAMP
2014 PARENT HANDBOOK

www.maurywellness.org 931-548-2420
 Wellness and Aquatics Complex
Summer Day Camp 2014
2014 Parent Handbook
Table of Contents

General Information Page 3

Camp Goals Page 4

What to wear at camp Page 4

What to bring to camp Page 5

Camp Policies Page 6-7

Camp Payment Policy* Page 8-9

Code of Conduct* Page 10-11

Sunscreen Permission Form* Page 12-13

Release and Waiver of Liability* Page 14-15

Medication Authorization Form* Page 16

Child Information Form* Page 17-20

* Indicates forms that must be signed and returned prior to the start
of camp

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 Summer Day Camp 2014

General Information
Hours: 9:00AM 4:00PM

1446 Oak Springs Drive Columbia, TN 38401

www.maurywellness.org
Phone Number: 931-548-2420

Meals:
Campers must bring 1 lunch & drink
and 1 afternoon snack & drink
NO PEANUT PRODUCTS PLEASE

Questions, Comments or Concerns:

Camp Coordinator: David Favours
dfavours@maurywellness.org

Program Director: Lindsey Howell

lhowell@maurywellness.org

2014 Pricing:
$110/week non-member
$85/week - member

Payments due by Friday before participation.

$10 fee for late payments

*Daily rates available for abbreviated weeks see schedule for

more information*

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 CAMP GOALS
1. To provide a memorable, educational, enjoyable, and enriching
experience for youth.
2. To help our youth grow spiritually, mentally, physically, and socially.
3. To help our youth develop good character.
4. To help our youth gain an appreciation of nature.
5. To help our youth develop and refine leadership skills.

What to Wear to Camp

(Here is a list of appropriate clothing that will be allowed at camp.)

DAILY ATTIRE:
T-shirt, shorts or pants, and sneakers. We are a highly active camp
and suggest that campers should not be sent to camp in their best
clothing. No sandals or flip-flops! (Please pack these for pool time if desired)

Please note
The following clothing items will NOT be allowed at camp:
clothing with bad words, gestures, or sayings
clothing with tobacco, drug, or alcohol symbols or words
clothing that is too revealing (at discretion of camp staff)

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 What to Bring to Camp

Here is a list of things you must bring to camp EVERYDAY:

SACK LUNCH & SNACK

Please no peanut products or items that must Micro-waved. Bring
2 drinks and pack an ice pack to keep items chilled.

SWIM SUIT & TOWEL

These items should be brought every day. **please bring a swim
suit that fits well and water shoes if desired**

WATER BOTTLE
Please label with your childs name in permanent marker.

SUNSCREEN
Please label with your childs name in permanent marker.

**If a camper brings a peanut product to camp, the camp staff reserves the
right to call parents for a new lunch/snack or have this child eat in a separate
area from other campers.

*The WAC is NOT responsible for personal items brought to camp by your child
that are lost, stolen, or damaged. Please label all personal items in advance.

ELECTRONICS POLICY:
*There will be no electronic games and toys permitted at Day Camp. All cell
phones are to be kept in campers back packs during the day as well.

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 Camp Policies
Pick Up & Drop Off:
We want your children to be safe while they are at camp. This policy helps to
make sure your child is not picked up by someone who may harm them.

You MUST have the Camp Information Form returned by the first day your child
attends camp. You need to identify the name of each person that is allowed to
pick up your child, including yourself. WE CANNOT RELEASE YOUR CHILD TO
ANYONE THAT IS NOT ON THIS FORM. We will contact the parent/guardian for
permission if someone not on the list comes to pick up your child. We know that
emergencies happen so parents should send written notice (signed and dated
by the parent/guardian) when someone not on the pick-up list will be coming to
pick up their child.

When you get to camp, you will be required to sign in and sign out your child.
PLEASE NOTE THAT CHILDREN MAY NOT BE DROPPED OFF AT CAMP PRIOR TO
7:00AM AND MUST BE PICKED UP BY 6:00PM. A LATE FEE of $5 will be added for
every 10 minutes past 6:00pm.

Special Accommodations: Day Camp activities begin at 9:00 AM and conclude

at 4:00 PM. Any family who must drop off during this period of time is responsible
for making special accommodations with the camp coordinator in advance.
Please be aware that it is the parent/guardians responsibility to meet the group
for special drop-offs and pick-ups.

Sick Camper:
If your child is sick and has a fever or any other illness that may be contagious,
we ask that you keep your child at home until they are healthy again. This helps
to prevent illness from going to all the children and other staff in our camp. In
addition, if your child gets sick during camp, we will call you immediately to pick
them up. Again, this will allow us to protect all the children and staff from getting
sick. This includes, but is not limited to, fever, head lice, vomiting, etc.

Dispensing Medication:
Medications can be administered to children by our Camp Coordinator only. If
your child has a medication that they must take, you need to bring it to camp in
the ORIGINAL MARKED bottle in a zip lock bag with your childs name written on
the bag. We are not responsible for storing medication during the week please
pack any needed medication in your childs bag each day. You must also fill

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out the medication authorization form for medication to be dispensed. This form
is attached at the end of this packet.

Risk Management:
The Wellness and Aquatics Complex takes the business of children very seriously.
Nothing is more important to us than your child. In order to share that
responsibility with you, we have several policies, procedures, and expectations
that you must be aware of.

Members and guest members of the WAC are checked against the national
sex offender database before we can allow use of our facility.
Lifeguards are certified through Ellis & Associates, Inc. and have extensive
training to provide safety to our aquatics facility. In order to provide
adequate safety to all using the aquatics facility we ask that you and your
child refrain from talking to lifeguards while they are guarding their pool.
All children under the age of 13 must pass a swim test before being allowed
access to the pool without a life jacket. Children who pass the swim test will
be given a swim band and will be recorded as passed for the 2014
calendar year. Children who have passed must be wearing a swim band
before they can enter the pool without a life jacket.
Cell phones are not permitted at camp. Camp staff will ensure that all cell
phones are packed away while the child is at day camp.

Progressive Discipline Policy:

The WAC wants every child to succeed and enjoy their time at Camp.
Unfortunately, there are times when discipline is necessary and the following
discipline plan will be enforced. If your child requires special attention due to
behavior issues a behavior plan will need to be developed with our staff, your
child and a parent/guardian. If the plan developed cannot be maintained
another course of action will be discussed with the child and parent/guardian.

These are the Consequences for Inappropriate Behavior:

Consequence #1: Warning.
Consequence #2: Written warning & action plan
Consequence #3: After two written warnings, the child will be suspended for
one day.
Consequence #4: Upon returning to camp, after first suspension, if another
write up occurs, the child will be suspended for one week.
Consequence #5: Upon returning to camp, after second suspension, if
another write up occurs, child will be suspended for the rest of the program.

Please Note: All disciplinary issues are at the discretion of the Program Director
and Camp Coordinator.

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 WAC Summer Day Camp
Camp Payment Policy

All registration and camp payments are non-refundable. Camp payments must
be paid the Friday before participation. If a payment is received after Friday,
there will be a $10.00 late fee. Each parent must fill out a payment form with
their payment for camp. There will be no refunds or credits to accounts for days
your child does not attend camp which you were previously signed up for. This
policy helps us to make sure we are staffed appropriately. We ask that you stay
up to date on your payments.

Refunds or credits will not be provided for paid days that are not attended. All
returned checks will have a $20.00 NSF fee included in your outstanding billing. If
a parent has 2 or more returned checks, cash, money order or credit card will
be required.

Mailing payments is also acceptable. Please use the following address:

Wellness and Aquatics Complex

Day Camp
1446 Oak Springs Drive
Columbia, TN 38401

Checks should be made payable to Wellness and Aquatics Complex or

WAC. Financial Assistance is available upon request. If requesting financial
aid, you will be asked to complete a scholarship request form and will be
contacted within one business week with the approved scholarship amount.
--------------------------------------------------------------------------------------------

Please keep this copy for your records and submit signed
copy to the Camp Coordinator.

www.maurywellness.org 931-548-2420
 WAC Summer Day Camp
Camp Payment Policy

All registration and camp payments are non-refundable. Camp payments must
be paid the Friday before participation. If a payment is received after Friday,
there will be a $10.00 late fee. Each parent must fill out a payment Form with
their payment for camp. There will be no refunds or credits to accounts for days
your child does not attend camp which you were previously signed up for. This
policy helps us to make sure we are staffed appropriately. We ask that you stay
up to date on your payments.

Refunds or credits will not be provided for paid days that are not attended. All
returned checks will have a $20.00 NSF fee included in your outstanding billing. If
a parent has 2 or more returned checks, cash, money order or credit card will
be required.

Mailing payments is also acceptable. Please use the following address:

Wellness and Aquatics Complex

Day Camp
1446 Oak Springs Drive
Columbia, TN 38401

Checks should be made payable to Wellness and Aquatics Complex or

WAC. Financial Assistance is available upon request. If requesting financial
aid, you will be asked to complete a scholarship request form and will be
contacted within one business week with the approved scholarship amount.
--------------------------------------------------------------------------------------------

Childs Name: ________________________________

I understand and agree to follow the payment policy as outlined on this page. If
I fail to make payments or payment arrangements, I understand that my child
may not be allowed to participate in the program.

Parent/Guardian Signature ______________________________ Date ______________

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 WAC Summer Day Camp
Code of Conduct
This form contains two separate codes of conduct- one for the campers, and one for the
parents. The counselors have already agreed to make a commitment to working with your child
and to provide a fun summer experience for your child. It is important for you and your child to
make a commitment to following the code of conduct that is appropriate for you.
It is good for parents to know what is expected of their children, and for children to know what is
expected of them. This form will be kept on file at the WAC. Your child will NOT be able to
participate in the WAC Summer Day Camp without a completed form on file.

All of the codes of conduct are part of the application and authorization to participate in
Summer Day Camp. Failure to comply with the code of conduct may result in removal from the
program.

Parent/Guardian Code of Conduct:

-
being of all the children ahead of my own personal desires.
ty or ailment that may affect the
safety of my child, or the safety of others.

regard to gender, race, religion, culture, or ability.

assist the experience however I can by attending camp programs or
volunteering whenever possible.

se my child for competing fairly and trying hard.

refrain from their use while on camp property.

rking with their groups and will never
question, discuss, or confront camp staff in front of their groups. I will take time to speak with
camp staff at an agreed upon time and place.

Camper Code of Conduct:

any camper, counselor, or another person.

counselors.

clean.
n to my counselor by staying in and with my group at all times and following the
camp rules.

that I cannot solve, I will tell my counselor.

break this code, I will be subject to disciplinary action.

Please keep this copy for your records and submit signed
copy to the Camp Coordinator.

www.maurywellness.org 931-548-2420
 WAC Summer Day Camp
Code of Conduct
This form contains two separate codes of conduct- one for the campers, and one for the
parents. The counselors have already agreed to make a commitment to working with your child
and to provide a fun summer experience for your child. It is important for you and your child to
make a commitment to following the code of conduct that is appropriate for you.
It is good for parents to know what is expected of their children, and for children to know what is
expected of them. This form will be kept on file at the WAC. Your child will NOT be able to
participate in the WAC Summer Day Camp without a completed form on file.

All of the codes of conduct are part of the application and authorization to participate in
Summer Day Camp. Failure to comply with the code of conduct may result in removal from the
program.

Parent/Guardian Code of Conduct:

-
being of all the children ahead of my own personal desires.
coordinator of any physical disability or ailment that may affect the
safety of my child, or the safety of others.

regard to gender, race, religion, culture, or ability.

d assist the experience however I can by attending camp programs or
volunteering whenever possible.

rying hard.
a camp environment for my child that is free of tobacco, alcohol, and drugs and I will
refrain from their use while on camp property.
camp staff and their authority while working with their groups and will never
question, discuss, or confront camp staff in front of their groups. I will take time to speak with
camp staff at an agreed upon time and place.

Camper Code of Conduct:

on.

counselors.
and by keeping the campus
clean.
counselor by staying in and with my group at all times and following the
camp rules.

that I cannot solve, I will tell my counselor.

disciplinary action.

Childs Name: _________________________________________________________

Parents Signature: _________________________________________________Date:__________________

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 WAC Summer Day Camp
Sunscreen Permission Form

Soaking up the suns rays used to be considered healthy before we learned about the dangers
of ultraviolet rays. These invisible rays, known as ultraviolet-A (UVA) and ultraviolet-B (UVB) cause
suntan, sunburn, and skin damage. There is not safe UV light. Protecting young people from
the sun is especially important as most of our lifetime exposure comes before the age of 20.

WAC Day Camp participants spend a great deal of time in the outdoors and are exposed to the
suns rays for the majority of the day. Since it is our commitment to promote healthy journeys; we
have the following policies to this regard.

Parents or legal guardians will be responsible for applying the first layer of sunscreen
prior to morning drop-off.

All campers and staff will wear sunscreen with an SPF of at least 15 on all exposed skin
(including lips), daily, even on cloudy days.

Parents or legal guardians will be responsible for providing their children with enough
sunscreen (in a sealed container) to take with them for later day applications.

ONE CONTAINER PER CHILD. DUE TO ALLERGIES WE CANNOT GIVE ANYONE ELSE ANOTHER CHILD
OR STAFF MEMBERS SUNSCREEN.

Children will participate in outdoor play and swimming frequently throughout the camp
season. Parents are expected to provide sunscreen lotion for the protection of their children.
Camp staff will remind children to apply sunscreen at least twice during each day and will
provide assistance if needed. If your child requires sunscreen more often, please provide
written instructions on how often your child should apply their sunscreen. WAC staff will be
contentious of your child being exposed to the sun and the possibility of sunburn but cannot
be responsible for a child that attends camp without appropriate sunscreen.

Please note that these decisions are made to protect your child. Furthermore, our staff members
have been trained on this subject and understand their responsibilities in adhering to this policy.

I verify that I have read, understand, and, for the protection and well-being of my child(ren)
agree to comply with the WAC Day Camp Sunscreen Policy. I also understand that if at any time
I fail to comply with the policy, my child will not be allowed to participate in the said program.

Please keep this copy for your records and submit signed
copy to the Camp Coordinator.

www.maurywellness.org 931-548-2420
 WAC Summer Day Camp
Sunscreen Permission Form

Soaking up the suns rays used to be considered healthy before we learned about the dangers
of ultraviolet rays. These invisible rays, known as ultraviolet-A (UVA) and ultraviolet-B (UVB) cause
suntan, sunburn, and skin damage. There is not safe UV light. Protecting young people from
the sun is especially important as most of our lifetime exposure comes before the age of 20.

WAC Day Camp participants spend a great deal of time in the outdoors and are exposed to the
suns rays for the majority of the day. Since it is our commitment to promote healthy journeys; we
have the following policies to this regard.

Parents or legal guardians will be responsible for applying the first layer of sunscreen
prior to morning drop-off.

All campers and staff will wear sunscreen with an SPF of at least 15 on all exposed skin
(including lips), daily, even on cloudy days.

Parents or legal guardians will be responsible for providing their children with enough
sunscreen (in a sealed container) to take with them for later day applications.

ONE CONTAINER PER CHILD. DUE TO ALLERGIES WE CANNOT GIVE ANYONE ELSE ANOTHER CHILD
OR STAFF MEMBERS SUNSCREEN.

Children will participate in outdoor play and swimming frequently throughout the camp
season. Parents are expected to provide sunscreen lotion for the protection of their children.
Camp staff will remind children to apply sunscreen at least twice during each day and will
provide assistance if needed. If your child requires sunscreen more often, please provide
written instructions on how often your child should apply their sunscreen. WAC staff will be
contentious of your child being exposed to the sun and the possibility of sunburn but cannot
be responsible for a child that attends camp without appropriate sunscreen.

Please note that these decisions are made to protect your child. Furthermore, our staff members
have been trained on this subject and understand their responsibilities in adhering to this policy.

I verify that I have read, understand, and, for the protection and well-being of my child(ren)
agree to comply with the WAC Day Camp Sunscreen Policy. I also understand that if at any time
I fail to comply with the policy, my child will not be allowed to participate in the said program.

Parent or Guardian Signature _________________________________Date: __________

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 WAC Summer Day Camp
Release and Waiver of Liability

You have registered your child for the WAC Summer Day Camp Program that involves
physical activity and interaction with children and others. This document is a release of
claims, and by signing it you do the following:

1. Acknowledge that when performing any physical component at camp your child
may suffer injury.

2. Present to the camp staff that your child is in good health and physical condition,
sufficient to engage in such activities and that your child is not suffering from any
condition that would prevent him/her from engaging in such activities.

3. Understand the Day Camp staff will provide accurate protections to your child while
at Day Camp and assume the risk of, and release the Wellness & Aquatics Complex
and its associates harmless from any liability for physical or other injury that has been
suffered by your child during, or as a consequence of, participation in day camp
activities and you agree that the WAC nor any other person involved in organizing or
teaching shall have any liability or responsibility for any injury or harm.

4. I authorize the WAC to photograph or video both myself and my child and
understand that all photos and video footage are property of the WAC and may be
used for publicity purposes.

5. I give the WAC and its staff permission to post my childs allergies in an area for camp
staff awareness only.

6. Acknowledge that I have received and understand the 2014 Parent Handbook for
the WAC Summer Day Camp.

Please keep this copy for your records and submit signed
copy to the Camp Coordinator.

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 WAC Summer Day Camp
Release and Waiver of Liability

You have registered your child for the WAC Summer Day Camp Program that involves
physical activity and interaction with children and others. This document is a release of
claims, and by signing it you do the following:

1. Acknowledge that when performing any physical component at camp your child
may suffer injury.

2. Present to the camp staff that your child is in good health and physical condition,
sufficient to engage in such activities and that your child is not suffering from any
condition that would prevent him/her from engaging in such activities.

3. Understand the Day Camp staff will provide accurate protections to your child while
at Day Camp and assume the risk of, and release the Wellness & Aquatics Complex
and its associates harmless from any liability for physical or other injury that has been
suffered by your child during, or as a consequence of, participation in day camp
activities and you agree that the WAC nor any other person involved in organizing or
teaching shall have any liability or responsibility for any injury or harm.

4. I authorize the WAC to photograph or video both myself and my child and
understand that all photos and video footage are property of the WAC and may be
used for publicity purposes.

5. I give the WAC and its staff permission to post my childs allergies in an area for camp
staff awareness only.

6. Acknowledge that I have received and understand the 2014 Parent Handbook for
the WAC Summer Day Camp.

Childs Name: _______________________________________

Parents Signature: ___________________________________

Date: ______________________

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 WAC Summer Day Camp
Medication Authorization Form

Campers Name _______________________________________________________________________

Session Dates _______________________________________________

Parents/Guardians Please Note:

Complete non-shaded areas for each medication for your child. (One form per child) All
prescription and non-prescription medications need to be in their original containers. All
prescription medication must be prescribed for the camper. NO exceptions!!

List each medication in a new box. List exact dosage (i.e., milligrams or teaspoons). Mark the
time of day the medication should be taken. List any special comments in comment box. A form
should be completed for each week of camp to provide accurate care for your child.

Rescue inhalers and Epi-Pens stay with the camper or with the campers counselor, depending
on your preference. However, they do need to be recorded on this form.

I hereby give permission for Camp Staff to administer the following medications according to the
directions on the label.

Parent/Guardian signature__________________________________________ Date_________________

Medication Dose Time Mon Tue Wed Thurs Fri Comments

10 mg. STAFF USE ONLY Must take before

EXAMPLE Claritin Lunch eating lunch.
(1 pill) DO NOT WRITE IN GRAY AREAS

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Please complete this form and
submit to the camp coordinator.

2014 Summer Day Camp

Child Information Form

Participant Name: __________________________________________________________________

Age: ___________ Date of Birth: ________________ Gender: Male / Female

Home address: ____________________________________________ City/ZIP: ____________________

Contact 1 Custodial Parent/Guardian

Name________________________________________________ Relationship_____________________

Home Phone_________________________ Cell Phone______________________ Prefer: __ Home __ Cell

Home Address____________________________________________________________________________

Place of Business_________________________________ Address__________________________________

Business Phone___________________________________ Other___________________________________

Contact 2 Second Parent/Guardian or Emergency Contact

Name___________________________________________________ Relationship_____________________

Home Phone_________________________ Cell Phone______________________ Prefer: __ Home __ Cell

Home Address____________________________________________________________________________

Place of Business_________________________________ Address__________________________________

Business Phone___________________________________ Other___________________________________

Contact 3If not available in an emergency, notify

Name___________________________________________________Relationship___________________

Home Phone_________________________ Cell Phone______________________ Prefer: __ Home __ Cell

Home Address____________________________________________________________________________

Place of Business_________________________________ Address__________________________________

Business Phone___________________________________ Other___________________________________

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Authorized list of individuals to drop-off and pick-up _______________________________.
(participant name)

Name Relationship Phone number

1.
2.
3.
4.
5.

RESTRICTIONS AND ALLERGIES

Restrictions:

Explain any restrictions including dietary restrictions and activities from which the participant
should be exempted.
___________________________________________________________________________

________________________________________________________________________________________

Allergies:

Allergies List all known. Describe reaction and management of the reaction.
Medication allergies (list)

________________________ ____________________________________________________________

________________________ ____________________________________________________________

Food Allergies (list)

________________________ ____________________________________________________________

________________________ ____________________________________________________________

Other allergies (list) - include insect stings/bites e.g. bees, wasps, spiders, and other allergies like
hay fever, asthma, etc.

________________________ ____________________________________________________________

________________________ ____________________________________________________________

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 Medications Being Taken
Please list ALL medications (including over-the-counter or nonprescription drugs) taken routinely.
This includes all medications that the participant is taking regardless of whether or not they will
take medication at camp. An additional Medication Permission Form must be completed prior
to attending camp for all medication that will be administered at camp. This will allow our staff
to accurately address any concerns that may arise as a result from medication taken on a
regular basis.

__This person takes NO medications on a routine basis

__This person takes medications as follows:

Med #1 _____________________________ Dosage___________

Reason for taking___________________________________

Med #2 _____________________________ Dosage___________

Reason for taking___________________________________

Please list any medications taken during the school year that participant does/may not take
during the summer:
_____________________________________________________________________________________________
_____________________________________________________________________________________________
Attach additional pages for more medications.

Please use this space to provide any additional information about the participants
behavior and physical, emotional, or mental health about which the camp should be
aware. Also list any significant life events that continue to affect the participant (death
of a loved one, family change, adoption, new sibling, abuse, other.)
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________

Physician/Dentist Information:
Name of physician or primary doctor(s)_______________________________________________
Phone________________________________

Name of dentist(s)________________________________________________________________
Phone________________________________

Name of orthodontist(s)____________________________________________________________
Phone________________________________

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 General Questions (Explain yes answers below.) Please Circle One:
Has/does the participant:

1. Had a recent injury, illness or infectious disease? YES NO

2. Have a chronic or recurring illness/condition? YES NO
3. Ever been hospitalized? If yes, list when. YES NO
4. Ever had surgery? If yes, list when. YES NO
5. Have frequent headaches? YES NO
6. Ever had a head injury/been knocked unconscious? YES NO
7. Wear glasses, contacts or protective eye wear? YES NO
8. Ever had frequent ear infections? YES NO
9. Have tubes in ears now? YES NO
10. Need to wear ear plugs while swimming at camp? YES NO
11. Ever passed out/been dizzy during or after exercise? YES NO
12. Ever had seizures? YES NO
13. Ever had chest pain during or after exercise? YES NO
14. Ever had high blood pressure? YES NO
15. Ever been diagnosed with a heart murmur? YES NO
16. Ever had back problems? YES NO
17. Ever had problems with joints (e.g. Knees, ankles)? YES NO
18. Have an orthodontic appliance being brought to camp? YES NO
19. Have any skin problems? YES NO
20. Have diabetes? YES NO
21. Have asthma? YES NO
22. Had mono (mononucleosis) in the past 12 months? YES NO
23. Had problems with diarrhea/constipation? YES NO
24. If female, have an abnormal menstrual history? YES NO
25. Ever been treated for attention deficit disorder (ADD) or attention

deficit/hyperactivity disorder (AD/HD)? YES NO

28. Ever been treated for emotional or behavioral difficulties

or an eating disorder? YES NO

Please explain any yes answers, noting the number of the questions.

__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________

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