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Oak Canyon Nature Center STATEMENT OF HEALTH AND CONSENT If at any time, this form needs to be updated or altered, please contact program staff immediately. This form valid for 2015 camp session only. Child’s Date of Home Cell Phone: Cell Phone: Mother or Legal Father or Legal Guardian: Email A. PARTICIPANT MEDICATION The Program Director must be notified if medication is brought to the program. Medicine must be given to the Program Director in an original container containing only a single dose. Participants must be able to administer the medication themselves. Will the participant be bringing medication to the program? Circle one YES NO If yes, what medication and in what dose? B. ALLERGIES Please list any known C. MEDICAL RELEASE Please read and initial either Section #1 or Section #2 SECTION #1 I hereby designate Anaheim Community Services Department, their employees, representatives, agents, servants or volunteers with full authority to authorize medical, health services and care for said minor. SECTION #2 I do not consent to medical treatment. D. AUTHORIZED PICK UP Please list individuals who are allowed to pick your child from this program other than the parent or legal guardian listed above: The Anaheim Community Services and its staff are committed to providing high quality programs that are safe and that will maximize the enjoyment one receives from participation. Recreation activities, by their very nature, may present circumstances that place the person(s) in or at the activity at some risk of injury. The potential of injury varies significantly depending on the type of activity and intensity of involvement. Any person wishing information on the potential of injury in any activity is encouraged to make contact with us at (714) 998- 8380. I HEREBY AGREE TO INDEMNIFY AND HOLD HARMLESS THE CITY OF ANAHEIM, its Boards and Commissions, officers, agents, or employees from any liability or claim or action for damages resulting from or in any way arising out of the participation in any City of Anaheim recreation program(s). I further understand and agree: to assume all risks inherent in the activities which are available and in which I may voluntarily participate, and understand that these activities involve risk to my person and property and to assume the risks, if any, arising from the conditions and use of equipment and facilities. I further understand that there may be risks and dangers not reasonably foreseeable at this time. In the event of injury or illness while the participant is attending City of Anaheim recreation activities, I herby authorize the City of Anaheim to consent to medical treatment on behalf of my child as deemed necessary. The City of Anaheim Community Services Department may take and use photos of participants for publicity purposes. I hereby grant the City of Anaheim permission to publish any images taken by the City showing my child’s/children’s participation. IF THE PARTICIPANT IS A MINOR, his or her custodial parent or legal guardian must read and execute this agreement. I hereby warrant that I am the custodial parent or legal guardian of who is a minor, and has my permission to voluntarily (PRINT PARTICIPANT’S FULL NAME) participate in City of Anaheim recreation activities I CERTIFY THAT I HAVE READ AND UNDERSTAND THIS WAIVER AND RELEASE AS IT APPLIES TO MYSELF AND TO ANY MINORS FOR WHOM I AM SIGNING. (Parent or guardian must sign for participants under 18 years of age) Child’s Name (Last, Initial only ONE section! ---PAGE BREAK--- O.A.K.S. Day Camp Policies and Information GROUP CHANGES AND REQUESTS: Requests for participants to be in the same group should be done in advance by contacting our office at (714) 998-8380 prior to the start of the camp week. PRESENTATION BEADS: WHITE – HEART A white bead will be awarded for helping one’s friends at Oak Canyon Nature Center. YELLOW – LEADER A yellow bead may be earned for helping the Group Leaders. GREEN – EARTH The green bead is presented to those who show their concern for the earth by helping to pick up trash and by taking only what they can use completely from nature. ORANGE – EAR The orange bead awards the person who shows their respect for others by listening to what they are saying. DARK BLUE - VISION/IMAGINATION The dark blue bead rewards those who put forth a special effort on an art project. RED – ACHIEVEMENT The red bead is for good sportsmanship in games. BROWN – COURTESY The brown bead may be given to those demonstrating good manners. LIGHT BLUE – APPRECIATION The light blue bead awards the person who demonstrates an understanding, or wisdom about nature. BLACK - EVERYONE'S RELATIVE The black bead is given to campers who pay attention and show interest in the traditions stations. PURPLE - LUNCH TIME This bead is rewarded for those who show a good behavior during lunch time. ATTENDANCE : “breast plate” style bone beads SPECIAL SECTION BEADS: GAMES – Beads found during Scavenger Hunt TRADITIONS – Bear Claw Bead ART – Indian Trading Bead NATURE – Theme Bead FOOD: Children should bring a sack lunch each day. Ice water and a mid-morning snack are available on a daily basis. Please read the enclosed information sheet “Helpful Hints for Eating Out-of Doors” on food to be brought for lunches. We coexist with a "social wasp," the yellow jacket, a small bee-type insect attracted to sweets and meat. We greatly appreciate your cooperation! CLOTHING: Children receive a Day Camp T-shirt on Monday, and are encouraged to wear it each day to camp. Children should wear clothing reflective of the weather. Children must wear closed-toe shoes and socks; sandals are not appropriate for the Oak Canyon setting. TRANSPORTATION: Participants should arrange their own transportation, car-pooling whenever possible. Parent or authorized supervising adult must sign-in and sign-out each camper. Children should not be dropped off earlier than 8:50 a.m. nor picked up later than 1:10 p.m., as day camp staff are not available for supervision. Children will not be released between 12:30pm and 1:00pm without prior approval from the Camp Director. STATEMENT OF HEALTH AND CONSENT: The Statement of Health and Consent form must be completed, signed by the parent/guardian, and on file at the Nature Center before the child can attend the camp session. No child will be allowed to remain at camp without this form on file. MEDICATION Children may not keep ANY medication with them or in lunch pails during camp. All medication must be turned into the Camp Director at the beginning of the session. Medications taken on a regular schedule will be kept in the office, while medications for emergency situations will be kept with the child’s leader. Medications must be given to the camp in a single dose and the child must be able to administer their own medication, except in the case of an emergency. Parents whose children carry Epi-pens will be required to train staff in their use on the first day of the session. An additional form may be required for children who bring medication to camp. PARTICIPANT CONDUCT: We want each child to enjoy the maximum amount of fun and learning. We recognize that children need clearly defined limits set in a non-threatening yet firm manner. We encourage children to exhibit self-control and apply supervision principles that build individual esteem. Children are provided close supervision, gentle guidance, and redirection. When all else fails, we will have the child think about the situation in a “Reflection Time.” This time includes a discussion with the Camp Director regarding making better choices. If the child’s behavior is not positively modified, then the parent will be contacted. We reserve the right to dismiss children who are disruptive, disinterested, or destructive to the educational experience of other children. REFUNDS AND SESSION TRANSFERS Refund requests will be granted only if received in writing before the first day of the camp session. A $5.00 fee applies. Transfer requests will be granted only if space permits. Transfer requests must be received in writing and are subject to a $5.00 transfer fee. ---PAGE BREAK--- MOST NON-SWEET FOODS ARE ACCEPTABLE: Vegetable sticks Beef jerky Cheese (String Cheese) Apples Crackers/Bread Sticks Potato and other chips Dried fruits Grapes Sunflower Butter (No Peanut Butter) STICKY-SWEET AND MEAT FOODS THAT SHOULD BE AVOIDED: Soft Drinks Fruit Punch Peanut Butter & Nuts due to allergies Candy Jellies/Jam Pudding Cups Fruit Cups Fruit Pies Ham and other flavored meats LUNCH SUGGESTIONS: Veggie Sticks: Bag and chill a variety of veggies: carrots, zucchini, celery, jicama. Trail Mix: Bag a variety of dried fruits, cereals, pretzels... Beverages: Water. **Lunches are not refrigerated, so please avoid packing perishable items Oak Canyon Nature Center Helpful Hints for Eating Out-of-Doors When eating a snack or lunch in the great outdoors, nature is always close at hand. You will enjoy a pleasant experience if you remember that we are guests visiting natural parkland. Yellow jacket wasps are a part of the natural environment at Oak Canyon Nature Center. The following suggestions are provided to discourage bothersome insects and potential insect stings. Learning waste-free ways to pack your lunch will also help lessen the impact of the outing on the Nature Center and the earth’s natural resources. Please avoid pre-packaged lunches as packaging is non-recyclable and the open containers attract wasps. Reusable lunch boxes or fabric bags that can be opened and then re-closed are highly recommended. Packing favorite treats in reusable single serving containers, which can also be re-closed, reduces the invitation to hungry wasps. Water bottles and refillable drink containers with small or straw openings are highly recommended. Take leftover foods home. Food that is thrown away at the Nature Center becomes a temptation for animals that really need to eat their natural diet! Program participants should be reminded to bring their lunch supplies home. By taking their containers back home to wash and reuse, participants will begin to realize how we are each responsible for the things we use and that these things aren’t “finished” just because we are through using them for the moment. Reduce, Reuse, and Recycle. COMMUNITY SERVICES