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TEEN ADVENTURE CAMP 2019 (Ages 12-15yrs) LAKES ELEMENTARY, 6211 MULLEN RD SE, LACEY MONDAY-FRIDAY, 7:30am-5:30pm NEW THIS YEAR! Online & phone registration (w/ full payment) available for Teen Camp! OR email/fax registration form, then call with 2 weeks payment (VISA/MC.) Registration confirmation receipt will be emailed. [email protected] Fax: 360.438.2669 Phone: 360.491.0857 Participant Name______________________ _______ Gender Date of Birth Address________________________________________________ City_______________________________ Zip Code ____________ GUARDIAN #1_____________________________ GUARDIAN #2_____________________________ RELATIONSHIP RELATIONSHIP Name ____________________________________ Name ____________________________________ Work Phone _______________________________ Work Phone _______________________________ Home/Cell Phone____________________________ Home/Cell Phone____________________________ Email ____________________________________ Email ____________________________________ TEENS WILL NEED A SACK LUNCH, SNACKS, WATER BOTTLE & BACKPACK EVERYDAY Dates Theme Fee Paid June 24-28 Adventureland $189 FOR July 1-5 * Sports Extravaganza $150 (*no camp July 4) OFFICE July 8-12 Wild Adventure Week $189 July 15-19 Around the Sound $189 USE July 22-26 Gettin’ Dirty $189 July 29-August 2 Treasure Hunting $189 ONLY August 5-9 Safari Party $189 August 12-16 Fun Under the Sun $189 Please If not pd in full, additional weeks payment due by 5pm the Monday prior to the week your child(ren) are attending, initial or you will be charged a $10 late fee and possibly withdrawn from camp to accommodate the waitlist. → PLEASE COMPLETE REVERSE SIDE → Lacey Parks & Recreation 420 College Street SE • Lacey, WA 98503 Teen’s Name (Please print ) 360.491.0857 • [email protected] Parent/Guardian Name (Please print ) *COMPLETED WAIVER MUST BE RETURNED PRIOR TO CAMP TO COMPLETE YOUR TEEN’S REGISTRATION* PERMISSION TO RELEASE/EMERGENCY CONTACTS Other than the adults on your household account, please list Emergency Contacts/Permission to Release of those you authorize to pick up your child from Lacey Parks & Recreation Day Camp. You will always be the first person we attempt to contact. Name _____________________Relationship________________________Phone_______________________ Name _____________________Relationship________________________Phone_______________________ Name _____________________Relationship________________________Phone_______________________ CAMPER’S HEALTH and BEHAVIORAL HISTORY Allergies (food, plant, insect, medication, etc): Please list any medications your child is taking: Please describe any information/behaviors staff should be aware of and explain management of behavior: TEEN CODE OF CONDUCT Must be read & signed by both parent and teen My signature indicates I understand and agree to follow the guidelines, as well as those stated by program staff. I understand that failure to follow the guidelines may result in disciplinary action including expulsion from the program. •I will remain in the building, the area and/or on the trip activity site. •I will demonstrate respect and courtesy to others. •I will refrain from using alcohol tobacco, illegal drugs and other sensory impairment substances. •I will refrain from using foul language. •I will obey all traffic laws, including wearing a seatbelt during transportation. •I will refrain from instigating and/or participating in physical or verbal altercations. •I will listen to staff and follow directions and rules. ______________________________________ __________________________________ Teen Signature Date PARENT/GUARDIAN - PLEASE READ and SIGN BELOW •I have read the Teen Code of Conduct with my Teen. •I DO__ DO NOT__ give permission for non-prescription medication (non-aspirin product, Neosporin) to be given to my child. •I DO__ DO NOT__ in case of emergency only, give permission to the physician selected by the camp staff personnel to hospitalize, secure treatment for, and order injections, anesthesia, or surgery for my child named on this form. Any directions to the contrary should be specified on this form with signature of parent/guardian. •I DO__ DO NOT__ grant the City of Lacey permission to use and publish my child’s name or otherwise identify my child in association with any photo in which my child appears for editorial, marketing and promotional purposes in print and electronic media. No financial or other liability to me will be incurred by the city or the photographer. •I fully realize that there are certain inherent risks to which my minor child(ren) will be exposed because of the nature of this activity. Fully understanding those risks, I hereby release the City of Lacey, its officers and employees, from any damages that may be suffered through participation in any activity related to the Lacey Parks and Recreation Day Camp. Parent/Guardian (signature) ___________________________________ Date____________________ *PLEASE KEEP THIS PAGE FOR YOUR REFERENCE* TEEN ADVENTURE CAMP 2019 LAKES ELEMENTARY, 6211 MULLEN RD SE, LACEY MONDAY-FRIDAY, 7:30am-5:30pm Teens need to bring a sack lunch, snacks, water bottle, swimsuit & backpack each day to camp. Spending money is optional. Dress for the weather/activity and HAVE A GREAT TIME! ***ALL TEEN CAMP ACTIVITIES SUBJECT TO CHANGE*** WEEK 1 Adventureland June 24 - 28 Monday: Welcome to Teen Camp, Games and Olympic Club Tuesday: Tukwila Fun Center Wednesday: Wild Waves (SWIM) Thursday: Nisqually Wildlife Refuge and Bowling Friday: BBQ and Swimming at Long Lake (SWIM) WEEK 2 Sports Extravaganza July 1 – 5* Monday: Stewart Heights Aquatic Center (SWIM) Tuesday: Hike at Lake Sylvia State Park & Swimming (SWIM) Wednesday: Seattle Storm Basketball Game Thursday: NO CAMP 4th of July* Friday: Olympia Farmers Market, Pizza, and Swimming at Black Lake (SWIM) WEEK 3 Wild Adventure Week July 8 - 12 Monday: Laser Quest with Olympia and Tumwater and Swimming at Steel Lake Tuesday: Slurpee Challenge and Kandle Water Park (SWIM) Wednesday: Explore Port Townsend and Fort Worden State Park Thursday: BoomShaka and Hike to the Beach at Burfoot Park (release form) Friday: Paddle Boarding, Swimming and BBQ and Millersylvania State Park (SWIM) WEEK 4 Around the Sound _ July 15 - 19 Monday: Explore Ocean Shores and Hike at Damon Point Tuesday: Wild Waves (SWIM) Wednesday: Wheel Fun Surrey Rentals at Point Ruston and Stewart Heights (SWIM) Thursday: Capital Lake Fair and Explore Downtown Olympia Friday: Team Bump Challenge, Swimming, and Pizza at Lake Cushman (SWIM) WEEK 5 Gettin’ Dirty July 22 -26 Monday: Sprinker Ice Skating and Spanaway Park Tuesday: Point Defiance Zoo and Explore Titlow Park Wednesday: Hiking and Swimming at Twanoh State Park (SWIM) Thursday: Ferry Ride to Seattle Waterfront and Pikes Place Market Friday: Olympia Farmers Market, Swimming and BBQ at Long Lake (SWIM) WEEK 6 Treasure Hunting July 29 – August 2 Monday: Northwest Trek Tuesday: See Snoqualmie Falls and Hike Twin Falls Trail Wednesday: Thurston County Fair and Swimming at Long Lake (SWIM) (Bring a can of food for the food bank drive!) Thursday: Movie at Olympic Club and Roller Dome Friday: Hike Tumwater Falls, Swimming and BBQ at Black Lake (SWIM) WEEK 7 Safari Party August 5 – 9 Monday: Rainiers Baseball Game (Hotdog & Drink included) Tuesday: Regal Cinema and Hike Evergreen Beach Trails Wednesday: Dash Point State Park and Laser Quest Thursday: Shaw Aquatic Center (SWIM) Friday: Ultimate Frisbee, Swimming and BBQ at Black Lake (SWIM) WEEK 8 Fun Under the Sun August 12 - 16 Monday: Staircase Rapids Hike near Lake Cushman Tuesday: Cirque Rock Climbing and Skateland with Tumwater and Olympia (release form) Wednesday: Wild Waves with Tumwater (SWIM) Thursday: Auburn Rock Climbing (SWIM) Friday: Last Day Celebrations with Games, BBQ and Swimming at Long Lake (SWIM) **Highlighted blue are days when campers should bring swimming gear** *Activities with ‘release form’ = completed forms are required to participate* ***ALL TEEN CAMP ACTIVITIES SUBJECT TO CHANGE*** After your initial registration & 2 weeks payment, weekly camp fees are due by 5pm the Monday prior to the week your child is attending camp. Payments for subsequent weeks may be made online, by phone (Visa/MC), or in person at Lacey City Hall. If payment is not received by due date, there will be a $10.00 late fee and possible withdrawal from the camp to accommodate our waitlists. PAYMENT DUE BY 5:00PM DATE PAID WEEK DATE OF CAMP $10 LATE FEE ADDED AFTER 5PM My Records 1 June 24-28 at time of registration 2* July 1-5 (no camp July 4) at time of registration 3 July 8-12 July 1 4 July 15-19 July 8 5 July 22-26 July 15 6 July 29-August 2 July 22 7 August 5-9 July 29 8 August 12-16 August 5 Lacey Parks & Recreation Department Notice Received Refund 420 College St SE Lacey, WA 98503 REFUND POLICYby 5:00pm Thursday prior to camp 100% 360.491.0857/fax 360.438.2669 1st Camp day 50% [email protected] 2nd Camp day 0% TaxID 910819427 No refunds for camp violations/dismissal OTHER SUMMER TEEN ACTIVITIES: www.ci.lacey.wa.us for more information/registration CAMP CASCADIA – Camping Adventure at Camp Cascade Resort July 16-19 SILVERWOOD THEME PARK, Athol, ID - Camping & 2-day Theme Park August 5-8 .
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