August 5 - 9, 2013 | Chinook Program Center, Waukesha

Chinook Program Center Offers:• Volunteer-led day camp for

grades K-12• Trained & experienced directors• Beautiful natural setting• Scenic nature trails• Fun and enriching experiences

O u t d o o r C o o k i n g • A r t s • C r a f t s • g a m e s • O u t d o o r S k i l l s • Te a m B u i l d i n g

C ampfires • Archery Range • nature Study • Spor ts Field • Woodworking Shop

Indian Springs Day Camp

Indian Springs Day CampAugust 5 - 9, 2013 | 9:30 a.m. - 5:30 p.m. | Chinook Program Center

Journey through your imagination and explore your creativity. Indian Springs Day Camp is a progression camp where every year is different as you discover new skills in various activities— lacing, woodworking, cooking, crafts, outdoor skills, and more. Our awesome camp team inspires campers and adult volunteers to come alive with fun. With snow cones, water play, archery, songs, games, and s’mores, every day is guaranteed to be a new adventure. new this year: program stations for girls to earn a badge and work towards a journey.

We start our day in our units. Most units are made up of 15 campers in the same grade. We will keep troops together. Every day’s schedule is different. Units cook four of the

five days over a campfire or with a propane stove. Some units will combine for activities where campers can discover new friends, or reconnect with old ones. Your CIT or Unit Leader will lead your group to the various activities. You’ll also have time to go to a program station and earn a badge or work towards a journey. Don’t forget to visit the games area where you can hide under the parachute or have a friendly game of volleyball.

There is so much to do during the day, but by the end of the week, you will come away with many skills. You don’t have to be an experienced camper to enjoy day camp. Camp is for everyone.

volunteer Director: Jean “Li lo” Mil ler mil lerent@tds.net 262-544-5882

Camp Sneak-A-Peek Saturday, March 9 2:00 - 4:00 p.m.Chinook Program Center

Daisy and Brownie Families and TroopsGet a sneak peek at all the fun you’ll have at day camp this summer. Girls will enjoy games, songs, crafts, and a camp snack, while parents and troop leaders have a chance to meet the camp director, see camp, and have questions answered.

• Fee: $5 per girl; adults and children are free

• Bring your camp registration or proof of registration to the event and receive a free water bottle.

• Register at www.gswise.org and click on Events and Camps. Click on Volunteer-Led Day Camp and then Camp Sneak Peek.

A Typical Day at Camp9:30 a.m. Campers arrive and

opening flag ceremony9:45 a.m. Water games, art, nature,

skill building, team building and fun

11:30 a.m. Lunch1:30 p.m. More water games, art,

nature, skill building, team building and fun

5:15 p.m. Songs, closing flag ceremony

5:30 p.m. Campers depart

Be a Superhero! Te e n Le a d e r s h i p O p p o r t u n i t i e s Close to 1,000 teen Girl Scouts spend part of their summer leading activities at day camp, becoming real-life superheroes to younger Girl Scouts.

90% of teens agreed that “at Girl Scout camp, my experiences have helped prepare me to be a better leader.”

Program Aide-in-Training (PAiT)E n t e r i n g G r a d e 7 Build your leadership skills as you learn how to be an effective Program Aide. In addition to participating in camp activities with other PAITs, you get the chance to show your leadership skills as you help and lead younger campers. PAITs pay the camper fee.

Program Aide (PA) E n t e r i n g G r a d e s 8 - 9 As a Program Aide, you will continue to mentor younger campers and help adults with activities and/or in a unit with campers. PA training and camp training are required. Check the website for PA training dates and your day camp’s web page for camp training dates. There is no fee to be a PA. PAs pay the overnight fee, if applicable.

Counselor-in-Training i and ii (CiT i and ii) E n t e r i n g G r a d e 1 0 - G r a d u a t i n g S e n i o r s Be a CIT…your next leadership step. CITs lead activities or lead a unit with an adult mentor. CIT training and camp training are required. Check the website for CIT training dates and your day camp’s web page for camp training dates. There is no fee to be a CIT. CITs pay the overnight fee, if applicable.

Camp: Where Imagination Comes Alive

volunteer Opportunities Camp cannot happen without adults like you. We need you, a family member, friend, or even a neighbor to volunteer even if it is only for a day or two. If you cannot volunteer during the week of camp, please offer to help with pre-camp preparations or camp set-up or take-down. In most troops, parents share the adult volunteer responsibilities.

Our volunteers tell us that their favorite part about being at camp is spending time with their camper, getting to know her friends, and seeing her build new skills and have fun.

Adults needed • Each day one adult is needed for every five girls.• Specific Roles: Five-day Volunteers, Unit Volunteers, Peewee Unit Volunteers, Boys Unit

Volunteers, Bus Captains, Overnight Chaperones, Activity Station Volunteers (crafts, outdoor skills, games, nature, kitchen), Camp take-down (Friday)

For more information on day camp go to

www.girlscoutdaycamp.com 800-565-4475

Fees • Camper (entering grades 1–7): Fee includes day

camp t-shirt, patch, busing, and some meals/snacks.

- $100 per camper on or before June 2 - $125 per camper June 3 - July 10 - Registration after June 2 may be accepted

if there is adequate adult coverage - Registration closes July 10.• PA/CIT (entering grades 8-12): No fee, includes

day camp patch, busing, and some meals/snacks.

- Girls pay overnight fee, if applicable. Register by June 2.

• Overnights $15/night - Girls entering grades 5-6: Wednesday - Girls entering grade 7 (PAIT):

Tuesday and Wednesday - Girls entering grades 8-12 (PA/CIT):

Sunday, Tuesday, Wednesday. • Peewees (ages 3-5) and boys (ages 6-12):

$15 per day, only on days the parent is volunteering

Financial Assistance Financial Assistance is available for registered members of Girl Scouts of Wisconsin Southeast to help families meet the cost of sending their girl to camp and events. Financial Assistance is funded by gifts to Girl Scouting and proceeds from the Girl Scout Cookie Program Activity. One resident camp, one day camp, and one event will be considered for Financial Assistance per girl. A Financial Assistance Form can be found on our website www.gswise.org and click on Forms. If registering online, mail completed form to the address listed within one week or mail with paper registration and $25 nonrefundable deposit.

Bus Transportation We reserve the right to cancel or change a bus stop if there are not enough bus riders. You will be notified at least two weeks prior to camp if a bus stop you registered for is canceled.Bus Stops• St. Mary’s Church/School, Hillcrest Elementary,

Prairie Elementary

girls with Additional needs Let us know of any concerns you may have. Our goal is to provide a positive camp experience for all girls. Providing us with information about medications, special diets, and nighttime routines along with physical and mental limitations, will help us provide a positive camp experience for your girl. For specific questions or situations, please email or call the volunteer day camp director.

Registration will automatically open Monday, February 4, at 11:00 p.m. Online registrations are processed first and then paper registrations.• Program Activity Credits (PAC)

earned through the Girl Scout Cookie Program Activity or Fall Nut Sale can reduce the cost for the girl who earned the PAC to attend

camp or an event. Write the camp/event name on the PAC and mail in if registering online or attach to paper registration form.

• Girls registering with an adult volunteer will guarantee registration.

• Registration may close early if girl registrations begin to exceed adult volunteer coverage.

Online• Go to www.gswise.org and click

on Events and Camp. Click on Volunteer-Led Day Camp and then How to Register.

• Create one account per family so that camper’s parent/guardian receives confirmation information.

• Pay full payment with a credit/debit card (Visa or MasterCard) or checking account.

• Adults volunteering complete the Adult Day Camp Registration and online application and background check. Adults volunteering at day camp are also asked to become a registered member of the organization.

• Complete any peewee/boy registrations.• Mail or bring used PACs to any council resource center.

Write the name of your day camp on the PAC.

Confirmations Confirmations will be sent by your volunteer day camp director two weeks prior to your camp session. Packing list, information about specialty or theme days, and more are listed on your day camp’s web page.Confirmations include:• Pick-up cards and procedures• Unit assignment and bus stop information (if taking the bus)• Address and directions to camp

All girls Welcome All girls are welcome to attend day camp. If your girl is not a registered Girl Scout, include an additional $12 for membership dues with payment.

Paper • Complete the Registration and Health History forms, pp. 5-6 or download forms.• Pay full payment with a credit/debit card (Visa or MasterCard) or checking

account.• Adults volunteering complete the Adult Day Camp Registration and online

application and background check. Adults volunteering at day camp are also asked to become a registered member of the organization.

• Mail in or bring registration form and used PACs to any council resource center. Write the name of your day camp on the PAC.

Refunds/Cancelations • Refunds, minus $25 nonrefundable processing fee, are available for

cancelations received six weeks prior to the session start date. Within six weeks, refunds, minus $25, will only be issued for medical reasons, summer school, a death or critical illness in the immediate family, or if the family moves out of the area.

• Cancelations must be made in writing.

How to Register

SecureYour Spot at Camp and Register OnlineToday!

Girl Scouts of Wisconsin Southeast

Register only one person per form. See camp information for specifics. Visit www.gswise.org for additional forms. Please check every category

I have read the camp information and agree that my camper and I will abide by the regulations and procedures stated therein, including those on refund, nonrefundable deposit, and health of camper. I understand that I am responsible for getting my camper to and from this camp or bus stop. I give my camper permission to ride the bus, if applicable. I give my camper permission to attend and participate in all phases of this session (except those noted on the Health History form), including off-site trips, if applicable. I give permission for photographs/video of my camper to be taken for GSUSA, GSWISE, and American Camp Association publicity and marketing purposes. If my camper is not already a registered Girl Scout, I give my permission for them to register as a member of the Girl Scouts of the USA.

Parent/guardian signature: __________________________________________ Date: _________________

Enclose full amount which already includes the $25 nonrefund-able deposit or enclose a minimum of $25 if applying for financial assistance. Outstanding balances, including gift certificates and Program Activity Credits are due May 13. If you register online or pay by credit/debit card, outstanding balances will be automatically charged no later than May 16. Pay in full if registration is received after May 13. Any additional fees or outstanding balances will be automatically charged 7-10 days prior to camp. For all credit/debit card or check/e-check transactions, bank/credit card statements will show payments processed by Active Network.

Check enclosed payable to GSWISE $

Charge r Visa r MasterCard Exp. date

Account #

Card holder’s name (print)

Signature

1. Check Participation (grade in fall)

r Camper (grades 1-6) r Peeweer PAIT (grade 7) r M r T r W r Th r F

r PA (grades 8-9) r Boyr CIT (grades 10-12) r M r T r W r Th r F

5. Choose FREE Camper T-shirt 6. Advanced Trading Post (optional) (Girls entering grades 1-7 only) Select One Additional T-shirt Price QTY

YM (10-12) YM $ 10.00 YL (14-16) YL 10.00 AS AS 10.00 AM AM 10.00 AL AL 10.00 AXL AXL 10.00 AXXL AXXL 12.00 AXXXL AXXXL 12.00 Progression Patch 2.25 Adult Rain Poncho 3.25 Youth Rain Poncho 3.25 Bandana 4.00

3. Choose Overnights (if applicable)

r Sr Mr Tr Wr TH

2. Choose Day Camp(s)

Kenosha and Racine campsr Trefoil/ Dare to Imagine • July 15-19r Windy Waters/Imagine Atlantis • July 29-Aug 2r Country Cousins/Country Cousins Silly Circus • Aug 5-9r Kenosha/ Once Upon a Day Camp • Aug 5-9

Washington and WauKesha county camps r Alpha Moraine • June 10-14r Lakeland • June 10-14r Deer Trails • June 17-21r Rising Stars/Meadow Springs • June 17-21r Prairie Hill • June 24-28r Arrowhead • July 8-12r Whispering Willows • July 15-19r Glacier Hills • July 15-19r River Valley • July 22-26r Sun Lakes • July 22-26r Sunny Trails • July 29-Aug 2r Woodland Trails • July 29-Aug 2r Indian Springs • Aug 5-9r Enchanted Waters • Aug 5-9r Northern Lights • Aug 12-16

7. Race/Ethnicity (optional, check all that apply)

Race r American Indian or Alaskan Nativer Hawaiian or Pacific Islander r White (Caucasian)r African American or Black r Asian

Ethnicity r Hispanic or Latinor Not Hispanic or Latino

8. Camp Fees

Camper fee: $ _____________Overnight fee (if applicable): $ _____________Trading Post fees: $ _____________Donation amount: $ _____________ Accept my tax-deductible gift to support camp.GSUSA Membership Dues ($12): $ _____________ (If not currently registered)Program Activity Credit (attach) PAC #____: – $ _____________FinAl TOTAl: $ _____________

r Financial Assistance requested - a completed Volunteer Led Day Camp Financial Assistance form, found at www.gswise.org, and must be received with camp registration form.

Camper’s name: __________________________________________________________________________________________________________________________________________________

Address: __________________________________________________________________________________________ City: ____________________________________________________

County: __________________________________________________________________________________________ State: _________________ Zip: _____________________________

Phone: (________)______________________ Birthdate: _________________________________________________________ Troop # (if applicable): _________________ Grade in Fall 2013: __________

Troop Leader Name: _______________________________________________________________________________ School: _________________________________________________

note: Confirmation information will be sent to your e-mail address listed below. Please print clearly.

E-mail address for confirmation: _______________________________________________________________________________________________________________________________________

Buddy Request (Name) (Check day camp web page for availability.): __________________________________________________________________________________________________

OvER FOR MAnDATORY HEAlTH HiSTORY FORM

2013 Volunteer Led Day Camp Registration

4. Choose Transportation Ride Bus private

List Bus Stop: _________________ To From To From

SMTWTHF

COMPlETE AnD MAil TO: Girl Scouts of Wisconsin Southeast

P.O. Box 14999Milwaukee, WI 53214-0999

CHECk All THAT APPlY

Camper’s name: ____________________________________________________________________________________________________________________________________________

Session #1: _______________________________________________________________________________________________ Date of session: _________________________________

Session #2: _______________________________________________________________________________________________ Date of session: _________________________________

Session #3: _______________________________________________________________________________________________ Date of session: _________________________________

Mother/guardian name: ________________________________ Phone during camp hours: (__________)____________________ Phone #2: (__________)________________________

Father/guardian name: _________________________________ Phone during camp hours: (__________)____________________ Phone #2: (__________)________________________

Camper is in custodial care of (check one): r Both r Mother r Father r Other _________________________________________________________________________________

Person(s) authorized to pick up child at camp/bus stop: ___________________________________________________________________________________________________________

Emergency Contacts (besides parent/guardian)

1. Name: ______________________________________________________________________________ Relationship: _______________________________________________________

Phone during camp hours: (_____________)____________________________________________ Phone #2: (_____________)________________________________________________

2. Name: ______________________________________________________________________________ Relationship: _______________________________________________________

Phone during camp hours: (_____________)____________________________________________ Phone #2: (_____________)________________________________________________

Medical History

Family physician name:______________________________________________________________________________________ Phone #: (____________)___________________________

Are any medications taken on a regular basis? r Yes r No If yes, does this need to be administered at camp? r Yes r No

If yes, explain: _______________________________________________________________________________________________________________________________________________

Do you have any restrictions or special needs related to physical activity? r Yes r No If yes, explain: ______________________________________________________________

____________________________________________________________________________________________________________________________________________________________

For Office UseDate: ____________________

Entered: ________________

immunization Dates (M/D/Y)(Series Completed, Year of Booster) “Current” is not acceptable.

Tetanus or DPT _____________________________

Polio _______________________________________

MMR _______________________________________

Hepatitis B _________________________________

Varicella/HIB ________________________________

Since last health exam:

r Exposed to a contagious disease

r Had a surgical operation

r Had a serious illness

Describe: ___________________________________

The following non-prescription medications are commonly stocked in the camp health center and used on an as needed basis to manage illness and injury. Cross out any of the following items the camper should nOT be given.

illness

r Heart defect/disease

r Musculoskeletal disorders

r Asthma

r Bleeding/Clotting disorder

r Seizures

r Diabetes

r Other ____________________

____________________________

____________________________

____________________________

____________________________

____________________________

Allergies – include severity

r Animals ____________________________

r Insect stings ________________________

r Pollen ______________________________

r Latex ______________________________

r Medicine/Drugs _____________________

r Nuts _______________________________

r Milk ________________________________

r Food (specify) ______________________

r Other (specify) _____________________

Type & Severity of Reaction __________

______________________________________

______________________________________

Others or Special needs

r Wears contacts/glasses

r Fainting

r Ear problems/tubes

r Hearing impairment

r Emotional behaviors

r ADD/ADHD (circle one)r medicated not medicated

r Sleep disturbances

r Menstrual cramps

r Nosebleeds

r Other ________________________

________________________________

Please explain any items that you check. Include any useful information relative to any of these health conditions.

____________________________________________________________________________________________________________________________________________________________

____________________________________________________________________________________________________________________________________________________________

I give my permission for my camper to receive necessary health care, prescribed medications, and emergency medical treatment. This health history is complete and accurate. I will not allow my camper to attend if they become exposed to any contagious disease, or if for any reason, I do not consider them to be in good physical condition. Upon arrival the camp health personnel have the right to refuse to admit anyone to the camp who does not meet the acceptable health conditions, e.g. temperature, contagious disease, etc.

Parent/guardian signature: ______________________________________________________________________________________ Date: ______________________________________

Girl Scouts of Wisconsin Southeast

Please print clearly and use blue or black ink.

2013 Health History

• Antibiotic ointment (Neosporin)• Anti-itch cream or lotion• Athletes foot ointment or powder• Aloe or burn gel

• Tums• Ibuprofen (Advil, Motrin)• Acetaminophen (Tylenol)• Benadryl

• Eye drops• Rubbing alcohol• Hydrogen peroxide• Laxative

• Anti-diarrheal• Epi Pen

COMPlETE AnD MAil TO: Girl Scouts of Wisconsin Southeast

P.O. Box 14999Milwaukee, WI 53214-0999

Adult volunteer’s name: _________________________________________________________________________ Camp Name: ___________________________________________________________

Address: _________________________________________________________________________ City/State/Zip: _____________________________________________________________

Email Address: _______________________________________________ Home Phone: (_________)___________________________ Cell: (_________)___________________________

Birthdate: ____________________________________________ Occupation: _________________________________________________________________________________________

Are you a registered Adult Girl Scout for 2012-2013? r Yes r No If no, you can enclose the $12 GSUSA membership dues and support Girl Scouting by becoming a member.

BACkgROunD CHECk AnD REFEREnCES (REquiRED) r Prior to submitting this form I have completed an online application and background check and submitted references at www.gswise.org. r I have already completed an online application and background check with the Girl Scouts Wisconsin Southeast within the last 3 years.

MEDiCAl HiSTORY

Name of family physician: __________________________________________________________ Phone number: (_____________)_________________________________________

AllERgiES

r Animals r Hay Fever r Insect Stings r Plant r Pollen r Medicine/Drugs r Food r Nuts r Milk r Latex r Other

Type and severity of reaction: _____________________________________________________________________________________________________________________________________

AREAS OF inTEREST - please check all that apply (directors will assign on the basis of need, not just interest)

r With my daughter r Not with my daughter r Boys unit r Peewee unit r Kitchen r Bus monitor r Shopper r Crafts r Nature r Equipment r Pre-camp preparation r Set up (day before camp) r Clean up (last day of camp) r Other: _____________________________________________________________________

CAMP FEES

r $12 Girl Scout Membership for 2012-2013 (recommended) r $10 Camp T-shirt Size: r AS r AM r AL r AXL r AXXL r AXXXL

r I would like a free camp patch r $ ___________ Donation (accept my tax deductible gift to support camp) (r For Trefoil only -adult horseback riding $30 ________)

r Total enclosed: $ _____________

illnESSES

r Bleeding/Clotting Disorders r Seizures r Asthma r Diabetes r Heart Defect/Disease r Musculoskeletal Disorder r Other

If other, list special needs: ________________________________________________________________________________________________________________________________________

MEDiCATiOnS

r Yes r No If yes, does this need to be administered at camp? r Yes r No

If yes, please explain: _____ ________________________________________________________________________________________________________________________________________

Do you have any restrictions or special needs to physical activity? r Yes r No If yes, please explain: __________________________________________________________________

Do you require a special diet or have any dietary restrictions? r Yes r No If yes, please explain: ______________________________________________________________________

CAMP SPECiFiCS

Name(s) and troop number(s) of camper(s) attending camp: _______________________________________________________________________________________________________

Name(s) of Pee Wee(s) and/or boys(s) attending camp: _______________________________________________________________________________ r M r T r W r Th r F

I am Volunteering for: Day(s) r S r M r T r W r Th r F r unknown Nights r S r M r T r W r Th

Transportation: Bus Stop ______________________________________ Ride Bus to Camp: r M r T r W r Th r F From Camp: r M r T r W r Th r F

Private Transportation: To Camp: r M r T r W r Th r F From Camp: r M r T r W r Th r F

Have you ever volunteered at day camp? r Yes r No If so, when and in what capacity? ____________________________________________________________________________

EMERgEnCY COnTACTS

Name: ___________________________________________________________________________ Relationship: ________________________________________________________________

Phone during camp hours: (_________)______________________________________________ Phone #2: (_________)_________________________________________________________

Name: ___________________________________________________________________________ Relationship: ________________________________________________________________

Phone during camp hours: (_________)______________________________________________ Phone #2: (_________)_________________________________________________________

SPECiAl nEEDS

r Wears Contacts/Glasses r ADHD or ADD r Hearing Defect/Disease r Hypertension r Other: ________________________________________________________________

iMMuniZATiOnS

r Tetnus DPT: _________________________________ r HepB: _________________________________ (optional)

I have read the camp information and agree that I will abide by the regulations and procedures stated therein, including those on refund, non refundable deposit, and health. I understand that I am responsible for getting to and from this camp or bus stop. I give permission for photography/video of me to be taken for GSUSA, GSWISE, and the American Camp Association publicity and marketing purposes. If I am not already a registered Girl Scout, I give permission to register as a member of the Girl Scouts of the USA. I give permission to receive necessary health care and emergency medical treatment. The health history on this form is complete and accurate. I will not attend if I become exposed to any contagious disease, or if for any reason, I do not consider myself to be in good physical condition. Upon arrival the camp health personnel have the right to refuse to admit anyone to the camp who does not meet the acceptable health conditions e.g. temperature, contagious disease, etc.

Adult volunteer signature: ________________________________________________________________________________________________ Date: __________________________________

Girl Scouts of Wisconsin Southeast

Only completed forms will be accepted. To be filled out by an adult.

2013 Volunteer Led Day Camp Adult Registration

COMPlETE AnD MAil TO: Girl Scouts of Wisconsin Southeast

P.O. Box 14999Milwaukee, WI 53214-0999