Mail in Registration 2011 - Old Trail School

Authorization Form 2011To register online go towww.oldtrail.orgORComplete form and remit with payment to:Old Trail School/S’CampP.O. Box 827Bath OH 44210-0827No phone registrationsPlease feel free to copythis form if you need toregister more S’CampersMedical AuthorizationIn the event of a child’s serious illness or accident while she/he is at camp or elsewhere under camp supervision, S’Camp’spolicy is first to notify the camper’s parent/guardian, then his/her physician, as designated below, as soon as reasonablypossible. However, if the camp staff is unable to locate such designees and considers immediate treatment necessary, then I, theundersigned parent/guardian, hereby authorize the camp to take such emergency measures as seem reasonably necessary underthe circumstances, including treatment and/or surgery by an available physician and/or nearby hospital.Camper 1 Camper 2Name: ______________________________________________Height/Weight:_ ______________________________________Last Tetanus: _________________________________________Immunizations: ______________________________________Conditions currentlyunder treatment for: ___________________________________Name/Dosageof medicines: _ _______________________________________Allergies: ___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Physician’s name/phone: _______________________________________________________________________________________Dentist’s name/phone: _________________________________________________________________________________________Medical carrier: ________________________________________________ Policy Number: _______________________________Emergency contact name: ________________________________________ Phone: ______________________________________Signature of Parent/Guardian: _____________________________________ Date: ________________________________________Authorization to Pick Up a CamperMy child may be released to: ___________________________________________________________________________________Signature of Parent/Guardian: ______________________________________Date: ____________________________Photo AuthorizationI hereby authorize and give full consent to Old Trail School to publish and copyright all photographs in which my child/childrenappear(s) while enrolled as a camper. I further agree that Old Trail School may transfer, use or cause to be used, these photos inSchool brochures, website, newsletter, advertising, posters, displays, slide shows, videotapes, catalogues and like publicationsor literature without limitations or reservations. I hereby consent to the use of photographs subject to the terms mentionedabove. I am the parent or guardian of the above-listed camper(s)._____________________________________________________________________________________________________________Signature of Parent/Guardian:Date:How did you hear about S’Camp? (please check all that apply)o Mailing o Library o OTS Parent o Friend o Othero Postcard o School o Newspaper o InternetPlease send this form with completed registration form on previous page toOld Trail School/S’Camp, P.O. Box 827, Bath OH 44210-082712

June 27 – July 1 Week 3MORNINGSDuct Tape Creations9 – 11:45 a.m. • Grades 3 – 8Join the fastest growing trend of bags, accessories and clothing – made from Duct Tape! Pencil pouches, bags, wallets, purses, the possibilities are endless! Comecreate and learn what all the fun is about! Instructor: Cheryl Sandor, BS, K-12 licensed OTS substitute teacher. Fee: $165Moms, Pops and Tots (Program for Parents and Toddlers)Held on Tuesdays and Thursdays during Weeks 1 thru 5 (10 sessions) June 14, 16, 21, 23, 28 and 30, July 5, 7, 12, and 14Two sessions 9 – 10:30 a.m. or 11 a.m. – 12:30 p.m.Ages 18 months to 3½ yearsParents are invited to bring their toddlers to join in fun, age-appropriate experiences. Moms, dads or both are required to participate in this program. Themes duringdifferent sessions will include: Cooking, Art, Tactile, Gross Motor, Music/Movement, Transportation, Beach, Bugs, Frogs, and Water. This program will be on Tuesdaysand Thursdays for 5 weeks and includes a snack and outdoor exploration. Instructor: Lynn Zidones, Masters in Early Childhood, OTS preschool teacher. Fee: $180Skippity-Do-DahSix week sessions 9 – 11:45 a.m. • Ages 3 – 5Skippity Do Dah, Skippity Ay, Come play with us and have a wonderful day! Come join us as we skip and laugh our way through the “Wild, Wild West withWoody,” go “South of the Border with Dora,” and go “Campin’ Out with Little Critter.” We’ll have fun as we take our “Pets on Parade with Clifford,” go exploring“Under the Sea with Ariel,” and “At the Zoo with Melman and Marty.” Young campers will be exposed to wonderful children’s literature selections, explore avariety of art materials, enjoy sand and water play, sing songs, play games and participate in a balance of indoor and outdoor activities. Ages 3 to 5 years (If achild can manage toileting & dressing needs independently and has not yet attended kindergarten). Daily nutritious snacks are provided. All campers shouldbring a towel and wear swim suits under their shorts for times of water play.Skippity-Do-Dah campers will delight in weekly themes: Week Three – “Under the Sea with Ariel”; Week Four – “At the Zoo with Melman and Marty”; WeekFive – “South of the Border with Dora”; Week Six – “Campin’ Out with Little Critter.” Instructors: Susan Atchison, BS Ed, MA Ed, Laura Daane, BA, MAT, and ErinMcNamara, BS, MEd, OTS preschool teacher’s Fee: $155/5-mornings; $95/3-mornings; $65/2-mornings.Super Duper Studies9 – 11:45 a.m. • Grades 4 – 5Do you know how to study? Which way is the right way for your learning style? With the help of this camp, you can answer those questions. We will assessyour learning style and address what are the best study strategies for you to use. Numerous techniques will be demonstrated to the class and you will have anopportunity to share what works best for you (it may even be one we don’t know about!!). Be prepared for success in the new school year by learning to study inthe summer. Instructor: Mallory Hawley, OTS Speech-Language Pathologist. Fee: $155AFTERNOONSAre You Ready to Rock II?12:15 – 3 p.m. • Grades 3 – 6This class is designed for students who have participated in “Are You Ready to Rock I?” that would like to continue their studies. The course will involve listeningto a variety of styles as well as developing further skills on their chosen instrument. Students are welcome to enroll as many times as desired. Instructor: JoeTerrett, Jazz guitarist and instructor at Firefly Music School. Fee: $150Classy Kids…”Because Bad Manners Are Totally Un-Cool”12:15 – 3 p.m. • Ages 7 – 9There is never an excuse for Bad Manners. Kids have fun while earning their Silver Spoon with the Baroness, learning the ABC’s of manners for everyday andspecial occasions with interactive role playing. Understanding the basics of good manners helps children act with more confidence in new or unfamiliarsituations, make friends, avoid embarrassment or bullying. Knowing what the proper etiquette is for different situations builds a foundation of self-esteem that willlast a lifetime. The course ends with a “High Tea” party and the awarding of a Silver Spoon to each student. Instructor: Baroness von Alvensleben, founder of TheSilver Spoon, etiquette and social graces for all ages. Fee: $150Wet and Wild Summer Games12:15 – 3 p.m. • Grades K – 3Come and join your friends for indoor and outdoor games galore, including sack races, limbo, water balloons, parachute play and more. Bring your toweland swimsuit daily for wacky water games and swimming in the OTS pool. We round off the week with a bowling party, ice cream sundaes and snow cones.Instructors: Jodi Johnson, BS, OTS science teacher and Cindy D’Arienzo, BS, OTS kindergarten reading teacher. Fee: $165MORNINGS/AFTERNOONS/ALL DAYA Pirate’s Life for Me!9 a.m. – 3 p.m. • Age 5 – Grade 1NEWNEWNEWAhoy Mateys! ARRRRrrr you looking for some adventure this summer? Just look for the mighty Jolly Roger flag! This week is full of pirate excitement, includingmany pirate stories and dramatic play. We will also be making our own pirate costumes, treasure maps and searching for buried treasure. We will have aswashbuckling good time and if you are brave enough, you may have a chance to walk the plank! Activities will be different from last year. See you this summer,me hearties! Instructors: Monica Piccari, BS, OTS Young 5s teacher and Rachel Rich, BS, OTS preschool teacher. Fee: $25513