Everest Adventure Camp - D.C. Everest Area School District

Summer Program
Ages 5 - 12
After Summer School
Camp
Twin Oaks Camp
Ages 8 - 12
Little Adventures
Preschool Camp
Ages 4 - 5
Leadership
Day Trips
Ages 12 - 13
NEW
GOLF CAMP
Ages 7 - 15
2016 Summer Day Camp
Catalog & Registration
Held at the
Greenheck Field House
Welcome to Everest Adventure Camp
Everest Adventure Camp
(Ages 5 - 12)
The Everest Adventure Camp offers summer camp for kids from kindergarten through 6th grade. Fun
activities that your child will experience include field trips, special guests and events, climbing wall,
swimming, ice skating, arts and crafts, weekly themes, science, fun games and much more.
Qualified staff and low staff to camper ratio for camper safety.
Breakfast, lunch and afternoon snack included in weekly fee.
Little Adventures Preschool Camp (Ages 4-5)
For campers ages 4 - 5 who have NOT attended Kindergarten.
This camp is a great way to add excitement into your childs
summer. Little Adventures preschool camp will participate
in field trips, guest speakers, water fun, crafts and games
weekly. Low staff to camper ratio for camper safety.
Choose one week or all summer!
Weekly Camp Themes
June 9, 10
Camp Hollywood
Week 1 - June 13 - 17
Super Hero Week
Week 2 - June 20 - 24
Shipwrecked
Week 3 - June 27 - July 1
Back to the Future
Week 4 - July 4 - July 8
Christmas in July
(No camp July 4)
Week 5 - July 11 - 15
Disney Discovery
Twin Oaks Camp
Week 6 - July 18 - 22
Legends of the Hidden Temple
Ages 8 - 12 years old
Transportation fee included
Week 7 - July 25 - 29
Messy mudder….
Week 8 - August 1 - 5
Adventure Care Olympics
Week 9 - August 8 - 12
Where the Wild Things Are
Week 10 - August 15 - 19
Zoo to You
Week 11 - August 22 - 26
Water, water Everywhere
Drop off /pick up at
Greenheck Field House
Campers will leave Greenheck at 8:30am and
return by 4:30pm daily.
August 8 - 12
A Bugs Life...
This week will engage campers in learning about the
outdoors while spending the days at Twin Oaks.
NEW
GOLF CAMP
Week 12 - August 29, 30, 31 Goodbye Summer...
Child Care Assistance accepted for qualified
families through the State of Wisconsin
June 13 - 17
August 1 - 5
LEADERSHIP CAMP (Ages 11 - 12)
July 11 - 15
Camp will be taught by PGA Golf Professional Buck Welsh at
Crane Madows Golf Course. Each day campers will learn about
full swing, chipping, putting, golf etiquette, rules and will play 9
holes of golf. Campers are encouraged to bring a wood, 5 or 7
iron, wedge and a putter. (A minimum amount of clubs will be
available at the golf course) All golfing levels accepted.
Golfers will golf and have instruction on rainy days.
Leadership Camp is geared towards the older campers.
Campers will travel by bus during the week to different areas
within Central Wisconsin. They will explore nature, outdoor
living, Wisconsin history and leadership skills. Some field
trips include Eau Claire Dells Park, New Zoo Adventure Park
and Rib Mountain State Park and many more exciting areas
of Wisconsin.
Leadership camp is limited to 20 campers per week.
Campers will be bussed to and from the Greenheck Field House daily.
Golf Camp is limited to 16 campers per week
Everest Adventure Care
Full Week Fee - $179.00/week
NON-REFUNDABLE $15.00 DEPOSIT REQUIRED PER WEEK/PROGRAM
D.C. Everest Summer School Program
4 week summer school program
Full 4 week fee: $393.00
Week to week fee: $104.00/week
5% discount for additional siblings for full time campers
($81.00-week of July 4 - July 8)
NO CAMP - MONDAY, JULY 4TH
(The week of July 4 - 8 Full Week Fee is $144.00)
Per day rate - Minimum 3 days per week required - $40.00/day
Limited part time space available - please call for more information.
Please mark box:
(check one)
Little Adventures Preschool Camp (Ages 4 - 5)
Hours for summer school weeks are:
Adventure Camp (Ages 5 - 12)
(Mark days or full week)
If attending summer school, my child(ren) will be
bussed (arrangements MUST be made with First
Student by May 22) in the morning to school from
Home
Adventure Camp
M T W TH F
Full
Summer
School
June 9, 10
Week 1 - June 13 - 17
Week 2 - June 20 - 24
Morning drop off 6:30 am until bus pickup
After summer school until 6:00 pm
Parents are responsible for arranging
transportation from and to Everest
Adventure Camp
Is your child(ren) qualified to receive
Week 3- June 27 - July 1
child care assistance from the state?
Yes
Week 4 - July 4 - 8
No
Week 5 - July 11 - 15
The fee includes
breakfast, lunch and an
afternoon snack.
Week 6 - July 18 - 22
Week 7 - July 25 - 29
Week 8 - August 1 - 5
Week 9 - August 8 - 12
Our concession stand will be open
daily for campers to purchase
sports drinks, juices, ice cream
and snacks. You can purchase a
reloadable gift card when
registering or during check in. All
gift cards are kept at camp during
the week.
Week 10 - August 15 - 19
Week 11 - August 22 - 26
Week 12 - August 29, 30, 31
TWIN OAKS CAMP (Ages 8 - 12)
LEADERSHIP CAMPS (Ages 11 - 13)
GOLF CAMP (Ages 7 - 15) Full Week Option ONLY
$205.00 PER WEEK
Transportation fee included
(Mark days or full week)
Leadership Camp
Twin Oaks Camp
July 11 - 15
August 8 - 12
Golf Camp June 13 - 17
Golf Camp August 1 - 5
M
T
W
TH
F
Full
Gift cards are available
in $5.00 increments.
Registration Information
Please complete the registration form below AND attach a copy of camper’s Immunization Record and
Health History Form and return to the Community Services Office. Questions may be directed to the
Community Services Office or Jacque Jakubek at 715-359-6563 ext 4.
Camper’s Full Name _______________________________________________ Age ________ DOB _________ Sex _____M _____F
Camper’s Address ____________________________________ City ___________________ State ________ Zip _________________
Parent 1 Name ______________________________________ Home # ________________________ Work # ___________________
Parent 1 Address _____________________________________ City ___________________ State ________ Zip _________________
Parent 2 Name ______________________________________ Home # ________________________ Work # ___________________
Parent 2 Address _____________________________________ City ___________________ State ________ Zip _________________
Email Address(es) for Camp Updates _______________________________________________________________________________
Emergency Contact Person _______________________________________ Relationship _____________________________________
Emergency Contact Address ____________________________ City __________________ State _________ Zip ________________
Emergency Contact Home # _______________________________________ Work # _______________________________________
List additional persons authorized to pick up camper:
Name ________________________________________ Relationship ___________________ Phone # __________________________
Name ________________________________________ Relationship ___________________ Phone # __________________________
(Note: Camp staff will request a photo ID from any unfamiliar authorized pick up before releasing camper)
Camper’s swimming ability: (circle one)
Strong
Average
Beginner
Non-Swimmer
By signing, the parent/guardian certifies approval of good health of the camper, and in the event that I cannot be reached in
an emergency, authorize DC Everest Adventure Camp staff to render first aid, give permission to the physicians selected by
DC Everest Adventure Camp to provide appropriate care. I grant permission for the camper to participate in all planned
camp activities including: hiking, swimming, field trips with bus travel, rock climbing and ice skating. EAC will use Cutter
Aloe & Vitamin E Clean Fresh Scent Skinsations bug repellant and NO-AD 45 Sun Screen for my child as needed. Everest
Adventure Care is not responsible for lost, stolen or damaged items. I also authorize Everest Adventure Camp to have and
use photographs, slides and videotapes of the person named in this registration as may be needed for its public relation
programs. I give permission for the child named to attend field trips supervised by the Everest
Adventure Camp staff at
all times, to and from camp by van, hired bus company or by foot. I agree to waive claims against Everest Adventure Camp
and its members and volunteers for injuries or damages that may result from the conduct of other persons including
participants in Everest Adventure Camp programs.
Parent/Guardian Signature_________________________________________________ Date ______________________
Method of Payments:
I authorize Everest Adventure Camp to process payments for the week(s) my child attends camp. Credit cards are charged the
Wednesday prior to the camper attending.
Camper Name: ________________________________________________________________________________________
Master Card _____ Visa _____ Account #: _________________________________________________________________
Security Code: __________ Exp. Date: ____________ Name on Card: ____________________________________________
Billing Address: ___________________________________ City _________________ State ________ Zip ______________
HEALTH HISTORY AND EMERGENCY CARE PLAN
Page 1 of 2
STATE OF WISCONSIN
Address – Medical Facility
PHYSICIAN / MEDICAL FACILITY INFORMATION
Name – Physician
Telephone Number – Work
Telephone Number
Telephone Number – Cellular
No I authorize the center to allow my child to self-apply sunscreen.
1.
Epilepsy / seizure disorder
Cerebral palsy / motor disorder
Non-food allergies – Specify.
Food allergies – Specify food(s).
Ingredient Strength
Any disorder including Cognitively Disabled, LD, ADD, ADHD, or Autism
Gastrointestinal or feeding concerns including special diet and supplements
Milk allergy. If a child is allergic to milk, attach a statement from the medical professional indicating the acceptable alternative.
Other condition(s) requiring special care – Specify.
Diabetes
Asthma
Check any special medical condition that your child may have.
No specific medical condition
Brand Name
Yes
No I authorize the center to apply repellent to my child.
Yes
No I authorize the center to allow my child to self-apply repellent.
HEALTH HISTORY AND EMERGENCY CARE PLAN If available, attach any health care plan information from the child’s physician, therapist, etc.
Yes
SUNSCREEN / INSECT REPELLENT AUTHORIZATION If provided by the parent, the sunscreen or insect repellent shall be labeled with the child’s name. Per DCF 251.07(6)(f)2.,
authorizations shall be reviewed every 6 months and updated as necessary. Per DCF 250.07(6)(f)2.a., Authorizations shall be reviewed periodically and updated as necessary.
Ingredient Strength
Brand Name
Yes
No I authorize the center to apply sunscreen to my child.
Telephone Number – Home
Name
Telephone Number – Cellular
Date – First Day of Attendance (mm/dd/yyyy)
Provide information where the parent(s) / guardian(s) may be reached while the child is in care.
Telephone Number – Home
Telephone Number – Work
Birthdate (mm/dd/yyyy)
Telephone Number
PARENT / GUARDIAN INFORMATION
Name
Address – Home (Street, City, State, Zip Code)
CHILD INFORMATION
Name (Last, First, MI)
Instructions: The parent / guardian should complete this form for placement in the child’s file prior to the child’s first day of attendance. Information contained on the form shall be shared
with any person caring for the child. The department recommends that parents / guardians and center staff periodically review and update the information provided on this form.
Use of form: This form is required for family and group child care centers and day camps to comply with DCF 250.04(6)(a)1. and 250.07(6)(L)5., DCF 251.04(6)(a)6. and 251.07(6)(k)5.,
and DCF 252.44(6)(g) of the Wisconsin Administrative Codes. Failure to comply may result in issuance of a noncompliance statement. Personal information you provide may be used for
secondary purposes [Privacy Law, s.15.04(1)(m), Wisconsin Statutes].
DEPARTMENT OF CHILDREN AND FAMILIES
Division of Early Care and Education
DCF-F (CFS-2345) (R. 03/2009)
Steps the child care provider should follow. If prescription or non-prescription medications are necessary, a copy of the form Authorization to Administer Medication should be
attached to this form. Note: group child care centers and day camps may use their own form.
Identify any child care staff to whom you have given specialized training / instructions to help treat symptoms.
a.
4.
5.
When to consider that the condition requires emergency medical care or reassessment.
Additional information that may be helpful to the child care provider.
7.
8.
Review dates:
SIGNATURE – Parent or Guardian
When to call parents regarding symptoms or failure to respond to treatment.
6.
c.
Date Signed (mm/dd/yyyy)
Signs or symptoms to watch for – Specify.
3.
b.
Triggers that may cause problems – Specify.
Page 2 of 2
STATE OF WISCONSIN
2.
DEPARTMENT OF CHILDREN AND FAMILIES
Division of Early Care and Education
DCF-F (CFS-2345) (R. 03/2009)
 Free Busing to and from Summer School
 Program held at the Greenheck Field House
 Program is available Monday through Friday,
June 9 - August 31, 2016 from 6:30 a.m.- 6:00 p.m.
 Breakfast, lunch, and afternoon snack included in fee
 Swimming, ice skating, arts & crafts, weekly field
trips, climbing wall, science, games, special guests
 Weekly payment plan
 Attend all summer or just for a special week or two
 Child Care Assistance accepted for qualified campers
 Qualified and caring staff
 Registration is open to all Wausau
Area Residents
Camp Payment, Credit and Refund Policy

Non-refundable $15 deposit per week (monies applied to weekly fee).

Remaining weekly tuition balance must be paid 1 week prior to the week the child will attend camp.

All part time schedules must be received two weeks prior to attendance. Changes cannot be made once schedules are set.
Limited part time space available - call for more information.

Weekly automatic credit/debit card withdrawal option.

No credits for illnesses and/or single day absences.

No refunds/credits unless the program is cancelled by Everest Adventure Camp.

All cancellations MUST occur before the program’s first day.

Deposits are transferrable with the program from week to week.

It is the parents/guardians responsibility to withdrawal from the program.

A credit is not issued if the cancellation does not occur and there is no attendance.

Everest Adventure Camp Coordinator can approve certain fees and policies on a case by case situations.

Prorated days for Golf Camp is not available.
www.greenheckfieldhouse.com
Committed to providing area residents with programs of excellence.