the application here

Join in the Fun!
2016
Spring Break & Summer Day Camp
Camp Sea Gull and Camp Seafarer are branches of YMCA of the Triangle
2015
Spring Break Day Camp
March 28th – April 1st 2016
Craven, Pamlico & Beaufort Counties / Grades 1-8
Spring Break Day Camp gives campers an opportunity
to spend time with their assigned huddles for the week
on activities at camp Seafarer: Campers receive a
swim test at the beginning of the week to identify each
camper’s swimming ability. Campers have the opportunity
to participate in a variety of water activities, such as
swimming, the zip line, canoeing, and the two water slides.
Other activities offered are golf, tennis, archery, riflery,
sharks tooth pile, athletics, and boat rides.
Summer Day Camp
1-week sessions / Rising Grades 1-5
Camp Sea Gull and Camp Seafarer place emphasis on
quality staff and safe programs that help to develop strong
character, skill and leadership. Campers will participate in
huddle groups with campers of similar age and grade. The
Summer Day Camp program offers 1-week sessions where
campers play on camp activities, receive swim instruction
on a daily basis, participate in assemblies and huddle
challenges, and have daily devotions with their huddles.
Adventure Camp
1-week sessions / Rising Grades 6-8
The one-week Summer Day Camp is designed for older
campers. Campers will participate in a special daily camp
activity, local field trips, and activities offered at Camp Sea
Gull and Camp Seafarer.
Day Camp Trainee Program
Rising Grades 9-10
This program is designated for campers who have an
interest in becoming a strong leader and positively
impacting children. Trainees meet several times a week
to learn about leadership qualities. They also assist in
huddle life as mentors to our summer day camp campers.
Trainees are required to go through an application and
interview process before being accepted into the Summer
Day Camp Trainee program. Once the day camp application
is received, trainees will be mailed a Summer Day Camp
Trainee application. The trainee application process deadline
is April 25, 2016. Once the Summer Day Camp Trainee
application has been received and reviewed, trainees will
be contacted for a phone interview to discuss their role at
Camp and identify potential upcoming leaders for the Day
Camp program.
Please complete and mail to:
Camp Seafarer c/o Day Camp
2744 Seafarer Road
Arapahoe, NC 28510
Camp Sea Gull & Camp Seafarer
2016 Day Camp Application
Please select the session(s) you are interested in attending:
Spring Break Day Camp, Grades 1-8, March 28 – April 1, $84 Res* $168 Non Res
1-Week Summer Day Camp, Rising Grades 1-5,
 Session 1 June 20 – June 24
 Session 2 June 27 – July 1
 Session 3 July 4 – July 8
 Session 4 July 11 – July 15
 Session 5 July 18 – July 22
 Session 6 July 25 – July 29
 Session 7 August 1 – August 5
 Session 8 August 8 – August 12
91 Res*
$
181 Non Res
$
Summer Adventure Camp
Grades 6-8
97 Res* $198 Non Res
 Session 1 July 18 – July 22
 Session 2 July 25 – July 29
 Session 3 August 1 – August 5
 Session 4 August 8 – August 12
$
*Resident pricing is ONLY available to children attending Pamlico County Schools and Aurora School System:
Pamlico Christian Academy, Pamlico County Primary School, Fred A. Anderson Elementary, Pamlico
County Middle School, Pamlico County High School and S.W. Snowden Elementary (Aurora).
Summer Trainee Program
Grades 9-10
$
350 Res* $700 Non Res
(Application Process Required)
 4-Week Trainee Session
June 20 – July 15
q My child will need financial assistance in order to attend camp. Please send information. I understand that with this application a $10.00
per session deposit is required when applying for financial assistance. Appropriate fees must accompany sessions indicated above.
(For Office Use Only)
ID#
Camper’s name (first/middle/last)_________________________________________________________________________________________________________________________________________________
Name called____________________________________________________________________________________ Rising Grade _______ School_________________________________________________________ Birth date ____/____/____
mm dd
q Male
yy
Age at Camp: Years______ Months______
q Female
Previous Seafarer camper?
q No q Yes
If Yes, how many years at Camp?______________________
(For Office Use Only)
ID#
Mother/Guardian’s name (Dr. Mrs. Ms.)_______________________________________________________________________________________________________________________________________
Birth date ____/____/____
mm dd
q Former Camper ___________________
yy
q Former Counselor ___________________
year or range of years
year or range of years
Home address____________________________________________________________________________________ City_________________________________________State _____________ ZIP__________________________
Occupation_____________________________________________________________________________________________
Home ( _ _ _ _ _ _ )_____________________________________________________
Name of Business____________________________________________________________________________________
Cell
( _ _ _ _ _ _ )_____________________________________________________
Email_____________________________________________________________________________________________________
Work
( _ _ _ _ _ _ )_____________________________________________________
(For Office Use Only)
ID#
Father/Guardian’s name (Dr. Mr.)________________________________________________________________________________________________________________________________________________
Birth date ____/____/____
mm dd
q Former Camper ___________________
yy
q Former Counselor ___________________
year or range of years
year or range of years
Home address____________________________________________________________________________________ City_________________________________________State _____________ ZIP__________________________
Occupation_____________________________________________________________________________________________
Home ( _ _ _ _ _ _ )_____________________________________________________
Name of Business____________________________________________________________________________________
Cell
( _ _ _ _ _ _ )_____________________________________________________
Email_____________________________________________________________________________________________________
Work
( _ _ _ _ _ _ )_____________________________________________________
Parents are:
q Married q Separated q Divorced q Single
q Re-married Primary contact:
q Mother
q Father
q Other ____________________________________________________________________
q Widowed
SUPPORT OUR CAMP ANNUAL FUND
Program fees only cover 90% of the cost of our programs. Please help us bridge this gap and meet our current and emerging needs by supporting the
Camp Annual Fund. YES! I wish to make a tax-deductible donation in addition to my child’s registration fee:
q $1000
q $750
q $500
q $250
q Other $______________
Check payment method: q Credit card provided below q Check enclosed q Bill me later q Other _______________________
PAYMENT OPTIONS:
Please see 2016 Youth Program Policies for additional payment/refund terms.
 Check enclosed (payable to Camp Sea Gull and Camp Seafarer)
 Please have someone contact me to charge my credit card.
q I agree that email from Camp Seafarer may be sent to any of the email addresses I have supplied on this form.
Signature of Parent/Guardian __________________________________________________________________________________________________________________________________________________
Camper’s Name________________________________________________________________________________________________________________________________________________________
2016 Health History Form To be completed by parent or guardian
Camper’s Date of Birth ____________ /_________ /_____________ Camper’s Age at Camp _______________ Primary Contact Name: __________________________________________
Mother’s Name: ______________________________________________________________________
Father’s Name:_______________________________________________________________________
Home Phone: (______________)__________________________________________________________
Home Phone: (_____________ ) ________________________________________________________
Work Phone: ( ______________) _________________________________________________________
Work Phone: (______________ )_________________________________________________________
Cell Phone: ( _____________ ) ___________________________________________________________
Cell Phone: ( ____________ ) ___________________________________________________________
In the case of separation or divorce, both sets of information are required.
If neither parent can be reached, in case of emergency notify ___________________________________________________________________________________________________________
Relationship _________________________________________________________________________ Home Phone: (_______________)_______________________________________________________________
Work Phone: (______________ )_________________________________________________________ ext. ____________ Cell Phone: (_____________ )_______________________________________________
HEALTH HISTORY: Please check  and attach a separate statement regarding potential problem areas:
 Recurring Strep Throat  Heart Disorder
 Serious Injuries
 Frequent Ear Infections
 Sleep Walking  Severe Headaches/Migraines
 Chronic Cough  Bed Wetting  Hepatitis
 Asthma/Wheezing  Fainting  Infectious Mononucleosis
 Chronic Constipation  Seizures  Tuberculosis
 ADD/ADHD Learning Disabilities  Kidney Problem/Urinary Tract Infection
 Chicken Pox - Date of Disease________________________________________________________________________________________________________________________________________________
 Other _______________________________________________________________________________________________________________________________________________________________________________
Allergic Reactions: (Please give details)
Insect Stings _________________________________________________________________________ Poison Ivy/Oak ___________________________________________________________________________
Drugs __________________________________________________________________________________ Food_________________________________________________________________________________________
Other___________________________________________________________________________________________________________________________________________________________________________________
Has your child been evaluated or received treatment or counseling by a psychologist or physician for an emotional or behavioral problem,
including hyperactivity?  No  Yes If yes, on a separate statement, please help us understand how to effectively address these concerns. Are
there other special concerns regarding your child’s medical history? (attach a separate statement if necessary)
__________________________________________________________________________________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________________________________________________________________________
NOTE:
• Please write or call the Camp if your child is exposed to or has contracted any potentially serious communicable diseases (such as chicken pox,
hepatitis, meningitis, etc.) during the three weeks prior to Camp attendance.
• In order to complete the registration process, this form (no substitutions) must be received one month prior to program
start date for physician’s review.
• Final acceptance is subject to review by the Camp Medical Committee and the Director reserves the right to rescind enrollment based upon
recommendation of medical staff.
PLEASE ATTACH A COPY OF THE FRONT AND BACK OF YOUR HEALTH INSURANCE CARD
PERMISSION TO EXAMINE, PRESCRIBE MEDICATION AND TREAT: I hereby give permission to the Registered Nurse or Physician selected by
the Camp Director to perform routine tests and treatment for the health of my child. In the event of an emergency or other acute event where
time will not allow me to be reached, or I cannot be reached, I hereby give permission for the Camp Physician to secure necessary consultative
care for my child, including hospitalization, anesthesia, surgery, and other medical treatment.
PERMISSION TO DISCLOSE INFORMATION: I agree to allow the Camp Physician or Health Clinic Director to speak with the Camp Director
and Camp personnel living or working with my child, regarding any medications my child is taking, as well as specific medical or psychological
conditions that may impact my child’s daily living.
PERMISSION TO RELEASE RECORDS: I authorize the Camp Physician or Health Clinic Director to release any health records related to my child
as may be necessary for treatment, referral, billing, or insurance purposes.
Signature of Parent/Guardian ______________________________________________________________________________________________________________ Date _______________________________
*DTP / DTaP/ DT (circle which)
Recommended immunizations in addition to those above required
**dT/TdaP
Miningoccal
*Polio (IPV/OPV)
HPV
***Hib
Hep A
****Hepatitis B
BCG/IPPD
*MMR (combined doses)
*****Chicken Pox
Pneumcoccal
*Required by State law
**Required by State law if child is 11 years old
***Required by State law for children born on or after 10/01/88
****Required by State law for children born on or after 07/01/94
*****Required by State law for children born on or after 04/01/01
Date of most recent PPD (Mantoux) Test ________________
Test results __________________
(if indicated by the guidelines published in the most recent Center for Disease
Control Redbook)
Camper’s Name________________________________________________________________________________________________________________________________________________________
2016 Behavior Expectations and Discipline Policy
It is important that staff maintain good order and discipline in all programs. Top objectives in all Camp programs are safety and a
positive atmosphere for learning and developing social skills. Camp Sea Gull and Camp Seafarer make every effort to help children
understand clear definitions of acceptable and unacceptable behavior.
The Camps do not condone and will not permit:
1. Corporal punishment.
2. Ridiculing, threatening, using inappropriate
loud voice.
3. Leaving children unattended.
4. Use of profanity.
A child’s behavior is expected to be consistent with the following:
1. Use appropriate language at all times.
4. Maintain a positive attitude.
2. Cooperate with staff and follow directions.
5. S
tay in program areas – running away is not acceptable.
3. Respect other children and staff, equipment and facilities, and 6. P
articipate successfully within the Camp’s staff-child ratios
yourself.
specific for Day Camp.
The Discipline Policy:
1. If a child is unable to comply with the behavior expectations, the Camp Director will hold a conference with the child.
The parent(s)/guardian will be notified.
2. If after the above meeting, the child is still unable to comply with the behavior expectations, the Camp Director will set up
a conference with the parent(s)/guardian. A behavior contract will be established and signed by the child (if appropriate),
parent(s)/guardian and the Camp Director.
3. If the child’s behavior continues to be dispruptive and/or unsafe, the child will be subject to suspension
or dismissal.
4. Failure of the parent(s)/guardian to attend conference(s) and cooperate will subject the child to suspension
or dismissal.
Behaviors, which may result in immediate dismissal, include but are not limited to:
1. An action that could threaten or pose a direct threat to the
4. Vandalism or destruction of Camp property or property
physical/emotional safety of the child, other children or staff.
of others.
Prohibited conduct may include, but is not limited to, abusive
5. Sexual misconduct.
jokes, insults, slurs, threats, name calling, bullying
6. P
ossession of or use of alcohol or controlled substances
or intimidation.
unless under the prescription of a physician.
2. Fighting.
7. Running away.
3. Possession of a weapon of any kind.
8. Biting.
Special Circumstances
Camp Sea Gull and Camp Seafarer are committed to providing children an opportunity for full and equal enjoyment
of the camping experience. If your child appears to have any serious behavioral problems, or special circumstances involving physical,
medical, or psychological concerns, the Director should be notified of this now, so reasonable modification can be considered. Children
cannot be accepted that do not have the promise of interacting cooperatively, compatibly, and safely with other children. Camping
is designed to be a strong influence in the lives of children it serves and typical problems are overcome. Camp Sea Gull and Camp
Seafarer recognize that most children’s problems are quite normal and correctable through a program of high expectations and positive
motivation. However, children with serious behavioral problems should have special guidance concerning their readiness before going to
Camp. These problems should be discussed with the Director and the advisability of accepting the child can be determined at this time.
The Director reserves the right to decline the application of any child, or send home any child who, according to the
Director’s discretion, is not a desirable associate for the other campers. If a camper is dismissed due to behavioral/social
issues the tuition is not refundable.
I have read, understand and agree with the policies stated in this document and have discussed the expectations of
behavior with my child.
Signature of Parent/Guardian ________________________________________________________________________________________________________________________________
Date________________________________________________________________________________________________________________________________________________________________
Child’s Name___________________________________________________________________________________________________________________________________________________________
2016 Youth Program Policies
Waivers/Permissions:
1. I permit my child to participate in activities planned by the Day Camp Director and staff.
2. Field Trips – I permit my child to leave Camp on authorized trips under the supervision of the Camp staff. I may review a written schedule of
activities to be conducted off the Camp premises.
3. Photography – I permit Camp Sea Gull and Camp Seafarer to utilize video-tape, audio or photography materials of myself or dependent
children, for the purpose of promotional materials for Camp Sea Gull and Camp Seafarer programs and services. This includes any printed
material, broadcast and print advertising, promotional videos and our Camp website which are produced or published by Camp Sea Gull and
Camp Seafarer. I understand that my child’s name is not published.
4. Transportation – I understand and agree that Camp Sea Gull and Camp Seafarer programs will provide transportation for my child 1) to
a Camp program from a pre-designated pick up location 2) from a Camp program to a pre-designated drop off location. Camp Sea Gull and
Camp Seafarer’s liability for my child begins when the child boards a YMCA vehicle and ends when the child exits the vehicle. Under some
circumstances, Camp Sea Gull and Camp Seafarer’s liability will continue if my child is exiting the YMCA vehicle to participate in a Summer
Day Camp Program. Pick up and drop off points will be determined prior to my child attending the Summer Day Camp Program. If the staff
encounter circumstances that they perceive as dangerous at the location where my child is scheduled to exit a YMCA vehicle, my child will not
be permitted to exit.
Medical Treatment Policies:
1. Accident Insurance – Participants are responsible for their own accident insurance when using the Camps and when participating in Camp
programs off-site.
2. Medication – Camps do not normally administer any medication and will do so only when directed in writing by the child’s parent(s) or
guardian. However, in the event of an emergency in which the parent cannot be contacted, Emergency Medical Staff and Camp Staff may take
appropriate action in the best interest of the child. A doctor’s prescription must accompany any medications or nutritional supplements.
3. Blood Borne Pathogen Exposure – I understand that, while my child is in the care of Camps, if a child is exposed to a body of fluid on
broken skin or mucous membrane (e.g. splashing in mouth or eye), from another child, the Camps will contact the parents of both children.
They will explain what has occurred, and then provide the names of the attending physician of the source child to the parents of the exposed
child. If a staff member has a blood or body fluid exposure from a child, the Camps will provide the name and telephone number of the child’s
attending physician to the staff member.
I have read and agree with the statement and specifically authorize the Camps to release the name and telephone number of my child’s
physician, and a description of the event to the parent(s) or guardian of any child who is exposed to blood or body fluid or any staff member who
experiences such exposure from my child.
Program Policies:
1. Babysitting Policy – Camp Sea Gull and Camp Seafarer strive to employ the very best staff possible in all of our programs. During staff timeoff or after they are no longer employed with us, these persons are private citizens and are no longer subject to our employment rules and
procedures. Camp Sea Gull and Camp Seafarer cannot and do not endorse or recommend its present or former staff members as babysitters to
any parent or guardian of any child in any of our programs. Any babysitting arrangements with present or former staff of Camp Sea Gull and
Camp Seafarer is separate and independent from any other programs and must be based on the independent investigation, responsibility and
judgment of the parent or guardian. I agree that Camp Sea Gull and Camp Seafarer shall not be responsible and will be held harmless from any
claims or liability in connection with such babysitting activities.
2. I understand that Camp Sea Gull and Camp Seafarer are not responsible for articles of clothing or personal belongings damaged or missing in
transit, loss or theft. Children should not bring money to camp.
3. It is policy of Camp Sea Gull and Camp Seafarer to consider applications and operate programs and facilities in a nondiscriminatory manner.
4. I understand that there are increased levels of risk with any adventure-based program. These programs at Camp Sea Gull and Camp Seafarer
include the zipline, giant swing, climbing wall, alpine tower and challenge course elements. My signature below gives my child permission to
participate on the activities.
Payment/Refund Policies:
1. I understand that a refund of all fees paid (less a $25 processing fee) will be made if Camp receives written notification of cancellation by
March 1, 2016 for Spring Break Day Camp and June 1, 2016 for Summer Day Camp Programs. Thereafter, the fees are not refundable
2. I understand that the total payment of fees for an applicant on the waiting list is refundable if space does not become available.
I have read, understand and agree with the policies stated in this document.
Signature of Parent/Guardian ___________________________________________________________Date_________________________________
Typical Daily Schedule
7:30 - 8:45 a.m. Rides In
8:45 - 9:30 a.m. Opening Assembly
9:30 - 11:50 a.m. Morning Activities
& Snack
12:00 - 12:45 p.m. Lunch*
1:00 - 1:30 p.m. Devotion
1:30 - 4:00 p.m. Afternoon Activities
4:00 - 4:30 p.m. Change/Pack, Snack
4:30 - 5:00 p.m. Closing Assembly
5:00 - 5:45 p.m. Rides Out
*Lunch and an afternoon snack are provided
by Camp.
Please send one snack and a drink with your
camper each day.
Camp Activities
Athletics Zipline
Assemblies Riflery
Shark Tooth Hunting Nature
Arts & Crafts Golf
Field Games Tennis
Swimming Archery
Canoeing Water Slides
Fishing
Our Staff
Camp Sea Gull and Camp Seafarer are committed
to providing skilled learners. We proudly recruit
staff that come highly recommended and are true
role models to the children within our own
community. It is of the utmost importance that
our staff exemplify the YMCA character traits of
caring, honesty, respect, responsibility and faith
in God. All staff attend training sessions to prepare
them and provide the tools needed to facilitate
safe, fun and growth experiences for each camper.
If you have questions about our programs
contact our Camp office, 252-249-1212.
Spring
GRADES 1-8
$
84 Resident* $168 Non-Resident
March 28 - April 1
Craven, Pamlico & Beaufort County Residents
*Camper must be a Pamlico County or Richland Township student to receive resident rates.
Summer
RISING GRADES 1-5
$
91 Resident* $181 Non-Resident
Session
Session
Session
Session
1
2
3
4
June 20 - June 24
June 27 - July 1
July 4 - July 8
July 11 - July 15
Session
Session
Session
Session
5
6
7
8
July 18 - July 22
July 25 - July 29
August 1 - August 5
August 8 - August 12
RISING GRADES 6-8
$
97 Resident* $198 Non-Resident
Session
Session
Session
Session
1
2
3
4
July 18 - July 22
July 25 - July 29
August 1 - August 5
August 8 - August 12
RISING GRADES 9 & 10
$
350 Resident* $700 Non-Resident
June 20 - July 15
**Trainee Session (application process required)
**If application is accepted, applicant will receive a 10% discount. 10% is not applicable to the Summer Trainee Session if receiving financial assistance.
Transportation
Transportation to and from central locations in our community are available for those campers who
pre-register. In order to ensure everyone’s safety, we have camp staff on board each bus for supervision.
Note: A minimum of six campers is required for each pick up and drop off location to confirm a bus station.
Register campers will be notified if a change is made. Seats on each bus will be reserved on a first come first serve basis.
Registration
Please return the following forms to: Camp Seafarer c/o Day Camp, 2744 Seafarer Road, Arapahoe, NC
28510 or email at [email protected].
Application • Health History Form • Behavior and Discipline Policy
Youth Program Policies • Transportation
You will be notified about your child’s enrollment in Day Camp shortly after we receive his/her completed
application packet. Upon acceptance, additional information will be mailed.
Financial Assistance Available
We believe that every child should have an opportunity to come to camp. Our philanthropic mission is to
make Camp Sea Gull and Camp Seafarer experience possible for families from all financial communities.
Financial assistance is available for each program offered (Spring Break Day Camp and Summer Day Camp)
and is awarded based on need. Priority is given to Pamlico County and Richland township area residents.
For more information on camperships, contact our Camp Development office at 919-582-9344.