Benton Girl Scout Day Camp

Take a New Bearing: Skills for Outdoor Fun and Adventure

Dates: July 14 – 18, 2003

Theme: Take a New Bearing: Outdoor Skills for Fun and Adventure. Learn how to share the adventure of the outdoors while being aware of the environment around you. Learn to use a compass and read a map, first aid and safety, to tie easy knots, to make drinking water safe, put up shelters and tents, to use a variety of cooking techniques, and just have fun. Cadette and Senior Girl Scouts will work towards the Program Aide Pin and Patch, or Leadership Pin by guiding younger scouts through the week of camp activities.

Site: Rock Creek Campground – Approximately 4 miles west on Hwy 34 from the junction in Philomath. A map will be included with your confirmation letter.

Hours: Monday through Thursday, 8:30 am – 4:30 pm

Friday, 8:30 am – 11:30 am

Thursday Overnighter: Parent/Daughter overnighter. More details in confirmation letter.

Thursday Evening Family Picnic: Bring a picnic to share with your camper, and enjoy the entertainment by each unit. Girls not staying overnight are encouraged to remain through the evening events.

Registration is open to all girls who will be entering grades 1-12 regardless of race or national origin. Scouts with special needs are welcome to attend camp, however because of the rough terrain of Rock Creek and the length of the camp day, we request that parents contact us to discuss what assistance is required of the camper prior to registering for camp. We want to make this a rewarding experience for all involved.

Fees: Includes daily snack, beverage for lunch, breakfast on Friday, craft supplies, T-shirt, and camp patch.

The success of camp depends on adults volunteering to help with camp activities, planning prior to camp, and clean-up the last day of camp. If you can help with camp preparation or planning and cannot be at camp because of work schedule, we will gladly consider these hours toward camp fees.

$45.00 per registered Girl Scout with no parent participation

$35.00 per registered Girl Scout with parent volunteering 1 day at camp

$25.00 per registered Girl Scout with parent volunteering 2 days at camp

$20.00 per registered Girl Scout with parent volunteering 3 days at camp

$15.00 per registered Girl Scout with parent volunteering 4 or more days at camp

$10.00 per registered Cadette or Senior Girl Scout volunteering as a Program Aid (must be entering grade 7 or above in the fall 2003).

Non-registered Girl Scouts are welcome to attend camp by paying an additional $7.00 Girl Scout registration fee (includes membership and insurance for the remainder of the 2002-2003 Girl Scouting year)

$3.00 per day for tag-a-longs (for children 4 years and older while an adult is volunteering at camp)

Program Certificates may be used to pay for all or part of camp fees (please send in registrations with certificates or a note you intend to use the certificate when received). Camperships are available to Girls Scouts registered with a troop or as a Juliette by May 1, 2003. Call camp director for application.

Deadline: May 3, 2003 or until camp is full. Total number of girls accepted will be dependent upon the number of program aides and full time adult volunteers. Priority will be given to campers with an adult volunteering at camp. A confirmation will be mailed to you around May 31, 2003 with a map and equipment list for camp.

Refunds: Full refund will be given up to 2 weeks prior to the start of camp. No refunds will be made after 2 weeks prior to the start of camp unless for medical reasons.

To Apply: fill out and detach appropriate form(s) and return with proper fee (make checks payable to Benton Day Camp) to:

Martha Lee

3285 NW Manzanita Pl

Corvallis, OR 97330

Questions: call Martha at 753-9456 or e-mail marthalgs@earthlink.net

Girl Scout Day Camp

Camper & Program Aide Registration

GIRL SCOUTS OR UNITED STATES OF AMERICA

GIRL SCOUTS OF SANTIAM COUNCIL

BENTON SERVICE UNIT

Complete both sides of this application and return with applicable fee.

SCOUT? NO YES TROOP NUMBER: __________ PROGRAM LEVEL (Fall 2003) BR JR CA/SR*

ATTENDED CAMP BEFORE? NO YES * CA/SR - HAVE YOU BEEN A PA BEFORE? NO YES

Name of one BUDDY (same troop level) camper you would like to be with: ________________________________

(if no BUDDY is put down, we will try to put your camper with at least one other troop member)

Personal Information

Name: ___________________________________________________ Home Telephone Number: __________________

Address: _________________________________________________ Work Telephone Number: __________________

City: ______________________________ State: ______ Zip: ________ Cell Telephone Number: __________________

Mailing address, if different: __________________________________________________________________________

Camper’s age: _________________________ Grade in September 2003: ____________________________________

Parent’s last name, if different: ________________________________________________________________________

Special Needs (if there are special needs the camp staff should be aware of): ____________________________________

__________________________________________________________________________________________________

Refund Policy: Full refund will be given up to 2 weeks prior to the start of camp. No refund will be made after 2 weeks prior to the start of camp.

Please enter the proper fee amounts (based on the number of days an adult is volunteering for camp) in the lines below.

__________ Fee for registered Girl Scout (based on fee schedule from information page)

_______ Number of days an adult is volunteering to help at camp (or prior to camp)

__________ Fee for non-registered Girl Scout ($7.00 Girl Scout registration fee – required if not a registered Girl Scout)

__________ Tag-a-long fee (for children 4 years and older while an adult is volunteering at camp)

______ Number of days tag-a-long attending camp

________ _ Total fee being paid (If paying with a program certificate, please include the certificate or a note stating you will be using the program certificate once it is received).

__________ Registered Girl Scout applying for campership (contact camp director for application)

Please circle size of T-shirt for you camper:

Youth Med Youth Large Adult Small Adult Med Adult Large Adult X-Large

Emergency Information

In case of emergency please notify:

Parent or Guardian: _____________________________________________ Daytime Phone: ___________________

Emergency Contact: ____________________________________________ Daytime Phone: ___________________

Regular Doctor or Clinic Name: ___________________________________ Telephone Number: ________________

Family Medical Insurance Co.: ______________________________________________________________________

Member ID and Group Number: _____________________________________________________________________

□NO □YES Is your child taking any medication?

If YES F Please explain what it is and when and why it is taken (if it is needed during camp hours, please bring medication in original container with instructions to camp and leave with camp director).

□NO □YES Is there any restriction of activity for physical reasons?

If YES F (Please explain) _____________________________________________________________________

___________________________________________________________________________________

□NO □YES Is Tetanus Vaccination current? Date of last shot ___________________________________________

□NO □YES Does the camper meet State School Immunization Standards?

(If NO, a waiver signed by physician must accompany registration)

Does the camper have or is she subject to any of the following? (Please check if YES)

□Asthma □Diabetes □Fainting □Bleeding Disorders □Hyperactivity □ADD or ADHD

□Heart Troubles □Convulsions □Other ________________________________________________

(Any condition requiring special care, medication or diet)

□NO □YES Is she allergic to BEE STINGS?

If YES F Does she need an injection or oral medication? NO YES

What is the time frame and instructions for the medication? ___________________________________

____________________________________________________________________________________

□NO □YES Any other allergies requiring special considerations (including food allergies)? ____________________

____________________________________________________________________________________

Does the camper have difficulty with any of the following? (Please check if YES)

□Eyes □Ears □Throat □Digestion □Lungs □Headaches

If YES F Explain what actions need to be taken as treatment: ___________________________________________

_____________________________________________________________________________________

Parental Authorization

I give my daughter permission to attend Girl Scout Day Camp and to participate in all activities of the unit in which she is enrolled, except as noted above because of health. I have read the camp flyer and understand the arrangements for time, place, food, and transportation. I waive all claims, whether on behalf of my daughter/ward/me, or my daughter’s other parent, and absolve Girl Scouts of Santiam Council, and its employees and volunteers, from any responsibility in the event of accident or injury to the child while she is involved in any of the activities as a camper at Day Camp or traveling to or from the camp. I will not allow her to attend if exposed to any contagious disease (including lice), or if for any reason I do not consider her in good physical condition.

I hereby give permission for my daughter to receive emergency medical or surgical treatment and to by hospitalized, if necessary. It is understood that every attempt will be made to contact me or the person named above before taking this action. I also give permission for my daughter to be photographed, and allow Santiam Council to use photographs for Girl Scout promotion via printed material or internet use on the council website (identification of girls will be kept confidential if used in promotional materials). The non-Girl Scout fee will include membership into Girl Scouts for the camper through the remainder of the 2002-2003 membership year.

_________________________________________________________ ______________________________

Signature of parent or guardian Date

Girl Scout Day Camp

Adult Volunteer Application

Girls Scouts of Santiam Council

Benton Service Unit

Text Box: For adult volunteers, a tag-a-long unit will be available for the day(s) you are volunteering (boys & girls age 4 and above). Cost is $3.00 per day.
My tag-a-long will be attending: M Tu W Th F Text Box: Daughter’s Name __________________________________
Have you volunteered at camp before? YES NO
Number of days volunteering? 1 2 3 4 Full Time
Which days will you be available?
Saturday set up
M Tu Wed Thurs
Fr (Camp takedown)
Fr (Transporting camp equipment to storage unit)

Personal Information

Name: ___________________________________________________ Home Telephone Number: __________________

Address: _________________________________________________ Work Telephone Number: __________________

City: ______________________________ State: ______ Zip: ________ Cell Telephone Number: __________________

Mailing address, if different: __________________________________________________________________________

Health Information:

Last Tetanus Vaccination: ______________________________________ Policy Number ________________________

Family Medical Insurance Company: ___________________________________________________________________

Member ID and Group Number: _______________________________________________________________________

Volunteer Interests:

□Unit Leader (Adults volunteering Full Time will most likely be Unit Leaders) Program level preference: BR JR

□Unit Help (Assist Unit Leader – you will be in a different unit than your daughter)

□Experienced First Aider

Would you be willing to assist with or have special knowledge in any of the following activities:

□Assist with camper arrival □Kitchen □Flag etiquette □Knots

□Assist with camper departure □Lashing □Knife Safety □Rope Making

□Teach First Aid to campers □Survival Skills □Water Purification □Tent Set-up

□Compass Use and Map Reading □Shelter Building □Dutch Oven Cooking

□Clothing and Fiber Selection □Crafts □Fire Building

We realize that not all parents are able to help during camp. We can use you help in other ways. Please indicate the areas in which you can assist us.

□Obtaining materials □Clerical (Mailing, etc) □Preparation of camp crafts

□Help contact guest speakers □Emergency back up during camp □Camp Set-up (Sat. prior to camp)

□Camp clean-up (Friday of camp) □Emergency phone calls □Cutting Wood Cookies

□Transport camp equipment to storage unit (Friday of camp)

To keep the cost of camp reasonable, are you willing to donate or loan any of the following items for camp?

□Firewood □5 gal. buckets with lids for sit-upons □2 -3 inch diameter wood that can be cut for nametags

□Water purification devices □Compasses

Tag-A-Long Registration

Personal Information

Name: _____________________________________________________________________ Age: ______________

Address (if different from volunteer’s): _______________________________________________________________

Day(s) attending camp: □Monday □Tuesday □Wednesday □Thursday □Friday X $3.00/day = ___________fee paid