Clarkstown Parks & Recreation - spring and summer 2015 - Parks Make Life Better

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Clarkstown Parks & Recreation - spring and summer 2015 - Parks Make Life Better
Parks Make Life Better

                          Clarkstown Parks & Recreation
                            spring and summer 2015
                                                                3/17/15
                                                                 3/30/15 11:37 AM
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Clarkstown Parks & Recreation - spring and summer 2015 - Parks Make Life Better
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                                                Town of Clarkstown
                                                              a message from
                                                                  your town board

                                                Dear Resident,

                                                We are pleased to send you the spring and summer Parks and
                                                Recreation Guide for 2015. Please take the time to learn about the many
                                                recreational programs available to you.

         Alexander Gromack                      Clarkstown remains committed to providing our residents with a variety
              Supervisor                        of quality programs that are both family friendly and of individual
                                                interest. Since space is limited, early registration will ensure your place.

                                                We encourage you and your family to take advantage of our first rate
                                                recreational facilities and parks in Clarkstown.

                                                Our Town is proud to offer the best, most versatile recreational programs
             Shirley Lasker
             Councilwoman                       in Rockland County and we hope that you have the opportunity to
                                                make use of them. If you have any suggestions or comments,
                                                please call our Parks and Recreation Commission at 845.639.6200.

                                                Sincerely,

              Frank Borelli                     Alexander J. Gromack
               Councilman
                                                Town Supervisor

                                                a.gromack@clarkstown.org | 845.639.2050
                                                towncouncil@clarkstown.org | 845.639.2056

          George Hoehmann
             Councilman

                                                     Stay in touch with what’s happening in Clarkstown…
                                                     Sign-up for our e-newsletter!
                                                To receive our e-newsletter:
                                                Visit our website at                          Send an email with your first
          Stephanie Hausner                     clarkstown.org and click              OR      and last name to:
            Councilwoman                        “Register to Receive e-News”                  enews@clarkstown.org

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Clarkstown Parks & Recreation - spring and summer 2015 - Parks Make Life Better
table of contents
       a message from the supervisor . . . . . . . .inside front cover                                                                                 tennis and golf . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
       recreation commission and ready clarkstown . . . . . . . . . . .1                                                                               birthday parties, park facilities . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
       general registration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2                                         senior citizen programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
       aquatics information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-6                                                community centers and boating information. . . . . . . . . . . .14
       day camps
           campsandandCIT program.  ..  .. . . . . . .. ..  ..  .. . . . . . ..  ..  .. . . . . . .. ..  ..  .. . . . . . ..  ..  .. . . . . .77
                       preschool                                                                                                                       mail-in registration for pools . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
       playgrounds, preschool
                      CIT program,    andclarkstown
                                                Engineering                  for Kids
                                                                        sports                 camp,            .  .  .  .  . 8                        mail-in registration for instructional programs . . . . . . . . . . .16
       camp/playground
       sandlot stars camp medical
                           . . . . . . . . . .consent
                                               . . . . . . . . . form .
                                                                 . . . . . . . . . . . ..  ..  ..  ..  .. . . . . . . . .. ..  .. 98                   dates to remember, family music festival,
       camp/playground
       camp/playgroundregistration form .  . form
                       medical consent         .  .  .  .  . . . . .. ..  ..  .. . . . . . ..  ..  .. . . .10
                                                                                                            .9                                         and special events . . . . . . . . . . . . . . . . . . . . . . inside back cover
       camp/playground registration form . . . . . . . . . . . . . . . . . . . 10

        clarkstown parks board & recreation commission
        Jo Anne Pedersen, Superintendent                                                                      Phillip DeGaetano                               The Parks Board and Recreation Commission
        Paul Schofield, Deputy Town Attorney                                                                  Lon Hofstein                                    sponsors and conducts a year round program
                                                                                                                                                              of activities, events, and services for the children
        Brian Tesseyman, Chairman                                                                             Shirley Washington                              and adults of the community under full-time
        Scott W. Milich, Vice Chair                                                                           Edward Bertolino                                professional supervision. For additional information
        John J. O’Connell, Secretary                                                                                                                          please feel free to call 845.639.6200.

                                                                                                              IF WE CAN’T CONTACT YOU…WE CAN’T ALERT YOU!

                                                                                  This system enables the Clarkstown Police to ALERT YOU about emergency
                                                                                  situations affecting your neighborhood, business or other designated locations
                                                                                  of concern to you within the Town of Clarkstown such as schools, day care
                                                                                  centers, and relatives’ homes.

                                                                                  You will receive notifications on:
                                                                                   Police Alerts (ex: burglaries and major crime events)
                                                                                   Public Work Alerts (ex: road closures and storm recovery efforts)
                                                                                   Public Health/Environmental Alerts (ex: flooding and snow emergencies)

                                                                                  You can register multiple technology devices (such as personal cell phone,
                                                                                  work cell phone, home phone, personal emails, or work emails) specifying
                                                                                  the best way to reach you in an emergency.

                                                                                  Individuals with disabilities who require assistance can register by calling
                                                                                  the Clarkstown Police at 845.639.5853.

                                                                                                                     DON’T BE LEFT OUT, REGISTER TODAY.
                                                                                                                     Visit our website at clarkstown.org
                                                                                                                     and click on the Ready Clarkstown logo.

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Clarkstown Parks & Recreation - spring and summer 2015 - Parks Make Life Better
REGISTRATION DATES & TIMES (No Registration Monday, May 25, Memorial Day and Friday, July 3rd and Saturday, July
                                     4th.)
       MAIL IN or IN PERSON registration will be accepted at the                      Directions to: ADMINISTRATION BUILDING – ZUKOR PARK/STREET COMMUNITY CENTER
       ADMINISTRATION BUILDING- ZUKOR PARK                                            Take Main Street in New City north, past the New City Library. Continue to First STOP sign.
                                                                                      Continue straight (Zukor Road) Administration Building / Community Center is first red
       31 Zukor Road, New City, NY 10956
                                                                                      brick building on left, across from Historical Society of Rockland County.

                                                When you register for a program two weeks (or less) prior to the start date.
                                       THE FEE MUST BE PAID IN CASH, MONEY ORDER OR CREDIT CARD.
                                             These are starting dates, registration will continue after the date of the specific program.
                ONLINE REGISTRATION BEGINS AT 6:00am (must have current username and password)
             Saturday, March 28
             					 ‡All full day Camps, Playgrounds and CIT
             					                                                                                                          program, Swimming: Group & Instructional
             					                                                                                                          (Pre-School), Tennis Instruction and
             					                                                                                                          Summer Golf Lessons
             Monday, April 6 		                   MAIL IN			                                                                ‡
                                                                                                                              All Camps, Playground, Pre-School, Pool
             					                                                                                                          Passes, Instructional Programs and
             					                                                                                                          Pre-school Swim
             *Saturday, April 11 10:00 - 12:00pm IN PERSON Special Registration		                                           Swim & Spray Park Birthday Parties, Private
             					                                                                                                          Swim, Pre-school swim instruction Sat-Sun
             Monday, May 4       9:30 - 4:00pm    IN PERSON 			                                                             ‡
                                                                                                                              Camps, Playgrounds, Pre-School,
             					                                                                                                          Swimming: & Instructional (Preschool),
             					                                                                                                          Tennis Instruction, Summer Golf Lessons
             					                                                                                                          and Pool Passes

                             3 Ways to Register:                                                        GO GREEN! REGISTER ONLINE
                         Online • Mail In • In Person                                                   Come in to get your 2015 username and password.
                                                                                                        Current proof of residency and child’s birth
                                                                                                        certificates(first time enrollee) are required. Please verify
      *NO OTHER PROGRAM OR FACILITY REGISTRATION WILL BE ACCEPTED                                       child’s grade (Fall 2015). There are a limited number of
             ON THE SPECIAL REGISTRATION DATE LISTED ABOVE.                                             openings available for online registration. If you have
               After these dates, registration continues for these programs on a
                                                                                                        any questions, please call the Administration office at
                  first-come, first-serve basis. Registration hours listed below.
                                                                                                        845-639-6200.
                   No more than one family's registration will be accepted
                  from a registrant at a time. You may go through the line
                                                                                                        ‡
                                                                                                            These programs are available for
                  a second time for another family's registration if you have                               on line registration
                                all the necessary information.

        SUMMER REGISTRATION SCHEDULE
       To register in all programs, proof of age (Birth Certificate/Drivers License) and residency are required. Examples: valid NYS Driver’s License
       and current utility bill of primary residence. (All Registration is based upon grade entering in the Fall of 2015.)

               IN PERSON REGISTRATION HOURS:                                  REFUND POLICY                                        will be required in writing. The request
                                                                              Refunds/credits for recreation programs will         must be made within seven (7) working
       Monday through Friday ................. 9:30am – 4:00pm                be processed upon request in accordance              days of the situation.
       Tuesday & Friday evenings............ 7:00pm – 9:00pm                  with the following policy:                           • No refunds will be granted after a
       Saturday morning............................... 10:00am – 12:00 Noon   • Full refunds/credits will be issued for            program/activity has been completed.
                  Administration Building – Zukor Park                        classes cancelled by the Parks Board and             • Credits will be good up to one (1) year
                            31 Zukor Road                                     Recreation Commission.                               from date issued. They will be void after
                         New City, NY 10956                                   • A letter must be written to the                    that time period.
                                                                              Superintendent of Recreation and Parks
                             REGISTRATION                                     explaining why a refund/credit is being              Refunds/make-ups will not be issued for

                            639-6200                                          requested.
                                                                              • Full refunds/credits will be granted to
                                                                                                                                   classes cancelled due to inclement weather.

                                                                              individuals if it is prior to the start of class/    RETURNED CHECK POLICY
           PROGRAMS, DATES & TIMES                                            activity, minus service fee for refunds.
                                                                              • A $25.00 service fee will be charged on all
                                                                                                                                   There will be a charge of $20.00 on all
                                                                                                                                   checks returned by a bank. For example:
            ARE SUBJECT TO CHANGE                                             refund applications except those cancelled           insufficient funds, endorsement missing,
                                                                                                                                   endorsement not as drawn, wrong bank,
                                                                              or closed by the Commission.
                                                                                                                                   signature, uncollected funds, account
                                                                              • Refunds submitted after class has started          closed, payment stopped, post dated,
                                                                              will only be issued for medical reasons or if        foreign checks not marked “Payable in
                                                                              you have moved. A physician’s verification
                                                                                                                                   New York”, other.
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Clarkstown Parks & Recreation - spring and summer 2015 - Parks Make Life Better
AQUATICS INFORMATION
         			                                                                                                                                      Pool Hours of Operation
         Facility Location Dates                                                                                                                  (Weather Permitting)
         Germonds Pool
           185 Germonds Road,                                                     June 20th – July 11th                                           12:00pm – 6:45pm
           West Nyack                                                             July 12th – Aug. 16th                                           12:00pm – 8:00pm
         		                                                                       Aug. 17th – Aug. 30th                                           12:00pm – 6:45pm
         		                                                                       Aug. 31st – Sept. 4th                                           4:00pm – 6:45pm
         		                                                                       Sept. 5th – Sept. 7th                                           12:00pm – 6:45pm
         Lake Nanuet
           1 Lake Nanuet Dr. &                                                    June 27th – July 11th                                           11:00am – 7:45pm
           Blauvelt Rd. Nanuet                                                    July 12th – Aug. 30th                                           11:00am – 6:45pm
         		                                                                       Sept. 5th – Sept. 7th                                           11:00am – 6:45pm
         Congers Pool                      Memorial Park,
                                           6 Gilchrest Road, Congers              June 27th – Aug. 30th (closed for the season)                   12:00 Noon – 6:45pm
                                  Pool Information: Germonds Pool 623-1221, Lake Nanuet 627-2135, Congers Pool 268-9739
           Information for all swimming facilities can be obtained by calling the pool during operation hours. In case of inclement weather, Congers Pool
             and Lake Nanuet will close; Germonds Pool will remain open unless there is thunder and lightning. Please call the facility before going.

                                  “EARLY BIRD SPECIAL” register or post marked by 5/31/15 - NO EXCEPTIONS
                                                Residents have a choice of Three Fee Schedules:
                                                                            2015 FEE SCHEDULE
                                                                          Daily Rate                               Individual Rate                      Weeknight/Weekend Rate
                                                                                                                      Seasonal                    Seasonal/Holidays July 4th & Sept. 1st
                                                                 Entering          M-F ONLY                                                        (M-F 4pm - closing and weekends)
                                                                 Between         Entering Between
                        CATEGORY                              12 Noon–4pm         4pm - Closing              By 5/31          On or after 6/1         By 5/31         On or after 6/1
        Youths 2-17                                             $8.00          $5.00             $100.00          $125.00                             $85.00             $105.00
        Adults 18-59                                            $10.00         $6.00             $140.00          $165.00                             $105.00            $125.00
        Senior Citizens 60 and over                             No Cost with Town of Clarkstown Senior Citizen Discount Card
                                                   Daily: Residents with a daily card pay each time attending pool.
                         Individual Seasonal: Purchase of an individual rate entitles residents admission to the pool at no additional charge.
                                $7.00 Cost of each I.D. card is included in seasonal fee schedule. When purchasing seasonal passes,
                                         each additional child after the 3rd will be free, but you must pay the $7.00 card fee.
        Weekends Only: Residents who did not purchase a pool pass (Seasonal or Daily) can use the pools on Saturdays and Sundays paying the guest fee. You
                       must show proof of Town of Clarkstown residency. Please see page 2 for examples of residency that will be accepted.

                                                                             *NO REFUNDS*
        DISABLED RESIDENT-ACCESS PASS                                                                     Daily rates for guest who accompany a resident with
        A resident who is appropriately certified may use Town facilities at
        no cost. There will be a $7.00 fee for each I.D. card. Must have proper
                                                                                                                            a current I.D. card
        documentation at the time of registration. For further information                                                     GUEST RATES
        contact the Administration Office – Zukor Park (Registration Hot                    Youth 2-17                                       $10.00
        Line Number 639-6200) during Registration Hours listed on page 2.
                                                                                            Adults 18-59                                     $12.00
        VETERANS
        Post 9/11 Combat Zone Veterans and immediate families are entitled                  Senior Citizens 60 and over                      $6.00 (NO fee with proof of residency)
        to free pool passes - must provide DD214 Form for verification.
        INCLEMENT WEATHER POLICY
        If the pools are unable to open at the regularly scheduled times due to adverse              3.   The pool will not reopen for at least one-half hour after the
        weather conditions:                                                                               weather conditions noted above cease. In the event of a
             • Radio station WHUD FM 100.7 will be notified.                                              continuation of adverse weather conditions, the decision to close
             • A sign will be posted at the front gate                                                    the pool will be left to the discretion of the Aquatic Director and
             • An attempt will be made to open as soon as possible                                        the Supt. of Recreation and Parks.
        If the pool is unable to reopen by 4:00pm
             • No evening swimming or programs will take place.
             • Radio station WHUD FM 100.7 will be notified.
                                                                                                     4.   No refunds
             • A sign will be posted at the front gate.                                              GENERAL INFORMATION
        For questions call: Pool facilities or                                                       Lessons will be conducted rain or shine (except during electrical storms). There
        639-6200 (Recreation & Parks Office).                                                        will be no make-up classes for missed classes. Upon entering the twelfth grade,
        If the pool opens, but one of the following is observed – lightning, hail, severe rain       you are considered an adult. American Red Cross Water Safety Instruction is
        storm or thunder:                                                                            provided for all age group lessons. Proof of age, grade and primary residency is
        1.     The pool will be cleared.                                                             required at the time of registration. Parent/spectators are not permitted in swim
        2.     Patrons will be instructed to clear pool deck and tree areas.                         areas during instructions.

                          * The area surrounding Lake Nanuet and Congers pool will have wireless access*
            No person shall utilize any mechanical, digital, or electronic viewing device or any other instruments capable of recording, storing or
             transmitting visual images in any indoor facility under the authority of the Clarkstown Parks Board and Recreation Commission.

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Clarkstown Parks & Recreation - spring and summer 2015 - Parks Make Life Better
Town of Clarkstown Swimming Facility Rules and Regulations
        All participants in the Pool are expected to behave in such a manner as not to disturb others using the pool. Please adhere to the following rules and
        regulations in and around the pool:
        Admission only on presentation of official I.D. Card and payment of                   Spitting or other discharges into pools prohibited. Anyone who has had
        designated fee each person must display his/her own pass for inspection.              diarrhea within the past two weeks should stay out of the water.
        Illegally used passes WILL be confiscated. Re-entry to pool will be deter-
        mined by hand stamp.                                                                  Alcoholic beverages prohibited at all Town of Clarkstown facilities.
        The number of persons permitted in pool area is regulated by the Health               Pets are not permitted in any park.
        Department. The capacity of each facility is posted and admission will be
        on a first-come, first-serve basis. Patrons must park according to atten-             Sun and Eye glasses are permissible in the water. No glass containers of any
        dant’s instructions. Parking will be permitted on park grounds to limit of
        existing parking facilities                                                           kind permitted in pool, on decks, or in locker areas. The following are not
                                                                                              permitted in swimming pool areas: ball playing, pushing, running, dunking
        Guest must enter with member.                                                         or boisterous conduct, toys, play devices, fins, masks, snorkels or any flota-
        Violence or rough play towards staff or other participants                            tion device except Coast Guard approved. Approved competitive swim
        will not be tolerated.                                                                goggles are permissible. Corrective lenses may be attached to approved
        Name-calling, or racial insults, or negative or verbal insults, or abusive lan-       swim goggles at a very reasonable cost.
        guage, or foul language, or swearing will not be tolerated.
                                                                                              Chairs, strollers, blankets, etc. must be kept at least 15 ft.
        Spitting or tobacco products, or smoking are not tolerated                            from water’s edge.
        in the pool area.
        Malicious destruction or stealing of property or other personal property              Laps lanes are for long distance continuous swimming only.
        will not be tolerated. (Parents/caregivers will be responsible for replacing          Radios are permitted, but the volume should be turned down so it does
        any property that their child(ren) may destroy and/or steals).
                                                                                              not interfere with other residents. Blasting of radios is prohibited in the
        No weapons and/or firearms are permitted.                                             pool area.
        No glass containers in pool area.
                                                                                              No checks will be accepted at the pools. Cash and Credit Cards- Visa/
        No drugs in parks.                                                                    Mastercard are accepted.
        Proper swimming attire is required at all times. Cut-off or rolled-up pants           No persons shall utilize any mechanical, digital, or electronic viewing
        not permitted for swimming.
                                                                                              device or any other instruments capable of recording, storing, or trans-
        The Commission reserves the right to close the grounds for cause (i.e.                mitting visual images in any indoor facility under the authority of the
        inclement weather, utility failure, etc.), with no refund or rain checks to           Clarkstown Parks Board and Recreation Commission.
        persons paying daily admission or guest admission. In the event of facility
        closure, a hand stamp will admit attendees to an alternate facility.                  Radios are not permitted in picnic areas.
        Children under 13 years old must be accompanied by an adult who will
        assume full responsibility for the child’s safety.                                    Failure to follow these rules and regulations could result in disciplinary
                                                                                              action, including removal from the pool and/or suspension or cancellation
        Wading areas restricted to children 7 years old and under, and their par-             of I.D. Card
        ents. Children under 6 must be accompanied to bathhouse by an adult.
        Swimming and diving permitted in designated areas only.                               Disciplinary Procedures for failure to obey Rules and Regulations:
        Health Department rules for sanitation and safety must be observed by                 Patron will receive one verbal warning for any violation of any of the above
        every patron. Infants in diaper/pull-ups not permitted in pools. Approved             rules and regulations, and if it continues, they will be asked to leave the
        swim diapers will be permitted in kiddie pools only, i.e. Congers Wading              facility for that day.
        Pool, or the Germonds Wading Pool. Approved swim diapers are permis-
        sible at Lake Nanuet in the zero depth entrance area only.                            If any violation of any of the above rules and regulations has not
        Persons with physical disorders such as skin lesions, inflamed eyes, nose,            improved within a reasonable time, he/she will be suspended for 2 days or
        mouth, or ear discharges, or bandages, may not swim.                                  longer, depending on the nature of the offense and at the discretion of the
                                                                                              Aquatic Director.
        All recreation, park, and swimming staff are required to strictly enforce
        the regulations. These rules and hours of operation will be amended or                If there is one more offense, their pool pass will be revoked.
        supplemented as necessary for the safety and welfare or patrons. Violators
        are subject to suspension of privileges. Any questions regarding these rules          Any weapons and/or firearms brought to the pools or parks are cause for
        and regulations or use of the facility should be directed to the head life-           immediate dismissal from the pool and park.
        guard at each location.

         AQUATICS                    Registration Information: On-line starts March 28, 2015 • Mail In starts April 6, 2015 • In Person starts May 4, 2015

        MORNING LAP SWIMMING                                                                  AQUA AEROBICS (10110A)
        AT GERMONDS POOL (10114 A)                                                            Physical conditioning through water exercise
        The lap lane section of the main pool will be used for the morning                    Location: Congers Lake Pool with some classes meeting at Lake
        lap swimming group. This is not an instructional program. Only                        Nanuet - TBA
        those registered will be allowed in the pool area during this time. No                Day/Time: Monday, Wednesday, Friday 7:00pm - 8:00pm
        children will be permitted                                                            Dates: June 29— August 7
        in the facility.                                                                      Eligible: Grade 12 and Older
        Day/Time: Monday - Friday 7:30 am- 8:30 am                                            Fee: $170.00
        Dates: June 29— August 14                                                             Note: Health Waiver must be signed before attending class.
        Eligible: Adults 19 years of age and up
        Fee: $100.00
        No Lap Swimming program on July 8, 15 and 22.

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Clarkstown Parks & Recreation - spring and summer 2015 - Parks Make Life Better
AQUATICS:                      Registration Information: On-line starts March 28, 2015
            		                             Mail In starts April 6, 2015 • In Person starts May 4, 2015
        ‡
         YOUTH SWIMMING- GROUP INSTRUCTION (10102)                                       ‡
                                                                                             PRE-SCHOOL SWIM INSTRUCTION- (10101)
        The object of this course is to teach individual basic water                     This class is designed to acquaint the young child with the
        safety and swimming skills and progress to advance levels.                       aquatic environment.
        PARENTS ARE NOT PERMITTED IN SWIM AREA.                                          The parent or an adult with the child will enter the water and
        Location: GERMONDS POOL		                  Fee $170.00                           learn together through play activities.
        June 29-July 10 Mon.-Fri.                                                        Location: CONGERS POOL		                   Fee $170.00
        (10102-A) 11:00am- 11:40am                                                       June 29-July 10 Mon.-Fri.
        July 13- July 24 Mon.- Fri.                                                      (10101-A) 11:10am- 11:40am
        (10102-C) 11:00am- 11:40am                                                       July 13- July 24 Mon.- Fri.
        July 27-August 7 Mon.-Fri.                                                       (10101-B) 11:10am- 11:40am
        (10102-E) 11:00am- 11:40am                                                       Eligible: Children three (3) year old (as of June 1, 2015)
        Eligible: 1st thru 11th grade                                                    through those entering Kindergarten. Child must be toilet trained.
        10 classes, 40 minutes each, grouped by ability,                                 10 classes, 30 minutes each, limit 10 swimmers per class.
        6-10 swimmers per instructor

                                                       PRIVATE SWIM INSTRUCTION
            All lessons will be conducted subject to availability of instructor. Parents are not permitted in swim area (except for pre-school swim instruction)
                                                   6 classes, 30 minutes each. One participant per instructor.
            		                                       Fee: $205.00 | Eligible: Ages 3 as of the first class through Adult/Senior
                                    In Person Registration: Saturday, April 11th, 10am to 12pm. On-line after 1:00pm
                              (Limited Registration) You may only register for one class per child or adult on the initial day of registration

                                        WEEKDAY                                                                      WEEKEND
             June 29-July 10 M,W,& F		               June 30-July 16 T&TH                July 11- July 26 Sat. & Sun.
             GERMONDS (6 max participants)                                               GERMONDS (4 max participants)
             (10103-A) 9:45-10:15		        (10103-C)              9:45-10:15             (10103-M) 10:25-10:55         (10103-N) 11:00-11:30
             (10103-B) 10:20-10:50		 (10103-D)                    10:20-10:50            CONGERS (2 max participants)
             CONGERS (3 max participants)                                                (10104-K) 8:45-9:15		 (10104-L) 9:20-9:50
             (10104-A) 9:50-10:20		        (10104-C)              9:50-10:20             LAKE NANUET (4 max participants)
             (10104-B) 10:25-10:55		 (10104-D)                    10:25-10:55            (10105-K) 9:25-9:55		 (10105-L) 10:00-10:30
             LAKE NANUET (6 max participants)
             (10105-A) 10:00-10:30		       (10105-B)              10:00-10:30            Aug. 1- Aug. 16 Sat. & Sun.
                                                                                         GERMONDS (4 max participants)
             July 13-July 24 M,W,& F		               July 21-Aug. 6 T&TH                 (10103-O) 10:25-10:55         (10103-P) 11:00-11:30
             GERMONDS (6 max participants)                                               CONGERS (2 max participants)
             (10103-E) 9:45-10:15		        (10103-G)              9:45-10:15             (10104-M) 8:45-9:15           (10104-N) 9:20-9:50
             (10103-F) 10:20-10:50		       (10103-H)              10:20-10:50
                                                                                         LAKE NANUET (4 max participants)
             CONGERS (3 max participants)                                                (10105-M) 9:25-9:55		 (10105-N) 10:00-10:30
             (10104-E) 9:50-10:20		        (10104-G)              9:50-10:20
             (10104-F) 10:25-10:55		       (10104-H)              10:25-10:55
             LAKE NANUET (6 max participants)                                            WEEKEND PRE-SCHOOL SWIM
             (10105-C) 10:00-10:30		       (10105-D)              10:00-10:30
                                                                                         INSTRUCTION
                                                                                         This class is designed to acquaint the young child
             July 27-Aug. 7th M,W,& F                                                    with aquatic environment.
             GERMONDS (6 max participants)                                               Location: CONGERS POOL
             (10103-I) 9:45-10:15		                                                      July 11- July 26 Sat.&Sun.		             FEE $110.00
             (10103-J) 10:20-10:50			                                                    (10101-D) 9:20-9:50am
             CONGERS (3 max participants)                                                Aug. 1- Aug. 16 Sat.&Sun.
             (10104-I) 9:50-10:20		                                                      (10101-E) 9:20-9:50am
             (10104-J) 10:25-10:55                                                       Eligible: Children three (3) year old (as of June 1, 2015)
             LAKE NANUET (6 max participants)                                            through those entering Kindergarten. Child must be
             (10105-E) 10:00-10:30                                                       toilet trained. Class Information: 6 classes, 30 minutes each, limit 4
                                                                                         swimmers per class.

                                                                                     5

Clarkstown_SpringSummer2015.indd 5                                                                                                                                3/30/15 7:21 PM
Clarkstown Parks & Recreation - spring and summer 2015 - Parks Make Life Better
COMPETITIVE SWIMMING                                                AMERICAN RED CROSS LIFEGUARD TRAINING
        Location: Germonds Pool                                            (10111B)
        Day/Time:Monday-Friday
                                                                            This course is designed to teach
        Class sessions will be assigned by coach
        Dates: June 22- June 26 from 5:00pm - 7:00pm                       lifeguarding skills that are essential
                 June 29 - July 30 from 8:30am - 10:30am                    to maintaining a safe aquatic
        First tryouts: Monday, June 22nd, at 5:00pm.                        environment. The American Red Cross Lifeguard Training,
        Fee: $185.00 (Includes T-shirts)                                    CPR for the Professional Rescuer, and First Aid certification
                                                                            may be obtained by passing all qualifying tests given at the
                                                                            end of the course.
        COMPETITIVE SWIMMING (10106A)                                       Mandatory Qualifying Test
        Eligible: Children up to 18 years of age as of June 22, 2015        Required Document
        according to established AAU & USS age group.                       Copy of birth certificate or Driver’s License
        Grouped by age                                                      Qualifying Test:
                                                                            -Swim 300 yards continuously. (100 yards front crawl, 100
                                                                            yards breaststroke, and 100 yards of either)
        PRE-COMPETITIVE SWIMMING (10107A)                                    -Swim 20 yards using a front crawl or breaststroke, surface
        Eligible: Children up to 18 years of age as of June 22, 2015
                                                                            dive to a depth of 10 feet and retrieve a 10 pound object,
        who are not yet the caliber of competitive swimmers.
                                                                            return to the surface, and swim 20 yards back to the
        At the time of their tryout, if skill level is not sufficient
        for precompetitive swimming, group lessons are                      starting point with the object.
        recommended. Grouped by ability. Stresses instruction to            Special Note: Any participant who turns 16 during
        improve competitive swim techniques                                 the summer and who successfully completes all course
        *** Parents are NOT permitted in swim areas                         requirements may be eligible for a part-time Lifeguarding
        except during competitions***                                       position at one of our facilities for the remainder of the
        Registration:Begins Tuesday, June 23rd at 9:30am                    season. This is a good opportunity to “get your foot in the
                                                                            door” for future employment at our swimming facilities.
        ***Must bring a signed application form from the
        instructor/coach to register for: Competitive, and Pre-
                                                                            Location: Germonds Pool & Street Community Center
        Competitive swimming, and Lifeguard Training
                                                                            TRYOUTS: June 24th 4 - 6pm or June 25th 4 - 6pm
                                                                            Day/Time: Tuesdays, Wednesdays and Thursdays
                                                                            5:00pm - 8:00pm
         SWIM ACROSS AMERICA                                                July 7, 8, 9, 14, 15, 16, 21, 22, 23, 28, 29, 30, 2015
         Day/Time: Sunday, July 12, 2015 at 7:00am                          Eligible: 15 & over (minimum age is 15 at start of course).
         Location: Germonds Pool                                            Limited Enrollment: 6 participants needed
         “Please join us for our 5th Annual Clarkstown Swim                 or class may be cancelled.
         Across America Event”. We will be joining with the                 Fee: $375.00 Lifeguard Training (includes Red Cross
         Long Island Sound Swim Across America events to help
                                                                            pocket masks and all tests) Payable at the Administration
         FIGHT CANCER. Proceeds will benefit United Hospice
                                                                            Building - Zukor Park
         of Rockland and cancer research programs at Memorial
         Sloan-Kettering Cancer Center, New York Presbyterian               Registration: Friday, June 26th at 9:30am at the
         Babies Hospital, and the Cancer Support Team.                      registration office, 31 Zukor Rd, New City
         For further details please visit SAA Long Island website:
         www.swimacrossamerica.org/Iong_island                                 ATTENDANCE AT ALL CLASSES
                                                                                     IS MANDATORY.
                                                                            THERE WILL BE NO MAKE-UP CLASSES
                                                                                ABSENCE MEANS FAILURE!

                       Parents are NOT permitted in swim areas except during competition!
                                                                        6

Clarkstown_SpringSummer2015.indd 6                                                                                                   3/30/15 7:21 PM
Clarkstown Parks & Recreation - spring and summer 2015 - Parks Make Life Better
3 Ways to Register: On Line • Mail In • In Person
                                                                         DAY CAMPS
                                       DON’T FORGET EARLY ONLINE REGISTRATION ON MARCH 28 AT 6:00AM
                                                          (see page 2 for on-line registration requirements)
                          *MEDICAL CONSENT FORMS MUST BE SUBMITTED AT TIME OF REGISTRATION SEE PAGES 9 & 10.*
                                We will be accepting MAIL-IN REGISTRATIONS for ALL CAMPS & PLAYGROUNDS starting Monday, April 6th.
            REGISTER EARLY, LIMITED ENROLLMENT. IN PERSON starts on Monday, May 4th. Proof of age, grade, and residency is required at the time of registration.
        ‡
            FULL DAY CAMP                                                                ‡
                                                                                             CIT PROGRAM (10508A)
        Activities include athletics, arts & crafts, game room, recreational             Counselor-in-Training program is available for students that are ages
        swimming four days a week (weather permitting) and four major trips.             15 or will not be 16 before June 29, 2015. They will go through a well -
        Day/Time: Monday-Friday, 8:30am - 5:30pm                                         rounded program with a director working on problem solving, games,
        Dates: June 29 – August7 (no program July 3rd),                                  activities and assisting counselors.
        Eligibility: Youth entering grades 1-5. (Kindergarten at Strawtown camp          Limited Space - only 14 students will be admitted. After you register an
        only)                                                                            interview will be held to insure you are appropriate for this position.
        Fee: Register by 6/7 $1,100.00/on or after 6/8 $1250.00 Includes
                                                                                         Location: Various locations
        admission and transportation to town swimming facilities, T-Shirt
                                                                                         Day/Time: June 25, 26, 6-9pm - Street Community Center
        and camp bag. Additional cost for each trip. No transportation is
                                                                                         June 27, 9-12 noon, - Felix Festa M.S.
        provided to and from camp. Children placed in groups by grade.
                                                                                         June 29- August 7, 8:30am - 5:30pm
        Locations:                                                                       (No program July 3rd)
        (10500-A)-CAMP CLARKSTOWN AT                                                     Eligibility: Ages 15 and anyone who will not be 16 by June 29, 2015
        GEORGE MILLER ELEMENTARY SCHOOL                                                  Fee: $650.00 includes 4 trips
        (10501-A)- CAMP CLARKSTOWN AT                                                    Further information is available at the recreation office.
        LAUREL PLAINS ELEMENTARY SCHOOL
        (10502-A)- CAMP CLARKSTOWN AT
                                                                                         ‡
                                                                                          EXTENDED SUMMER CAMP
        STRAWTOWN ELEMENTARY SCHOOL                                                      AT STREET COMMUNITY CENTER
        *NEW (10502-K)-Full Day Kindergarten at                                          FULL DAY FOR ONE OR TWO WEEKS
        Strawtown Elementary School                                                      Activities include: arts & crafts, athletics, games plus special events.
                                                                                         Eligibility: Youths entering 1-6th grade.
        ‡
            FULL DAY CAMP EXTENDED HOURS                                                 Full Day Day/Time: M-F 8:30am - 5:30pm Swimming Included
        Day: Monday-Friday                                                               Both Weeks:
        Dates: June 29 – August 7 (no program July 3rd)                                  (10510-A) Aug. 10- Aug. 21 Fee: $445.00 (on or after 7/20 $495.00)
        Eligibility: Youth entering grades 1-5.                                          (10510-A1) Aug. 10- Aug. 21 Early drop off Fee: $70.00
        (10500-) George Miller Elementary School                                         (10510-A2) Aug. 10- Aug. 21 Late pick up Fee: $70.00
        (10501-) Laurel Plains Elementary School                                         (10510-A3) Aug. 10- Aug. 21 Early/Late $115.00
        (10502-) Strawtown Elementary School
        (C) Early Drop-Off 8:00am-8:30am $170.00                                         1st Week:
        (D) Late Pick-Up 5:30pm-6:00pm $170.00                                           (10510-B) Aug. 10- Aug. 14 Fee:$230.00 (on or after 7/20 $280.00)
        (E) Both Early & Late $300.00                                                    (10510-B1) Aug. 10- Aug. 14 Early drop off Fee; $40.00
                                                                                         (10510-B2) Aug. 10- Aug. 14 Late pick up Fee: $40.00
        ‡
         MIDDLE SCHOOL CAMP AT                                                           (10510-B3) Aug. 10- Aug. 14 Early/Late $65.00
        CLARKSTOWN HIGH SCHOOL NORTH (10503A)                                            2nd Week:
        Activities include athletics, arts & crafts, game room, recreational             (10510-C) Aug. 17- Aug. 21 Fee:$230.00 (on or after 7/20 $280.00)
        swimming four days a week at Germonds Pool (weather permitting),                 (10510-C1) Aug. 17- Aug. 21 Early drop off Fee: $40.00
        four major trips.                                                                (10510-C2) Aug. 17- Aug. 21 Late pick up Fee: $40.00
        Day/Time: Monday Friday, 8:30am 5:30pm                                           (10510-C3) Aug. 1.7- Aug. 21 Early/Late Fee: $65.00
        Dates: June 29- August 7 (no program July 3rd)                                   No transportation to and from the playground.
        Eligibility: Youth entering grades 6-10                                          Children placed in groups by grade.
        Fee: Register by 6/7 $1,325.00 /on or after 6/8 $1,475.00 Includes               An additional fee may be required for special activities.
        admission and transportation to town swimming facilities, T-Shirt and
        camp bag. Camp trips are included in the fee. No transportation is
        provided to and from camp. Children placed in groups by grade.                       IMMUNIZATIONS NEEDED FOR FULL DAY CAMPS
        There will be no camp for campers that do not go on trips.                           Haemophilus- influenza Type B Shot
        *Limited enrollment.                                                                 Hepatitis B Shot
                                                                                             Varicella (Chicken Pox) Shot
                                                                                             STRICTLY ENFORCED!
        SNEAKERS MUST BE WORN IN ALL CAMP
        AND PLAYGROUND PROGRAMS                                                              T-Shirt / Camp bag and information sheet pickup:
                                                                                             Street Community Center- 31 Zukor Rd., New City
            When you register for a program two weeks (or less) prior to                     Sat., June 6, 10:00am-1:00pm
                 the start date, THE FEE MUST BE PAID IN CASH,                               Mon., June 15, 8:00am-12:00pm and 3:00pm-7:00pm
                        MONEY ORDER OR CREDIT CARD.                                          Thurs., June 25, 8:00am-12:00pm and 3:00pm-7:00pm

                                                                                     7

Clarkstown_SpringSummer2015.indd 7                                                                                                                             3/30/15 7:21 PM
Clarkstown Parks & Recreation - spring and summer 2015 - Parks Make Life Better
3 Ways to Register: On Line • Mail In • In Person
                             PLAYGROUNDS/PRE-SCHOOL/ENGINEERING FOR KIDS
                        DON’T FORGET EARLY ONLINE REGISTRATION ON MARCH 28 AT 6:00AM
                                                             (see page 2 for on-line registration requirements)
                            *MEDICAL CONSENT FORMS MUST BE SUBMITTED AT TIME OF REGISTRATION SEE PAGES 9 & 10.*
        We will be accepting MAIL-IN REGISTRATIONS for ALL PRE-SCHOOL & PLAYGROUNDS starting Monday, April 6th. REGISTER EARLY, LIMITED ENROLLMENT.
                              IN PERSON starts on Monday, May 4th. Proof of age, grade, and residency is required at the time of registration.

         ‡
             PLAYGROUNDS (10701-)                                                              ‡
                                                                                                   ENGINEERING FOR KIDS
         Activities include arts & crafts, athletics, games. drama & music, plus special                          Engineering For Kids has grouped its most popular engineering
         events. (Limited Enrollment)                                                                             program lessons by theme to provide a selection of summertime
                                                                                                                  camps for 3rd to 6th Grade. Each camp is interactive and competitive
         LOCATIONS:                                                                                               in nature. Camps are offered as 3 hour, 5 days a week session and
         ‡
             (B) Lakewood                       ‡
                                                  (F) George Miller Elementary School                             can be paired with Electronic Game Design to make a full day camp.
                                                      (9:15am–12:15pm)                         Here are the camps that we recommend for this summer’s session:
         ‡
           (C) Congers Community Center         ‡
                                                  (G) New City                                 Eligible: Grades 3-6
                                                                                               Location: Street Community Center
               Grades 3-5 (9:15am–12:15pm)                                                     Fee:
         ‡
           (D) Link                            ‡
                                                 (H) West Nyack                                (10601-A) Momentum Madness $260.00            (10602-A) Survivor- Engineers Cove $260.00
         ‡
           (E) Pascack Community Center $215.00 (on or after 6/8 $290.00)                      (10601-B) Electronic Game Design $260.00      (10602-B) Electronic Game Design $260.00
         Day/Time: Monday-Friday, 9:00am – 12:00 Noon.                                         (10601-C) Both classes            $385.00     (10602-C) Both classes               $385.00
         Dates: June 29 – August 7, 2015 (no program July 3rd)                                 (10601-D) Early Drop Off          $10.00      (10602-D) Early Drop Off             $10.00
         Eligibility: Youths entering Kindergarten through 5th grade.                          (10601-F) Late Pick up            $40.00      (10602-F) Late Pick up               $40.00
         Fee: Register by 6/7 $195.00 / on or after 6/8 $270.00                                When signed up for two classes on the same day, there will be a 1 hour
         Includes T-Shirt. No transportation to and from playground.                           supervised lunch break.
         Youths placed in groups by grade. An additional fee may be required for               (10601-A) Momentum Madness: Zero to sixty in two seconds?! How fast can an object
         special activities.                                                                   go without compromising safety? Students in this camp will work with their Pit Crew to
                                                                                               design and build vehicles, such as dragsters and hovering levitrons, which should able to
         ‡
          SUMMER SIZZLERS FOR GRADES 5TH-10TH                                                  withstand astonishing speeds. Fasten your seat belt, the race has begun!
         (10701-I)                                                                             Dates / Time: August 10 – 14, 2015 9:00am-12:00pm
         Thrill to a Summer of athletics, crafts, and special events plus plenty of FUN!       (10601-B) Electronic Game Design (Racing Games): During the Electronic Game
                                                                                               Design Racing Games camp, students will use Multimedia Fusion 2® to create their own
         Location: Little Tor (10701-I)                                                        PC video game. Students design a racetrack, race cars and an environment in which their
         Day/Time: Monday-Friday, 9:15am -12:15pm                                              cars compete. At the end of the class, students take home a copy of the game they create.
         Dates: June 29 - August 7 (no program July 3rd)                                       Dates / Time: August 10 – 14, 2015 1:00pm-4:00pm
         Eligibility: Youth entering grades 5th -10th.
         Fee: Register by 6/7 $195.00 / on or after 6/8 $270.00                                (10602-A) Survivor - Engineer’s Cove: Stranded on an abandoned island - surrounded
         Includes T-Shirt. No transportation to and from playground                            by darkness, cold temperatures, wild animals, and other dangers. Students in this camp
         Limited space. Minimum number required to run this program. Youth placed              will join tribes and compete in various engineering-related challenges against other tribes
         in groups by grade. An additional fee may be required for special activities.         to survive and eventually escape the harsh island conditions. Join us in the first ever
                                                                                               Engineering for Kids® Survivor challenge – Engineer’s Cove.
         ‡
          EXTENDED SUMMER PLAYGROUND AT                                                        Dates / Time: August 17 – 21, 2015 9:00am-12:00pm

         STREET COMMUNITY CENTER                                                               (10602-B) Electronic Game Design (Platform Games): During the Electronic Game
                                                                                               Design Platform Games Camp, students will use Multimedia Fusion 2® to create their
         HALF DAY FOR ONE OR TWO WEEKS (10701-J)                                               own PC video game. A platform game is a side-scrolling, Mariotype game where students
         Activities include: arts & crafts, athletics, games plus special events               program characters and a two-dimensional obstacle course. They attempt to avoid or
         Half Day Day/Time: Monday-Friday, 8:30am - 11:30am                                    overcome enemies and reach an end goal on multiple levels. At the end of the class,
                                                                                               students take home a copy of the game they create.
         Eligibility: Youths entering Kindergarten-6th grade.
                                                                                               Dates / Time: August 17 – 21, 2015 1:00pm-4:00pm
         (10701-J)         Aug. 10- Aug. 21          Fee:$95.00
         		                                          (on or after 7/20 $130.00)                Extended Care Fee (Optional): Participants requiring additional child-care outside
         (10101-J1)        Aug. 10- Aug 14           Fee: $60.00                               of 9 AM to 4 PM can sign up for extended care which includes supervision.
         		                                          (on or after 7/20 $95.00)                 • Monday – Friday Mornings from 8:30 am to 9:00 am ($10)
         (10701-J2)        Aug. 17- Aug. 21          Fee: $60.00                               • Monday – Friday Afternoons from 4:00 pm to 5:30 pm ($40)
         		                                          (on or after 7/20 $95.00)
         PRE-SCHOOL (10901)                                                                        HELPING HANDS (10904)
         Have your child beat the heat in our fun-filled air-conditioned,                          A.K.A. “The Lunch Bunch” is an afternoon of cooperative play and relaxed
         certified teacher run classroom environment. Themed weeks loaded                          enrichment activities.
         with creative crafts, sprinkler and water tables and daily activities for                 Eligibility: Any child already enrolled in our pre-school program.
         social and physical development.                                                          Time: 11:30-1:30 pm
                                                                                                   Day: Monday - Friday
         Eligibility: Age 3 to 4 ½ as of June 1st, 2015 and any 5 year old who will
                                                                                                   Location: Street Community Center
         NOT be attending Kindergarten
                                                                                                   Dates: June 29-August 7 (No program July 3rd)
         Note: Child must be toilet-trained- no diapers.
                                                                                                   Fee:             (A) 2 days $252.00
         Limited enrollment!
                                                                                                                    (C) 3 days (Mon Wed & Fri ) $357.00
         Location: Street Community Center
                                                                                                                    (D) 5 days $609.00
         Time: 9:00am - 11:30am
         Ages 3- 3½       (B)     3 day program:
                 		               Tues., Wed. & Thurs.      $504.00
         Ages 3 ½ -5 (C)       3 day program:
                		             Mon.,Wed., & Fri.         $476.00
                        (D) 5 day program:
                		             Mon-Fri		                 $812.00
         Dates: June 29 - August 7 (No program July 3rd)

                                                                                           8

Clarkstown_SpringSummer2015.indd 8                                                                                                                                             3/30/15 7:21 PM
CLARKSTOWN	
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                2.  	
  Name:	
  	
                  	
                         	
                    	
                   	
                   	
  	
  	
  	
  	
  Relationship:	
   	
                                 	
                	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  Phone	
  #:	
                                               	
                	
                ___	
  
                2.  	
  Name:	
  
                MEDICAL	
    2. Name:	
    INFORMATION:	
  
                                                     	
               	
   	
                 	
   	
                	
   	
            	
   	
  	
  	
  	
  	
  Relationship:	
                       	
  
                                                                                                                                                                        	
  	
  	
  	
  	
  Relationship:	
      	
   	
           	
   	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  P	
  	
  	
  hone	
  
                                                                                                                                                                                                                                                                                                                                 	
  	
  	
  	
  	
  	
  	
  	
  P#hone	
  
                                                                                                                                                                                                                                                                                                                                                                    :	
     #:	
   	
        	
   	
           	
   ___	
   ___	
  
                                	
  
                    	
   MEDICAL	
  
                MEDICAL	
  
                Doctor’s	
            N	
  ame:	
  
                                           INFORMATION:	
  
                                                          I	
  NFORMATION:	
         	
                    	
                   	
                      	
                                   	
             	
                	
                   _Phone#:	
                                                                                                       	
                  	
                	
            ___	
  
                    	
   	
                   	
  
                Please	
  
                Doctor’s	
     list	
  
                                      Naame:	
  
                    	
  	
   Doctor’s	
     ny	
  aNllergies	
  
                                                      ame:	
  
                                                           	
             (	
  bee	
  
                                                                                     	
   stings,	
  
                                                                                                  	
   	
  foods,	
  	
  medications,	
  
                                                                                                                                	
          	
   	
   etc.)	
  	
   	
                             	
   	
           	
   	
                       	
  
                                                                                                                                                                                                                                       	
   _Phone#:	
                                          _Phone#:	
         	
                                               	
       	
   	
             	
   	
  __________	
  
                                                                                                                                                                                                                                                                                                                                                                                                                   	
   ___	
   ___	
  
                                       	
  
                Please	
      ldist	
  
                    	
   Please	
    escribe	
      tahe	
  
                                             list	
  
                                       	
  any	
            ny	
  saymptoms	
  
                                                   allergies	
       llergies	
            (bee	
  
                                                                          (bee	
  stings,	
  of	
  the	
         allergy:	
  
                                                                                                         sftings,	
  
                                                                                                                oods,	
  fm
                                                                                                                          oods,	
    __________________________________________________________________________	
  
                                                                                                                                        medications,	
  
                                                                                                                                edications,	
                        etc.)	
   e	
   tc.)	
   	
   	
                	
   	
           	
   	
                                                  	
   	
                                                      	
   	
         	
   	
             	
   __________	
  
                                                                                                                                                                                                                                                                                                                                                                                                                   __________	
  
                       Are	
  any	
  
                                  dm    edications	
  
                                Please	
  
                       Please	
            describe	
  
                                      escribe	
           otr	
  he	
  
                                                                 precautions	
  
                                                  the	
  symptoms	
                noaecessary	
  
                                                                        symptoms	
  
                                                                           of	
  the	
   f	
  llergy:	
    for	
  the	
  
                                                                                                the	
  allergy:	
         allergy	
  (ie.	
  Epi-­‐Pen)_____	
  	
   	
   	
   	
   __________	
  
                                                                                                                    __________________________________________________________________________	
  
                                                                                                          __________________________________________________________________________	
  
                       Is	
  your	
  
                       Are	
          cm
                                       hild	
  
                                 Are	
  
                               any	
     any	
  required	
  
                                                        otr	
  o	
  ptrecautions	
  
                                                  medications	
  
                                         edications	
                 ake	
  
                                                                        or	
  m edication	
  
                                                                              precautions	
   onr	
  ecessary	
  
                                                                                     necessary	
     use	
   an	
  the	
  
                                                                                                       for	
        inhaler	
  
                                                                                                                      for	
     during	
  
                                                                                                                              the	
  
                                                                                                                           allergy	
     ie.	
  Ecpi-­‐Pen)_____	
  
                                                                                                                                      a(llergy	
  amp	
  
                                                                                                                                                   (ie.	
  Ehpi-­‐Pen)_____	
  
                                                                                                                                                             ours?	
  	
   	
   	
   	
  YES	
  	
   	
   	
                                                                                                                                                             	
   	
  NO	
  	
   	
   __________	
  
                                                                                                                                                                                                                                                                                                                                                                                                       __________	
  
                       If	
  yes,	
  
                       Is	
           pclease	
  
                              our	
  Is	
            lcist:	
  	
  
                                            your	
  required	
  
                                          hild	
        hild	
  required	
  	
   to	
  
                                                                    to	
  take	
        ake	
  	
  medication	
  
                                                                                   mtedication	
       or	
  u	
   se	
  oar	
  n	
  uise	
  
                                                                                                                                         	
   an	
  inhaler	
  
                                                                                                                                       nhaler	
          	
   dcuring	
  
                                                                                                                                                      during	
   amp	
  	
  hcamp	
  
                                                                                                                                                                              ours?	
  h	
  ours?	
  
                                                                                                                                                                                             	
      	
   	
   	
  YES	
  	
   	
  YES	
  
                                                                                                                                                                                                                                     	
   	
                                                                                                                                                      	
   	
  
                                                                                                                                                                                                                                                                                                                                                                         	
   	
  NO	
  	
   	
  NO	
                          __________	
  
                       Medical	
  
                       If	
   yes,	
  If	
   yCes,	
  
                                               omments	
  
                                      please	
           ist:	
  	
   l–ist:	
  	
  
                                                       pllease	
         	
  Limitations	
  
                                                                                     	
   	
  for	
  
                                                                                                	
   camp	
  	
   activities	
  
                                                                                                                   	
      	
   (i.e.	
  
                                                                                                                                 	
   physical,	
  
                                                                                                                                          	
   	
   visual,	
  
                                                                                                                                                       	
   	
   auditory,	
  
                                                                                                                                                                     	
   	
   etc):	
  
                                                                                                                                                                                   	
   	
                                                                                                                                                       	
   	
                 	
   	
                	
   	
             	
   __________	
  
                                                                                                                                                                                                                                                                                                                                                                                                                              __________	
  
                       	
   Medical	
  
                       Medical	
   C	
   omments	
  
                                              	
   –	
  Limitations	
  
                                            Comments	
      –	
   	
  Limitations	
  
                                                                              	
   camp	
  
                                                                           for	
               	
  
                                                                                      for	
  acctivities	
  
                                                                                               amp	
          	
   physical,	
  
                                                                                                       activities	
  
                                                                                                             (i.e.	
   (i.e.	
  	
   physical,	
  
                                                                                                                                             	
   vaisual,	
  
                                                                                                                                       visual,	
               a	
  uditory,	
  
                                                                                                                                                     uditory,	
       etc):	
   e	
   tc):	
   	
   	
                                                                                                                                                                   	
   	
                	
   	
                  	
     ___	
  
                                                                                                                                                                                                                                                                                                                                                                                                                    	
   __________	
  
                                                                                                                                                                                                                                                                                                                                                                                                                              __________	
  
                       	
                       	
   	
     	
   Medication	
  
                                                                  	
   	
   	
   can	
  o	
   nly	
  
                                                                                                	
   be	
  self-­‐administered	
  
                                                                                                            	
   	
   	
   	
      b	
   y	
  	
  the	
  camper	
  
                                                                                                                                                           	
   	
   due	
  
                                                                                                                                                                       	
   to	
  
                                                                                                                                                                             	
   the	
  f	
  act	
  
                                                                                                                                                                                                	
   that	
  t	
  here	
  
                                                                                                                                                                                                                    	
   is	
  n	
  o	
  R	
   N	
  on	
  	
  location.	
  
                                                                                                                                                                                                                                                                	
     	
   	
                                                                                                                                                              	
   ___	
   ___	
  
                        Has	
  your	
  child	
  recently	
   been	
  cean	
  
                                                       Medication	
  
                                                 Medication	
           xposed	
  
                                                                                can	
  
                                                                              only	
   bte	
  
                                                                                         oo	
  nly	
  
                                                                                               s(elf-­‐administered	
  
                                                                                                 in	
  bthe	
   last	
  six	
  months)	
  
                                                                                                         e	
  self-­‐administered	
        to	
   aamper	
  
                                                                                                                                            bcy	
  
                                                                                                                                  by	
  the	
       	
  tche	
  
                                                                                                                                                          ommunicable	
  
                                                                                                                                                                 camper	
          disease	
  
                                                                                                                                                                   due	
  to	
  dtue	
  
                                                                                                                                                                                  he	
   tfo	
         (fsuch	
  
                                                                                                                                                                                                 the	
  
                                                                                                                                                                                           act	
         act	
  
                                                                                                                                                                                                   that	
         as	
  m
                                                                                                                                                                                                                 that	
  
                                                                                                                                                                                                            there	
        easles,	
  
                                                                                                                                                                                                                        its	
  here	
   s	
  ncohicken	
  
                                                                                                                                                                                                                                no	
  RiN	
     o	
          pox	
  
                                                                                                                                                                                                                                                n	
  Rlocation.	
  
                                                                                                                                                                                                                                                       N	
  on	
      or	
  mumps,	
  etc.)	
  
                                                                                                                                                                                                                                                                   location.	
  
                       	
  Has	
  your	
  
                                      	
  child	
  
                                    Has	
              	
   recently	
  
                                            your	
  recently	
  
                                                     child	
        	
   ebxposed	
  
                                                                 been	
     een	
  eYes	
  
                                                                                      to	
  (in	
  tt	
  he	
  
                                                                                     xposed	
            o	
  (in	
  
                                                                                                                last	
     Date:__________	
  
                                                                                                                      the	
   last	
  
                                                                                                                         six	
         six	
  months)	
  
                                                                                                                                 months)	
                  t	
  o	
  a	
  communicable	
  
                                                                                                                                               to	
  a	
  communicable	
      	
  	
  No	
  disease	
  
                                                                                                                                                                                                 	
   disease	
  
                                                                                                                                                                                                        (such	
  a(s	
  
                                                                                                                                                                                                                   such	
   as	
  measles,	
  
                                                                                                                                                                                                                         measles,	
            chicken	
  
                                                                                                                                                                                                                                      chicken	
   pox	
  or	
  pm
                                                                                                                                                                                                                                                                ox	
   or	
  mumps,	
  
                                                                                                                                                                                                                                                                  umps,	
     etc.)	
   etc.)	
  
                                                           	
                                                                                                                          	
  
          	
        	
   	
  
         IMMUNIZATION	
            	
   	
  RECORDS:	
  
                                                	
   	
   REQUIRED	
  
                                                                	
   Yes	
   Yes	
  
                                                                                B   Y	
        	
   PDate:__________	
  
                                                                                      	
   N.Y.S	
    LEASE	
  Date:__________	
  
                                                                                                                 F   ILL	
   I     	
  ALL	
  
                                                                                                                               N	
           	
   DATES	
  	
   	
  	
  N–o	
  
                                                                                                                                                                          	
   N 	
  	
  NA	
  o	
  
                                                                                                                                                                                 O	
                      	
  
                                                           	
          	
                                                                                                              	
   TTACHMENTS	
  
                                                                                                                                                                                                     	
             	
  	
  	
  	
  	
  (Full	
  Days	
  Camps	
  ONLY)	
  
          	
  
         IMMUNIZATION	
  
         MMR	
     V     	
   –	
  Mumps,	
  
                   IMMUNIZATION	
  
                     accine	
            RECORDS:	
  
                                                RECORDS:	
  
                                                M         REQUIRED	
  
                                                     easles,	
       REQUIRED	
  
                                                                   Rubella	
    BY	
  
                                                                               (3	
        N.Y.S	
  
                                                                                             BY	
  N
                                                                                      doses):	
      PLEASE	
  
                                                                                                      .Y.S	
  PLEASE	
  
                                                                                                    1.	
        	
  FILL	
  IN	
   	
  A	
   LL	
  
                                                                                                                               FILL	
               D	
  A
                                                                                                                                                 IN	
   ATES	
  
                                                                                                                                                           LL	
  2.	
  D–ATES	
  
                                                                                                                                                                          	
  NO	
  	
  A   –	
  TTACHMENTS	
  
                                                                                                                                                                                                 NO	
  ATTACHMENTS	
  
                                                                                                                                                                                                               	
   	
  	
  	
  	
  	
  (Full	
  
                                                                                                                                                                                                                    3.	
                   	
  	
  	
  	
  D
                                                                                                                                                                                                                                                           	
   (ays	
  
                                                                                                                                                                                                                                                                 Full	
  CDamps	
  
                                                                                                                                                                                                                                                                           ays	
    ONLY)	
  
                                                                                                                                                                                                                                                                            	
   Camps	
   ONLY)	
  
          	
  	
  
         OPV/IPV	
  
         MMR	
   V  	
   	
  
                     (Polio)	
  
                 MMR	
  
                   accine	
        	
  
                              –	
  (M
                         Vaccine	
  3	
  umps,	
  
                                         doses):	
  	
  
                                           –	
  Mumps,	
  
                                                   Measles,	
  R	
  ubella	
  
                                                           Measles,	
          (3	
  	
  doses):	
  
                                                                         Rubella	
          (3	
  doses):	
  
                                                                                                     1.	
     1.	
   	
                                                                                                                      	
   	
                                                  	
   2.	
          2.	
   	
            	
   	
                 	
   3.	
             3.	
   	
            	
   	
             	
  
          	
        	
   Chicken	
  Pox):	
   	
  
         Varicella	
  
          	
       OPV/IPV	
  
         OPV/IPV	
        	
       (Polio)	
  
                         (Polio)	
                     (3	
  doses):	
  	
  
                                     (3	
  d	
   oses):	
  	
            	
                       	
   	
   	
                             	
   	
          	
   1.	
  
                                                                                                                                                                  	
                 1.	
   	
   	
                                          	
   	
   	
                                             	
   2.	
  
                                                                                                                                                                                                                                                                                                            	
           2.	
   	
   	
       	
   	
   	
            	
   3.	
  
                                                                                                                                                                                                                                                                                                                                                                            	
              3.	
   	
   	
       	
   	
   	
        	
  
          	
  	
          	
  	
  
         Diphtheria/Tetanus	
  
                   Varicella	
  
         Varicella	
                 	
   P	
  	
   ox):	
  
                                   (Chicken	
  
                    	
   (Chicken	
                 DTP/DTaP	
      	
   	
  	
   (3	
  	
  d	
  oses):	
  
                                                             P	
   ox):	
                         	
   	
   	
   	
                        	
   	
          	
   	
   1.	
  
                                                                                                                                                                       	
             	
   	
   	
  
                                                                                                                                                                                     1.	
                                                    	
   	
   	
   	
                                        	
   	
   2.	
  
                                                                                                                                                                                                                                                                                                                 	
          	
   	
   	
        	
   	
   	
           	
   3.	
  
                                                                                                                                                                                                                                                                                                                                                                              	
                	
   	
   	
        	
   	
   	
            	
  
          	
   (3	
  Diphtheria/Tetanus	
  
         HiB	
       d	
  oses):	
  
                            	
  
         Diphtheria/Tetanus	
        	
   	
   	
   DTP/DTaP	
  
                                                        	
   D	
   	
  TP/DTaP	
  
                                                                         (3	
  d	
  oses):	
  
                                                                                     	
   (3	
  doses):	
  
                                                                                                    	
                                                      	
   1.	
                1.	
   	
                                               	
   	
                                                  	
   2.	
          2.	
   	
            	
   	
                 	
   3.	
             3.	
   	
            	
   	
             	
  
                       	
  
         Hep	
  (B
         HiB	
   3	
  	
  HiB	
  
                          (3	
  
                          d      d(oses):	
  
                                   3	
  doses):	
  
                            oses):	
          	
                                 	
   	
                  	
   	
                  	
   	
                  	
   1.	
                1.	
   	
                                               	
   	
                                                  	
   2.	
          2.	
   	
            	
   	
                 	
   3.	
             3.	
   	
            	
   	
             	
  
                 	
           	
  
         EMERGENCY/TRIP	
  
         	
  
         Hep	
        B	
  Hep	
                     	
   AUTHORIZATION:	
  
                                     B	
  (3	
  doses):	
  
                           (3	
  doses):	
                         	
   	
         	
   	
             	
   	
                	
   1.	
     1.	
   	
             	
   	
         	
   2.	
        2.	
   	
              	
   	
                	
   3.	
     3.	
   	
         	
   	
                  	
  
         	
  In	
  
         	
   the	
  EMERGENCY/TRIP	
  
                         	
  event	
  that	
  I	
  cannot	
  
         EMERGENCY/TRIP	
                                               be	
  
                                                            AUTHORIZATION:	
   reached	
  and	
  an	
  emergency	
  occurs,	
  I	
  hereby	
  give	
  permission	
  to	
  the	
  physician	
  selected	
  by	
  the	
  Town	
  to	
  
                                                                             AUTHORIZATION:	
  
         hospitalize	
  
         	
  	
   the	
  In	
  
         In	
                        a   nd	
   s ecure	
     t   reatment	
           for	
   m y	
  child.	
    	
  I	
  aun	
  
                                                                                                                             nderstand	
     that	
      I	
  thhe	
   Town	
   of	
  Cplarkstown	
            tdo	
  
                                                                                                                                                                                                                 oes	
  
                                                                                                                                                                                                                       the	
  ntpot	
  tohe	
  
                                                                                                                                                                                                                                          ffer	
    accident	
   insurance	
          atnd	
  
                                                                                                                                                                                                                                                                                           he	
  tTto	
  
                                                                                                                                                                                                                                                                                                    hat	
      mty	
  
                         	
  event	
  
                                   the	
  tehat	
  
                                            vent	
  I	
  ctannot	
  
                                                           hat	
  I	
  cannot	
  
                                                                        be	
  reached	
  
                                                                                  be	
   reached	
  
                                                                                               and	
     an	
  aend	
  
                                                                                                                  mergency	
       emergency	
  
                                                                                                                                          occurs,	
     occurs,	
  
                                                                                                                                                                 ereby	
  
                                                                                                                                                                        I	
  hereby	
  
                                                                                                                                                                              give	
    ermission	
  
                                                                                                                                                                                         give	
  permission	
                    o	
  hysician	
  
                                                                                                                                                                                                                                                physician	
  
                                                                                                                                                                                                                                                      selected	
  
                                                                                                                                                                                                                                                              selected	
  
                                                                                                                                                                                                                                                                   by	
  the	
  bTy	
  own	
        own	
        o	
  
         personal	
  insurance	
  bears	
  primary	
  responsibility	
  in	
  case	
  of	
  an	
  accident.	
  	
  I	
  understand	
  that	
  by	
  signing	
  this	
  form	
  I	
  give	
  permission	
  for	
  my	
  
         	
  hospitalize	
  
                   	
  hospitalize	
  
                             and	
  secure	
  
                                       and	
  stecure	
  
                                                 reatment	
  
                                                          treatment	
  
                                                               for	
  my	
  for	
  
                                                                             child.	
  
                                                                                    my	
  	
  cI	
  hild.	
  
                                                                                                    understand	
  
                                                                                                              	
  I	
  understand	
  
                                                                                                                            that	
  the	
  
                                                                                                                                      that	
  
                                                                                                                                            Town	
  
                                                                                                                                               the	
  oTf	
  
                                                                                                                                                        own	
  
                                                                                                                                                              Clarkstown	
  
                                                                                                                                                                  of	
  Clarkstown	
  
                                                                                                                                                                             does	
  ndot	
  
                                                                                                                                                                                        oes	
  
                                                                                                                                                                                              offer	
  
                                                                                                                                                                                                not	
  aoccident	
  
                                                                                                                                                                                                          ffer	
  accident	
  
                                                                                                                                                                                                                     insurance	
  
                                                                                                                                                                                                                               insurance	
  
                                                                                                                                                                                                                                   and	
  that	
  
                                                                                                                                                                                                                                             and	
  
                                                                                                                                                                                                                                                   mty	
  
                                                                                                                                                                                                                                                     hat	
  my	
  
         child	
   to	
  
         personal	
         attend	
  
                       personal	
  
                                 insurance	
     ainsurance	
  
                                                    nd	
  btravel	
  
                                                             ears	
  pbto	
     all	
  Tprips	
  
                                                                           rimary	
  
                                                                            ears	
         rimary	
      /	
  Town	
  
                                                                                             responsibility	
                     Pools	
  
                                                                                                                   responsibility	
    in	
  c/	
  ase	
  
                                                                                                                                                   Swimming	
  
                                                                                                                                                          in	
  
                                                                                                                                                           ocf	
  ase	
           af	
  t	
  
                                                                                                                                                                    an	
  aoccident.	
  an	
  Town	
     	
  Ip	
  uools	
  
                                                                                                                                                                                                 accident.	
             	
  Ia	
  und	
  
                                                                                                                                                                                                                     nderstand	
           Clarkstown	
  
                                                                                                                                                                                                                                      nderstand	
  
                                                                                                                                                                                                                                              that	
  by	
     inter-­‐playground	
  
                                                                                                                                                                                                                                                          that	
  
                                                                                                                                                                                                                                                             signing	
  
                                                                                                                                                                                                                                                                    by	
  signing	
  
                                                                                                                                                                                                                                                                            this	
  form	
              cive	
  
                                                                                                                                                                                                                                                                                                          ompetitions	
  
                                                                                                                                                                                                                                                                                         this	
  I	
  fgorm	
    pI	
  ermission	
       that	
  
                                                                                                                                                                                                                                                                                                                                           for	
  tm
                                                                                                                                                                                                                                                                                                                       give	
  permission	
        ake	
  
                                                                                                                                                                                                                                                                                                                                                         y	
  for	
  my	
  
         place	
      o
         child	
  to	
     n	
  
                       child	
   d ays	
  
                            attend	
       I 	
   s end	
  
                                    to	
  aattend	
         t    hem	
  
                                                    nd	
  travel	
       t    o	
  
                                                                 and	
  travel	
    c amp.	
  
                                                                          o	
  all	
  Ttrips	
     	
   I 	
   a uthorize	
  
                                                                                          o	
  all	
  /T	
  Trips	
  
                                                                                                                  own	
                t he	
  
                                                                                                                             /	
  PTools	
        u  se	
  
                                                                                                                                      own	
  /P	
  Sools	
  o
                                                                                                                                                     wimming	
   f	
   p hotos	
  
                                                                                                                                                                 /	
  Swimming	
              f
                                                                                                                                                                                  at	
  Town	
  or	
   p romotional	
  
                                                                                                                                                                                                      at	
  pTools	
  
                                                                                                                                                                                                                    own	
  apnd	
          p
                                                                                                                                                                                                                                    ools	
   urposes.	
  
                                                                                                                                                                                                                                           Clarkstown	
  
                                                                                                                                                                                                                                             and	
  Clarkstown	
  
                                                                                                                                                                                                                                                               inter-­‐playground	
  
                                                                                                                                                                                                                                                                            inter-­‐playground	
        competitions	
  competitions	
   that	
  take	
  
                                                                                                                                                                                                                                                                                                                                                        that	
  take	
  
         	
  place	
  oplace	
  
                           n	
  days	
  
                                     on	
  I	
  d send	
  
                                                    ays	
  It	
  hem	
  
                                                                 send	
  tto	
  
                                                                              hem	
  
                                                                                    camp.	
  
                                                                                         to	
  c	
  Iamp.	
  
                                                                                                          	
  authorize	
  
                                                                                                                        	
  I	
  authorize	
  
                                                                                                                                       the	
  use	
       the	
  
                                                                                                                                                            of	
  upse	
  
                                                                                                                                                                         hotos	
  
                                                                                                                                                                             of	
  pfhotos	
    or	
  promotional	
  
                                                                                                                                                                                                                 for	
  promotional	
      purposes.	
  
                                                                                                                                                                                                                                                     purposes.	
  
         	
  	
        	
   	
                       	
                  	
                     	
                               	
                  	
                      	
                            	
                        	
              	
               	
                  	
                     	
                 	
  
         Parent/Guardian	
  
         	
            	
   	
                       S
                                                	
   	
   ignature	
  
                                                                   	
   	
    ( required)	
  
                                                                                         	
   	
                     	
   	
     	
                  	
  
                                                                                                                                              	
   	
                        	
  
                                                                                                                                                                        	
   	
                   	
   	
  	
              	
   	
   	
              Date	
  
                                                                                                                                                                                                                                                	
   	
          	
   	
            	
   	
               	
   	
              	
   	
             	
  
         	
  
         Parent/Guardian	
   Signature	
  
               Parent/Guardian	
           (required)	
  
                                   Signature	
   (required)	
  	
   	
   	
   	
   	
                                                                                                                                                        	
   	
                                                  	
   	
            	
   Date	
   Date	
  
         __________________________________________________	
  	
                                                                                                                                                                                 	
                                                       	
                 _____________________________	
  
         	
                       	
  
         (For	
   Office	
   Use	
  ONLY)	
  Camp	
  Medical	
  Director	
   	
  
         __________________________________________________	
  	
  
                    __________________________________________________	
  	
      	
   	
   	
  	
                                                                                                                                                                                                    	
   	
  	
        	
   Date	
  
                                                                                                                                                                                                                                                                                                                              _____________________________	
  
                                                                                                                                                                                                                                                                                                                                       _____________________________	
  
       	
  (For	
  Office	
  
                          	
   UOse	
  
                     (For	
      ffice	
      	
   COamp	
  
                                        ONLY)	
  
                                             Use	
           C	
   amp	
  
                                                     NLY)	
  M     edical	
       	
  
                                                                           MDedical	
  
                                                                                 irector	
        	
  	
  
                                                                                        Director	
                                                          	
   	
  	
              	
   	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  99
                                                                                                                                                                                                                                               	
   	
   	
                                           	
   	
            	
   Date	
   Date	
  
       	
  
       	
            	
   	
             	
   	
        	
   	
             	
   	
          	
   	
                                                        	
   	
                  	
   	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  9
                                                                                                                                                                                                                                          	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  9	
  
       	
  
       	
            	
  
       	
  
Clarkstown_SpringSummer2015.indd                      9                                                                                                                                                                                                                                                                                                                                                                                     3/30/15 7:21 PM
       	
            	
  
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