WATERLOO COMMUNITY CENTER SUMMER PLAY PROGRAM
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
WATERLOO COMMUNITY CENTER SUMMER PLAY PROGRAM
FOR BOYS AND GIRLS ENTERING GRADES 3 - 6 IN SEPT. ‘21
DATES: July 6th - August 6th
FEE: $50 per family, due at registration on 6/19 or 6/21
SITE: Waterloo Community Center, 3 Oak Street
TIME: Monday – Fridays, 9am - 3pm at Waterloo Community Center
*No out of camp trips this year. Program is entirely on-site.
ACTIVITIES: Sports, games, arts & crafts, spray park, playground, and more.
Participants can take advantage of the free lunch program or bring a bag lunch.
*Trevor’s Gift Backpack program is available with food pickup on Friday afternoons.
Spray Park is closed to public during program hours
REGISTRATION INFORMATION:
REGISTER IN PERSON ON SAT. 6/19, 10AM – 12PM OR TUES. 6/21, 6PM-8PM AT
THE WATERLOO COMMUNITY CENTER. THESE ARE THE ONLY DAYS TO
REGISTER. LIMITED TO THE FIRST 50 CHILDREN TO REGISTER AND PAY $50
PER FAMILY REGISTRATION FEE.
MUST ATTEND WATERLOO CENTRAL SCHOOLS OR BE A RESIDENT OF THE
TOWN OF WATERLOO, FAYETTE, OR JUNIUS.
PROOF OF UP TO DATE IMMUNIZATIONS ARE REQUIRED AT REGISTRATION
ANY QUESTIONS PLEASE CALL 315-539-5309
*This program is regulated by the Seneca County Department of HealthSUMMER PLAY PROGRAM REGISTRATION FORM
NAME________________________________ DOB_______________ GRADE_________ (AS OF 9/21)
ADDRESS__________________________________________________ MALE / FEMALE: _________
PARENT/GUARDIAN INFORMATION:
NAME___________________________________________ PHONE # ___________________________
NAME___________________________________________ PHONE # ___________________________
*EMAIL ADDRESS_______________________________________
EMERGENCY INFORMATION:
ANY MEDICAL PROBLEMS/ALLERGIES? ________________________________________________
______________________________________________________________________________________
EMERGENCY CONTACT NAME & #______________________________________________________
(OTHER THAN PARENT/GUARDIAN)
MY CHILD HAS PERMISSION TO LEAVE PROGRAM ON THEIR OWN: YES OR NO
**CURRENT IMMUNIZATIONS ARE REQUIRED TO ATTEND. PLEASE PROVIDE A COPY OF
IMMUNIZATION RECORD FROM CHILD’S PHYSICIAN. **
*COVID-19 INFORMATION:
IF YOU OR YOUR CHILD HAS ANY OF THE FOLLOWING SYMPTOMS DO NOT ATTEND:
FEVER OR CHILLS (100.4 OR HIGHER), COUGH, SHORTNESS OF BREATH OR DIFFICULTY
BREATHING, FATIGUE, MUSCLE OR BODY ACHES, HEADACHE, SORE THROAT, NAUSEA OR
VOMITING, CONGESTION/RUNNY NOSE, DIARRHEA, NEW LOSS OF TASTE OR SMELL. IF YOU ARE
ILL OR CARING FOR SOMEONE THAT IS ILL, OR HAVE BEEN EXPOSED TO COVID-19, DO NOT
ATTEND.
PARENTS ARE REQUIRED TO FILL OUT A COVID SCREENING FORM EACH DAY THAT THEIR CHILD
PARTICIPATES. PLEASE HAVE YOUR CHILD BRING IT WITH THEM EACH DAY. FORMS ARE
AVAILABLE ON OUR WEBSITE.
THE FOLLOWING SAFETY PROTOCOLS ARE REQUIRED: MASKS COVERING THE MOUTH & NOSE,
HAND WASHING &/OR HAND SANITIZING BEFORE AND AFTER ACTIVITY, NO HAND SHAKES, FIST
BUMPS, OR HIGH 5’S, MAINAIN 6 FT. SOCIAL DISTANCING UNLESS SAFETY OR THE CORE ACTIVITY
REQUIRES SHORTER DISTANCE. BRING YOUR OWN WATER BOTTLE WITH NAME ON IT.
I, the undersigned, agree to let my child participate in the Waterloo Community Center program indicated above. I understand and agree that the
Waterloo Community Center, its directors, managers, coaches, and Village of Waterloo Officials shall in no way be held liable for any injury or risks,
including, but not limited to, the risks associated with the Novel COVID-19 Virus, while participating in the above program. I understand that it shall
be my responsibility to transport my child to and from this program. Summer Recreation Programs routinely require extreme physical conditioning
and contact. I understand that it is my responsibility, through consultation with a physician to insure that my child is fit to participate in this program.
I do, hereby, assume all normal risks and hazards incidental to the conduct of the above named program. I further waive and release the Waterloo
Community Center or any personnel appointed by the Waterloo Community Center or the Village of Waterloo.
My child’s coach and/or director have my permission to give first aid or seek medical attention in the event of injury or illness involving my child.
PARENT/GUARDIAN___________________________________________DATE__________________
(SIGNATURE)GIRLS’ VOLLEYBALL CAMP
FOR GIRLS ENTERING GRADES 1 – 12 IN SEPT. ‘21
CAMP DIRECTOR: Kaitlin O’Hara, Waterloo Girls Varsity Volleyball Coach
DATES: Monday, July 12th - Thursday, July 15th
SITE: Waterloo High School Gymnasium
TIME: Grades 1-7: 1:30pm – 3:30pm
Grades 8-12: 3:00pm – 5:30pm
FEE: $45/Camper OR $85/2 Campers in the same family by Wednesday, June 30th
Late Registrations will be accepted but a T-Shirt will NOT be guaranteed.
Our Waterloo Volleyball camp will focus on instruction that includes developmental training in
techniques on passing, setting, attacking, blocking, serving, and defense. Each court will be based on
skill level, age, and experience. Every camper will receive a camp T-Shirt.
If you should have any questions or concerns please contact:
Head Varsity Volleyball Coach Kaitlin O’Hara at kaitlin.ohara@waterloocsd.org
____________________________________________________________________________________________
BOYS’ LACROSSE SKILLS CLINIC
FOR BOYS ENTERING GRADES 1 - 6 IN SEPT. ’21 session 1
For BOYS entering grades 6-12 in Sept ’21 session 2
CLINIC DIRECTOR: Waterloo Varsity Boys Lacrosse Coaches,
with assistance from coaches from the Waterloo Youth Program
DATES: Monday July 26th – Thursday, July 29th
SITE: Lafayette Field
TIME: 5:00pm – 6:00pm grades 1-6 session 1
6:00pm-7:30pm grades 7-12 session 2
FEE: $25 dollars per participant
camp t-shirt will be provided
*EACH BOY NEEDS TO HAVE HIS OWN STICK. BRING YOUR OWN EQUIPMENT
Other equipment will be distributed on an as needed basis.
THIS CLINIC WILL COVER BASIC SKILL DEVELOPMENT WITH
AN EMPHASIS ON INDIVIDUAL SKILLS, TEAM PLAY,
SPORTSMANSHIP AND FUN!!!!WATERLOO BOYS’ BASKETBALL SUMMER CAMP
“Li4le Ballers” Camp for Boys Entering Grades K-2 in 2021-2022
Monday, June 28 – Friday, July 2
An introduc+on to basketball from 9:00-10:15 am each day at the Middle School Gymnasium. The cost of this program is
$30 (Cash or Checks payable to WCC). The camp is an introduc+on to basketball skills and concepts. Campers will be
taught the rules of the game and how to properly shoot, pass, dribble, pivot, and play defense in a fun atmosphere.
There will be a mixture of drills and basic skill games. Campers will shoot on lower hoops and no experience is
necessary! Campers will receive a t-shirt. RegistraQon forms and payment must be received by Wednesday, June 16.
Anyone registering aWer June 16 will not receive a t-shirt.
“Basketball Academy” for Boys Entering Grades 3-8 in 2021-2022
Monday, June 28 – Friday, July 2
Times: Grades 3-5: 10:30-12:30
Grades 6-8: 1:00-3:00
Where: High School Gymnasium
Cost: $40 (Cash or Checks payable to WCC)
The basketball academy will focus on the fundamentals of the game, from both an individual and team perspec+ve.
Players at this camp will par+cipate in daily fundamental sta+ons and also be exposed to compe++ve situa+ons with skill
compe++ons and daily games. Camp will be broken down by grade/ability level. Instruc+on will be provided by
experienced coaches and players. Campers will receive a t-shirt. RegistraQon forms and payment must be received by
Wednesday, June 16th. Anyone registering aWer June 16th will not receive a t-shirt.
Contact Coach Tim Darnell at (315) 730-6605 or Qmothy.darnell@waterloocsd.org with quesQons.
BOYS’ SOCCER CAMP
FOR BOYS ENTERING GRADES 7 – 12 IN SEPT. ‘21
CAMP DIRECTOR: Gary Diaz, Waterloo Boys Varsity Soccer Coach
DATE: Saturday, July 10th
SITE: Waterloo High Soccer Field
TIME: Grades 7-9: 8:00 am – 10:00 am
Grades 10-12: 10:15 am – 12:15 pm
Our Waterloo Soccer camp will focus on instruction that includes developmental training in
techniques of passing, defending, scoring, and team communication. Each group will be based on
skill level, age, and experience.
If you should have any questions or concerns, please contact:
Head Soccer Coach Gary Diaz at:gary.diaz@waterloocsd.orgWATERLOO GIRLS’ BASKETBALL SUMMER CAMP
“K-2 Camp” Girls Entering Grades K-2 in 2021-2022
Tuesday, July 6th-Friday, July 9th
Basketball Fun! Introduction to basketball that will focus on teaching the fundamentals while having fun and interacting
with others.
Camp Director: Michael Bree, Waterloo Varsity Girls Basketball Coach
Dates: Tuesday, July 6th-Friday, July 9th
Time: 9:00am-10:15am at Waterloo Middle School Gymnasium
Registration Deadline: Wednesday, June 30th
Fee: This Is A Free Camp
“3rd-8th Camp” Girls Entering Grades 3rd-8th in 2021-2022
Tuesday, July 6th-Friday July 9th
Camp will be used to continue developing basketball fundamentals, individual ability, and team concepts. We will focus
on creating a fun environment while developing team play.
Camp Director: Michael Bree, Waterloo Varsity Girls Basketball Coach
Dates: Tuesday, July 6th-Friday, July 9th
Time: 10:30-12:30 at Waterloo High School Gymnasium
Registration Deadline: Wednesday, June 30th
Fee: This Is A Free Camp
______________________________________________________________________________________________________________________________________
CHEERLEADING CAMP
FOR GIRLS AND BOYS ENTERING GRADES 1 – 12 AS OF SEPTEMBER ‘21
CAMP DIRECTOR: Tiffany Williams, Waterloo Varsity Cheerleading Coach
DATES: Wednesday July 21st – Friday July 23rd
SITE: Lafayette School Gymnasium
TIME: Grades 8-12 from 4:00pm – 5:30pm
Grades 1-7 from 6:00pm – 7:30pm
FEE: $30/Camper or $55/2 Campers same family due by Monday June 28th
Our Waterloo Cheerleading camp will focus on age appropriate cheerleading jumps, motions, sideline cheers, stunts.
Every camper registered by 6/28 will receive a camp T-Shirt.
If you should have any questions or concerns please contact: Varsity Cheerleading Coach Tiffany Williams at
tiffany.williams@waterloocsd.org or 315-745-9952CAMP/CLINIC REGISTRATION FORM
NAME_________________________________________________GRADE__________ (AS OF 9/21)
ADDRESS_____________________________________________ MALE / FEMALE (CIRCLE ONE)
PHONE #_________________________________AGE__________DATE OF BIRTH____/____/____
*EMAIL ADDRESS__________________________________________________________________
T-SHIRT SIZE: (CIRCLE ONE) YS, YM, YL, AS, AM, AL, AXL, AXXL
ANY MEDICAL PROBLEMS/ALLERGIES? _____________________________________________
___________________________________________________________________________________
PARENT/GUARDIAN DATA:
NAME____________________________________________ PH # ____________________________
NAME____________________________________________ PH # ____________________________
EMERGENCY CONTACT NAME & #___________________________________________________
(OTHER THAN PARENT/GUARDIAN)
CAMP/CLINIC REGISTERING FOR:
________________________________________________
*COVID-19 INFORMATION:
IF YOU OR YOUR CHILD HAS ANY OF THE FOLLOWING SYMPTOMS DO NOT ATTEND:
FEVER OR CHILLS (100.4 OR HIGHER), COUGH, SHORTNESS OF BREATH OR DIFFICULTY
BREATHING, FATIGUE, MUSCLE OR BODY ACHES, HEADACHE, SORE THROAT, NAUSEA OR
VOMITING, CONGESTION/RUNNY NOSE, DIARRHEA, NEW LOSS OF TASTE OR SMELL. IF YOU ARE
ILL OR CARING FOR SOMEONE THAT IS ILL, OR HAVE BEEN EXPOSED TO COVID-19, DO NOT
ATTEND.
PARENTS ARE REQUIRED TO FILL OUT A COVID SCREENING FORM EACH DAY THAT THEIR CHILD
PARTICIPATES. PLEASE HAVE YOUR CHILD BRING IT WITH THEM EACH DAY. FORMS ARE
AVAILABLE ON OUR WEBSITE.
THE FOLLOWING SAFETY PROTOCOLS ARE REQUIRED: MASKS COVERING THE MOUTH & NOSE,
HAND WASHING &/OR HAND SANITIZING BEFORE AND AFTER ACTIVITY, NO HAND SHAKES, FIST
BUMPS, OR HIGH 5’S, MAINAIN 6 FT. SOCIAL DISTANCING UNLESS SAFETY OR THE CORE ACTIVITY
REQUIRES SHORTER DISTANCE. BRING YOUR OWN WATER BOTTLE WITH NAME ON IT.
I, the undersigned, agree to let my child participate in the Waterloo Community Center program indicated above. I understand and agree that the
Waterloo Community Center, its directors, managers, coaches, and Village of Waterloo Officials shall in no way be held liable for any injury or risks,
including, but not limited to, the risks associated with the Novel COVID-19 Virus, while participating in the above program. I understand that it shall
be my responsibility to transport my child to and from this program. Summer Recreation Programs routinely require extreme physical conditioning
and contact. I understand that it is my responsibility, through consultation with a physician to insure that my child is fit to participate in this program.
I do, hereby, assume all normal risks and hazards incidental to the conduct of the above named program. I further waive and release the Waterloo
Community Center or any personnel appointed by the Waterloo Community Center or the Village of Waterloo.
My child’s coach and/or director have my permission to give first aid or seek medical attention in the event of injury or illness involving my child.
PARENT/GUARDIAN___________________________________________DATE__________________
(SIGNATURE)
MAIL COMPLETED FORM WITH PAYMENT TO: WATERLOO COMMUNITY CENTER,
41 W. MAIN ST, WATERLOO NY 13165, OR DROP OFF AT 3 OAK ST.2021Waterloo Community Center Youth Soccer
For Boys & Girls in 1st through 6th Grades (as of Sept.
’21). Cost: $30 includes t-shirt.
Player
Name: Information
Grade in Sept. ’21: Phone:
Address: Birthdate:
Age Male/Female T-Shirt Size (circle one) YS YM YL AS AM AL AXL
Parent/Guardian
Name: Information Phone:
Name: Phone:
Email Address:
Emergency
Any Medical Problems we should be aware of?
Emergency Contact Name Emergency Contact Phone:
*COVID-19 INFORMATION:
IF YOU OR YOUR CHILD HAS ANY OF THE FOLLOWING SYMPTOMS DO NOT ATTEND:
FEVER OR CHILLS (100.4 OR HIGHER), COUGH, SHORTNESS OF BREATH OR DIFFICULTY
BREATHING, FATIGUE, MUSCLE OR BODY ACHES, HEADACHE, SORE THROAT, NAUSEA OR
VOMITING, CONGESTION/RUNNY NOSE, DIARRHEA, NEW LOSS OF TASTE OR SMELL. IF YOU ARE
ILL OR CARING FOR SOMEONE THAT IS ILL, OR HAVE BEEN EXPOSED TO COVID-19, DO NOT
ATTEND.
PARENTS ARE REQUIRED TO FILL OUT A COVID SCREENING FORM EACH DAY THAT THEIR CHILD
PARTICIPATES. PLEASE HAVE YOUR CHILD BRING IT WITH THEM EACH DAY. FORMS ARE
AVAILABLE ON OUR WEBSITE.
THE FOLLOWING SAFETY PROTOCOLS ARE REQUIRED: MASKS COVERING THE MOUTH & NOSE,
HAND WASHING &/OR HAND SANITIZING BEFORE AND AFTER ACTIVITY, NO HAND SHAKES, FIST
BUMPS, OR HIGH 5’S, MAINAIN 6 FT. SOCIAL DISTANCING UNLESS SAFETY OR THE CORE ACTIVITY
REQUIRES SHORTER DISTANCE. BRING YOUR OWN WATER BOTTLE WITH NAME ON IT.
I, the undersigned, agree to let my child participate in the Waterloo Community Center program indicated above. I understand and agree that the
Waterloo Community Center, its directors, managers, coaches, and Village of Waterloo Officials shall in no way be held liable for any injury or risks,
including, but not limited to, the risks associated with the Novel COVID-19 Virus, while participating in the above program. I understand that it shall
be my responsibility to transport my child to and from this program. Summer Recreation Programs routinely require extreme physical conditioning
and contact. I understand that it is my responsibility, through consultation with a physician to insure that my child is fit to participate in this program.
I do, hereby, assume all normal risks and hazards incidental to the conduct of the above named program. I further waive and release the Waterloo
Community Center or any personnel appointed by the Waterloo Community Center or the Village of Waterloo.
My child’s coach and/or director have my permission to give first aid or seek medical attention in the event of injury or illness involving my child.
Parent/Guardian Signature: Date
A successful sports program relies heavily on parent/guardian volunteers.
We are in need of:
Coaches: Previous coaching experience helpful but not necessary
Coach Helpers: No soccer experience required. Help direct players at practice and
assist coaches during games.If you are interested in helping, check the boxes that apply. Thank you for your
commitment!!
Registrations: Deadline is July 31st. Drop off at WCC or mail to 41 W. Main St.,
Waterloo NY 13165.
Practices will begin in mid-August with games being held on Saturdays beginning in September.
Please call 315-539-5309 with any questions.Waterloo Community Center COVID Screening Ques8onnaire
PARENTS ARE REQUIRED TO FILL OUT A COVID SCREENING FORM EACH DAY THAT THEIR CHILD PARTICIPATES
IN A WCC PROGRAM. PLEASE HAVE YOUR CHILD BRING IT WITH THEM EACH DAY AND GIVE TO THEIR
COACH/DIRECTOR. FORMS ARE ALSO AVAILABLE ON OUR WEBSITE.
Name____________________________________________
Address___________________________________________
Phone #_____________________________ Date_____________ Time_____________
Please answer Yes or No to each quesQon:
If you answer Yes to any quesQon, please do not a4end program unQl you can answer No to each quesQon.
1. Do you have a fever (100.4F or higher)? Yes / No
2. Have you had any of the following COVID-19 symptoms within the past 10 days? Yes / No
• Cough
• Shortness of breath or difficulty breathing
• Fever
• Muscle or body aches
• Headache
• Chills
• Sore throat
• New loss of taste or smell
• Conges+on or runny nose
• Nausea or vomi+ng
• Diarrhea
3. Have you had a posi+ve COVID-19 test within the past 10 days? Yes / No
4. Have you had close or proximate contact within the past 10 days with anyone who has tested posi+ve
for COVID-19 or who has or had reported symptoms of COVID-19? Yes / No
5. Have you re-entered/entered New York State from one of the restricted states in the past 10 days?
Yes / No
*Please check to confirm you have a mask in your possession available for immediate use: ______
Signature___________________________________________You can also read
