South East Consortium Summer Day Camp Programs

1 South East Consortium Summer Day Camp Programs Thank you for your interest in the South East Consortium Summer Day Camp Programs . I am delighted to share with you the following information which provides a basic understanding of these unique and highly respected inclusive Summer day camp Programs . Once again, this year we will be offering SEC Summer Day Camps in the Town of Eastchester and Village of Scarsdale. Based on the fact the highest percentage of campers comprising enrollment in 6th, 7th & 8th grades reside in Eastchester, Bronxville and Tuckahoe, South East is partnering with the Town of Eastchester Department of Recreation to enroll Summer campers in the aforementioned grades in the Eastchester Camp Galaxy which is located at Greenvale School. This will solve the overcrowding in Scarsdale and will offer our Eastchester, Bronxville and Tuckahoe campers the opportunity to attend camp in their own town. If you decide your child meets our eligibility requirements and you wish to pursue enrollment, please complete the enrollment packet and forward with payment as stated below.

2 If you are new to South East, you will be required to make an appointment with your child for a brief in-take appointment to assess your child's preparedness for camp and to finalize enrollment. If it's decided your child will be enrolling for camp, more comprehensive information will be provided. Please read the following carefully, as the structure of camp has changed to accommodate the program's growth. Orientation Meeting for Families: An orientation meeting for families will be held on Wednesday, June 13th at the Mamaroneck Town Center, South East Consortium Office, Suite 316 from 6:30-8:00PM. It is highly recommended all families attend. It is mandatory for any new families to attend. Camp Dates: June 26th August 3rd for SEC Eastchester Day Camp (28 days) between the hours of 9:00AM 3:00PM. No Camp on Wednesday, July 4th in observance of Independence Day. Camp Location and Age/Grade Levels: The Town of Eastchester will be hosting camp for 6th 8th graders at Camp Galaxy who reside within Eastchester, Tuckahoe and Bronxville.

3 All campers enrolled with South East are interactively grouped with municipal campers as appropriate. South East campers are supervised by South East staff who will be accountable to a South East Camp Director at each camp location. Camp Galaxy (6th-8th Grades): Greenvale School, 1 Gabriel Rescigno Drive (next to Haindl Field) for Campers residing in Eastchester, Tuckahoe and Bronxville. Camper Eligibility: Any child, age 5-14 who is diagnosed with a Developmental Disability (ask for a definition) who resides in one of the component municipalities and is confirmed OPWDD eligible for reimbursement under the New York State Office for People with Developmental Disabilities Office guidelines will be given priority. Children with other special needs or those who do not qualify for OPWDD Eligibility are encouraged to seek enrollment but will need to pay an additional fee. However, it must be understood that South East, due to staffing limitations, cannot accept any child requiring specialized health care or supervision which exceeds the ability of South East to properly accommodate.

4 Also, South East cannot accept for enrollment children who present severe behavioral challenges and are deemed inappropriate for such a camp environment. Camp Cost: Confirmed OPWDD Eligible/HCB Medicaid Wavier $ Non-OPWDD Eligible/Other $ The average cost incurred by South East for your child to attend Summer camp is approximately $1, Interpretation of Medicaid Waiver regulations permits SEC to assess families a cost of $ based on allowable expenses. Campers who are Non-OPWDD Eligible/Other are assed a fee of $ Enrollment: Enrollment is open to members of the Consortium through May 18, 2018. If space is available enrollment will be open to members outside the Consortium after 5/18/18. Please note we have a limited number of spots available at each camp site this year. 6th 8th grade camp site enrollment is determined by the municipality to which you pay your taxes, not by school district or mailing address. Please fill out the corresponding forms for the camp your will be attending.

5 Payment: Full payment for camp would be appreciated at the time of enrollment/acceptance. A. payment plan for camp requires $100 deposit due at the time of enrollment/acceptance and the second payment by May 7th, and the final payment on June 18th. Full payment must be received by June 18th for your child to attend camp. Camp Staff: South East employs a seasoned, experienced professional as Camp Director at each camp site. South East provides counselor staff at a 1:2 ratio to supervise campers at all times. If it is mutually agreed your camper requires 1:1 supervision, then we will discuss with you available options. Camp counselors range from teacher aides, to college and high school students. All staff realize their primary function is to provide productive, enjoyable camp activities for campers in a respectful and safe manner. South East shares the services of an EMT personnel for health purposes. Each staff must undergo a criminal background check and fingerprint screening.

6 All staff attend a three-day orientation session prior to the start of camp. South East Consortium for Special Services, Inc 740 W. Boston Post Road, Ste 316. Mamaroneck, NY 10543. Telephone: (914) 698-5232. South East Consortium Camp Galaxy at Eastchester Enrollment Form 2018. It is imperative that all requested information below is provided. There will be no exceptions. Failure to provide the requested information may result in your child not being accepted. Each camper must have a current South East Admission Application and SEC. Medical form on file (which is valid for 3 years). In addition, updated immunization record needs to be attached to this enrollment form. *Note:6th 8th grade camp site registration is determined by the municipality to which you pay your taxes, not by school district or mailing address. Name of Camper: _____. Address: _____. Municipality you pay taxes to: _____. Camper Information: Date of Birth: __/___/_____ SS # mandatory: ___ ___ ___ - ___ ___ - ___ ___ ___ ___ Gender: _____.

7 Primary Diagnosis: _____Secondary Diagnosis: _____. Is your child on Medicaid Waiver? _____ If so, what is the CIN ? _____. Parent/Guardian: _____. Home Phone: _____ Cell Phone: _____. Email Address: _____ Emergency Contact: _____. My Camper will be attending ALL 6 weeks of camp. My Camper will be away from camp on _____. What Camp Are You Requesting? Camp Galaxy (6th 8th Grade) Code: GALA 310. Summer Camp Confirmed OPWDD Eligible/HCB Medicaid Wavier $ Summer Camp Non-OPWDD Eligible/and other $ A minimum Deposit of $ is due with enrollment form to hold a spot for your camper. DEPOSIT$ _____TOTAL$_____. Payment for camp must be made by June 18th, 2018. PAYMENT PLAN: Payment plan for camp requires a deposit of $100 due with application, seconded payment by May 7th and final payment on June 18th. If you agree to the term of this agreement, please sign and date. Signature_____Date_____. FOR OFFICE USE ONLY. Date Registration Received: _____ Date Medical Received _____Payment made by: _____/_____.

8 Date(s) Payment(s) Received: _____/_____ Check(s) #: _____ / _____ Amount(s): _____/ _____.. JSK DP MB Medical Immunization Records IEP Application Sunscreen Swim South East Consortium for Special Services, Inc. 740 West Boston Post Road, Suite 316 | Mamaroneck, NY 10543. Program Admission Application Please complete this application accurately and completely to ensure safety and program effectiveness This application is valid for three years Name of Participant: _____ DOB: _____/____/_____ Sex: M F (circle one). Participant's Social Security # (required): _____ Participant's Medicaid Waiver # (if applicable): _____. Parent/Guardian's Name: _____. Address: _____, _____, _____, _____. Street Municipality State Zip Code Home Phone: _____ Cell Phone: _____ Email: _____. Emergency Contacts: (if parent(s)/guardian(s) are unavailable: Primary Person: _____ Best Phone #: _____. Secondary Person: _____ Best Phone #: _____. Relationship to Participant: Primary_____ Secondary _____.)

9 Parent/Guardian's Release Statement I am the parent/guardian of _____ (Participant) on whose behalf I have submitted this Admission Application for his/her participation in the Programs and activities of the South East Consortium (SEC). I represent and warrant that, to the best of my knowledge and belief, the Participant is physically and mentally able to participate in SEC's Programs and activities. The SEC has my permission to use (both during and after a program or activity) the likeness, name, voice or words of the Participant in television, radio, film, newspaper, magazine and other media or formats, for the purpose of advertising or communicating about the SEC's Programs and activities and/or for the purpose of applying for or raising funds to support these Programs and activities. I hereby release and discharge the SEC, and its officers, directors, employees, supervisors and volunteers from any and all claims for damage, personal injury and other liability in connection with events occurring while the Participant is involved in the SEC's Programs and activities.

10 If, during the Participant's involvement in the SEC's Programs and activities, he/she were to need emergency medical treatment, I hereby authorize the SEC to take such measures as it may deem necessary for the benefit of the Participant's health and well-being (including, if necessary, hospitalization). Do you carry health/medical insurance for the Participant? Yes No. If No I will be responsible for payment of all medical services rendered. Name of Insurance Company: _____ Policy #: _____. _____. Release of Test Score Information Required by New York State OPWDD. In order to ensure the Participant's eligibility to receive the important funding which is provided to the SEC by the New York State Office for People with Developmental Disabilities (OPWDD), the SEC is required to provide to said Office the individual scores, Vineland Adaptive Behavior Scale Scores or other recognized assessment instruments in connection with the Participant. By submitting this application to SEC, you are confirming that the SEC may release this required information to the New York State OPWDD.