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City of Salem, Massachusetts
Board of Health
120 Washington Street, 4th Floor; Salem, MA 01970 PubHcHealthh
PreventPr m°m Protect.
Tel (978) 741-1800 Fax. (978) 745-0343
Kimberley Driscoll health@Salem.Com - -Larry Ramdin,-MPH, REHS,CHO
Mayor - Health Agent
PUBLIC POOL HEALTH PERMIT
Permit#
PO-17-14 License For : SWIMMING POOL - SEASONAL
Date of Print
6/29/2017 Granted To: Children's Island, LVO YMCA
Permit Issued
6/29/2017 Address: Salem Harbor Salem MA 01970
Permit Expires
8/25/2017 Location of Establishment: CHILDRENS ISLAND
Permit Fee
$40.00 Restrictions: Children's Island Pool Permit 2017
Late Fee
$0.00 Notes:
This permit or license is granted in conformity with the statues and ordinances relating thereto, and expires on 8/25/2017 , unless sooner
revoked or suspended.
Larry Ramdin, MPH, REHS, CHO
Health Agent
CITY OF SALEM, MASSACHUSETTS
BOARD o1=HrAI,rH
120 WASHrNG'1'ON SIREI3T,4TH+FLoOR
TEL.(978)741-1800
KIMBERLEY DRISCOLL FAx(978)745-0343
MAYOR , LRAMDINQSALEM COM
RECEIVED
LARRY RAMDIN,RS(REHS,CHO,CP-FS Q
ACTING HEALTH AGENT JUN U 2 2017
CITY OF SALEM
BOARD OF HEALTH
APPLICATION FOR LICENSE TO CONDUCT A RECREATIONAL CAMP
Name of Camp: t_ I. aft e) b,:4 (1.1 Tel# a - /I �
Address of Camp: Sfi 1{ E r6.T n Le, 4,4 7 a
Camp Website: wov7 nayrJ ,�� c_ -a_ Fax# ��.5�
Name of Camp Director: �I�M%G�_ I 1,1�(�S Tel#
Camp Director mailing address:_., �(a G-1;s �/ �� Email:_ �.�nQ�?Sr��nas �
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For The Emeraency Telephone Notification System:
Emergency contact name: ��,n kv - ,, Tel#: C-1-7`-o )
Dates of operation: From: (R uw I -T To:
Type of Camp: Day: �( Recreational: Sports: Travel: Trip:
Approximate# of campers:�s Campers Ages-._S--'> #of counselors: W
#of volunteers per season V
Please attach the following information
Medical consultant agreement and camp medical policy.
Certificates of compliance from Salem Fire Prevention and Salem Building Department.
Check payable to the City of Salem ($10).
Written copies of your Emergency, Special Contingency and Staff Orientation pians.
I agree to comply with all mandates of the State Sanitary Code, Chapter IV, 105 CMR 340., "Minimum
Standards for Recreational Camps for Children", including required staff background checks. I understand that
noncompliance may result in suspension of this license.
Pursuant to MGL Chapter 63C, Section 49A, I certify under the penalties of perjury that I, to my best
knonledge and belief, a filled all state tax returns and paid all state taxes required under the law.
Signature Date SS#or Federal dentification Number
knza � u-Z7-1Z 7 .44 a N
Updated 5/23tI1 reccamp app. hecktt 8,Dat — I— i q
•. LYMCM/CNI OfTlPl00 Y11G -
CHILDREN'S
ISLAND CAMP
X
COMMUNICATION & AQUATICS. SAFETY PLAN
General Procedures
Senior Leadership Team:
If at any point either the Camp Director will not be available to participate in
a non-aquatic emergency if one were to occur, the remaining Assistant .
Camp/Program: Directors will take their place. Ifthe Camp Director. and
• Aquatics Supervisor are unavailable. in an aquatic, emergency, the Head
Lifeguard will act as the position in an emergency situation: If none.of these
specified individuals are available in an emergency, the Camp. Director will
designate a replacement in advance who will act as the position in the case of
emergency. The replacement, and the position they are filling .should be
communicated toallstaff.in-advance. - -
Radio Procedures
• Radio should be considered primarily a safety device and should not be used
excessively for non-essential communication.
If calling a specific person, transmitter should begin transmission with"[Name
1] to [Name 2], [Name 1] to [Name2]," Responder replies ""[Name 1] to
[Name 2] Go ahead"
• In the case of emergency, only designated people (Camp Director; Assistant
Camp/Program, Directors, Camp Nurse, staff on scene). should be initiating
radio communication. In the case of a Missing Camper Alert, the counselor who
is missing the camper should be calling the Alert over the radio.
• If longer conversation is necessary, staff should move their conversation to
another channel. They should reportthatthey are switching channels to. that.
in the case of an emergency they Can be notified on that channel.
Any staff who. is issued_ a radio is responsible for keeping the radio on their
person and turned up loud enough that they can hear communication at all
times. They are.also responsible for returning the radio at the end of the camp
day so it may be charged. Staff should report any technical issues to camp •
director immediately.
Sailing Camp and Wakeboarding Camp staff will be designated a different
channel to be reached on so they may communicate freely without disrupting
Main Camp.
Radio Locations
• Directors, Unit Leaders, lifeguards, and Facilities Director will be issued walky
talky radios.
• Additional radios will be distributed at the discretion of the Camp Director and
Assistant Camp/Program Directors.
• The office will contain one marine radio and one land radio. The last director
to leave the office will carry the marine radio with them.
• Marine radios will be distributed to the sailing director, office and each powered
boat.
Identify Swimmers & Non-swimmers
• Green swimmer: means that they have passed the swim test and can swim
in any location of the pool and beaches. They will receive a green bracelet
before swimming in any location.
• If a camper has not passed the swim test, the camper will not receive a band
and they must wear a lifejacket at all times, in the pool and in the ocean.
Additionally, the camper must not go past his/her chest in the ocean.
• Group leaders should record their camper's levels on their attendance sheets
and advise the swimmer accordingly.
Swim Test
• The swim test is meant to determine if a swimmer has the endurance and
swimming ability to safely swim in the ocean and deep end of the pool.
o In the ocean: jump off of dock, tread water for 1 minute, swim between
designated areas manned by life guards
o In the pool (if ocean is unavailable): swim length of pool and back
freestyle starting in shallow end, then swim half of the length of the pool
backstroke so the camper is at the middle of the pool, then tread water
for 1 minute.
• The swimmer will not pass if at any point the swimmer requires the assistance
of a lifeguard, can't complete any portion of the test without a break, or if
lifeguards feel it would not be safe to pass them.
Kayak Procedures
Everyone must be wearing lifejacket at all times while participating in kayak
activity.
0
• • Swimmers and kayaks should not be mixed. If a beach has kayaks launching
or returning to it, lifeguards should clear the water until kayaks are all clear of
swimming area.
• Any time campers are in a kayak, a lifeguard should be in a kayak and assigned
to assist those campers.
Kayak guard must be equipped as normal (fanny pack, tube, whistle) as well
as be equipped with a marine radio when kayaking around the island.
• Non-lifeguard staff should participate in kayaking with their groups, Kayak
guard should pair weak paddlers with staff in tandem kayaks.
• Prior to embarking, Kayak guard must give clear instructions to campers and
staff about destination, parameters, and safety procedures.
Beach bag Contents
First Aid Kit
• CPR mask
• Bag valve
• Air horn
Adequate mask/snorkel sets
All Materials must be checked at the beginning of the day by Director of Aquatic
Programming to make sure they have all contents, along with a check at the
end of the day of first aid supplies around the Island.
Inclement Weather
• Swimming and kayaking should be done on the lee side (the side farthest away
from where the wind is coming from) of the island whenever possible (if the
wind is blowing into Wally beach, Archery and Back beaches should be used
and vice versa)
• Lifeguards should be constantly aware of weather conditions. If at any time
the weather makes the situation unsafe, it is a lifeguard's responsibility to pull
the swim mers/kaya kers out of the water.
• Tides, cloud cover, seaweed, and other elements can affect visibility.
Lifeguards should monitor visibility carefully and remove swimmers from
cloudy areas. -
• If a lifeguard hears or sees thunder or lightning, they will call out the report
over the radio. All lifeguards will pull all participants out of water and move
them to sheltered areas. 0
• A minimum of 30 minutes must pass between the final sighting/hearing of
thunder or lightning and swimmers re-entering the water.
Guarding Procedures
Supervising Lifeguard -
At each location (beach/pool) before bathers enter the water or board kayaks •
a lifeguard will be designated as the "Supervising Lifeguard". Every lifeguard
in an aquatic area should be aware of who the supervising lifeguard is.
Supervising lifeguard should be chosen based on experience.
Supervising Lifeguard Responsibilities
• Handling radio, ensuring it is on their person, ensuring that it has adequate
charge and that it is on the correct channel.
• Ensuring beach bag is present and appropriately stocked.
• Communicating with other guards about their responsibilities, placement, and
zones.
• Assigning a specific, non-guard, staff person to control the buddy board.
• Communicating expectations to extra non-guard staff/CIT/and campers.
Buddy Board
• Each swimming area has a chalk board or dry erase board mounted on the
beach for use as a buddy board. They are mounted strategically so as to
block/bottleneck the entrance and exit from a swimming area.
• Everyone on a beach/on the dock/on the pool deck including campers, CITs,
and staff (excluding "on duty" lifeguards) must be represented on the buddy
board.
• Supervising lifeguard will assign a staff person to run the buddy board. That
staff person should continue to run the buddy board until the supervising
lifeguard assigns a new staff to run the buddy board. •
• Under no circumstances should campers, CITs, volunteers, or parents be
allowed to write or erase anything on the buddy board.
• Groups should arrive at the swimming area with their buddies figured out.
Whenever possible swimmers should be paired with swimmers of equal
ability. It is also important to figure out which campers will not be swimming
and have them paired with each other.
• As a buddy pair enters the swimming area, they must stop and check in with
the buddy board staff. Buddy board staff will write the pair's names on the
board with a dash connecting them.
• Only one triplet is allowed. If two triplets exist, break them up into 3 pairs.
• No swimmers should enter the water until the buddy board has been
completed.
• Once the buddy board staff has recorded all of the buddy pairs they should
count the buddy pairs and write the total number of pairs in block numbers
at the top right hand corner of the board. Triplets should be expressed as a
1/2, so 5 pairs and a triplet (13 swimmers) would be written as 6 1/2.
• Once the number has been recorded, lifeguards should call an immediate
buddy check (swimmers should still be on the beach/dock/pool deck) to
confirm that their count matches the buddy board.
• Any time anyone leaves or enters the swim area the event should be
recorded on the buddy board. At all times, the number in the top right
•
• corner of the board should be an accurate representation of how many
people are in the swim area.
Buddy Checks
• Buddy checks can be initiated by any lifeguard at any time. They should be
performed once before the swimmers enter the water (to confirm the buddy
board count), once at the end of the swim period (to initiate clearing of
water), and at regular intervals in between. A well-executed buddy check
should take Jess than 45 seconds.
• Buddy check is signaled by one long blast of a whistle followed by lifeguard
shouting "buddy check".
• During a buddy check, the only voices should be those of the lifeguards.
Staff should encourage campers around them to be quiet and find their
buddies, but this should be done in a way that does not distract from the
lifeguards.
Buddies should immediately find each other, clasp their hands together and
raise their hands. If they are in shallow water they should be standing up. If
they are near a dock they should pull themselves up onto the dock and sit.
• Lifeguards should count buddy pairs, compare their counts with fellow
lifeguards, and if the count is consistent ask the buddy board operator for the
board's count. If all the numbers match, guards should blow a whistle once
and say "swim on".
• If there is any discrepancy between lifeguards, they should recount to
• determine where the discrepancy lies. If the board does not match the
lifeguard count, lifeguards must move quickly to determine where the
discrepancy comes from.
o The board operator will call out a buddy pair who will exit the water
and go to a designated spot. They will continue to quickly call buddy
pairs until it is determined that a person is missing, people have the
wrong buddies, or a person is in the water but not on the board.
o If at any point the process is taking too long, or lifeguards suspect that
a swimmer is in distress in the water, they should immediately begin
lost bather procedures.
o ANY time there is a lifeguard to board discrepancy that involves
buddies getting out of the water or a lost bather procedure, an incident
report must be completed by supervising lifeguard and board operator.
Aquatic Vigilance
• 10-10-10 scanning
• 10 seconds to review entire area of responsibility
• 10 seconds to respond to emergency
• 10 seconds to get to victim
• Scanning techniques
• Ocean: Surface scanning
• Pool: bottom, middle, surface
•
• Conversations •
• OK - transition talk, should not take more than 30 seconds
• OK - patron questions (keep it short & sweet)
• NO - non- transition conversations lasting more than 10 seconds
• Make sure the guard is never taking his/her eyes off the water during
conversations, and the transitioning guard is standing behind the on
duty guard
• Guards are encouraged to drink plenty of H2O - keeping hydrated is key to
being alert
• Guard Ratio - guards need to maintain a safe swimmer ratio
• Pool Swim - 1 guard for every 25 bathers
• Beach Swim - 1 guard for every 20 bathers
• Guards should have no other job other than guarding while they are "in the
chair" - secondary responsibilities are completed when they are on a rotation
break.
• Use correct guarding techniques
• Head should be rotating while 10/10 scanning - guards should have
sunglasses or hat to block sun rays
• Sitting upright in a lifeguard chair (not bench) while guarding or
walking around area of responsibility... must continue to watch water
• Able to see entire area of responsibility while guarding
• Dress Code for lifeguards- no sweat pants or sweat shirts permitted •
• Guard Shirt, Bathing suits, Fanny Pack, Whistle, Rescue tube on and in
the ready position
Aquatics Quick Check
Aquatic Safety Quick Check card will be completed a minimum of 3 times a
week by Director, Assistant Director, or Aquatic Supervisor. Any immediate
concerns should be brought to the Director's attention immediately.
Aquatics In-service training
• At least once every other week, lifeguard staff will participate in in-service
training. Contents of the training will be determined by Camp Director in
consultation with Children's Island and YMCA Aquatics Directors.
Whistle Signals
• 1 short blast - used to gain the attention of a swimmer or guard.
9
• 2 long blasts - Emergency
1 long blow - Used to signal buddy check and end of an activity.
•
• Emergency Procedures
Medical Emergency
• Nearest staff with radio will report "Medical Emergency Alert, [location],
Medical Emergency Alert, [medical attention needed (including if
backboard/AED is needed)] [male/female and age] "
• Director will "copy" to reporting staff and coordinate delivery of needed
supplies (backboard/Aed).
• All lifeguards and Camp Nurse must report to the scene of the incident as
quickly as possible, if a staff member is the sole counselor for a group they
must make sure their group is being watched before leaving.
• All non-lifeguard staff members must take campers to the nearest shelter (Arts
and Crafts or Main Lodge) and make sure windows are closed if the incident is
visible from them.
• Director will contact emergency services by calling Salem Harbormaster line or
through 911 call.
• If emergency services are en route, Camp Director will designate a staff to
coordinate clearing dock space and assisting emergency personnel to location.
• Assistant Camp Director will report to office to locate camper information.
Assistant Camp director will contact emergency contacts and relay information
about medical emergency.
• Staff not involved in performing first aid should remove campers from location
if possible.
• Mobility of subject will be determined by Camp Nurse.
• If it will be necessary to move subject splinting/backboarding should be
performed as needed.
If camper is to be transported off of island, Assistant Camp Director is
responsible for the relay of paperwork and an incident report form to
accompanying personnel. Camper should be accompanied by leadership staff
designated at time of emergency by Camp Director (Sr. Director of Camp
Services if onsite, Assistant Camp Director or Program Director if not) as well
as staff involved in first aid who can provide information about the care given.
• Assistant Camp Director will communicate transportation plans to emergency
contacts.
• As soon as possible witnessing staff should complete incident report form. All
participating staff should document incident in writing within 24 hours of
incident.
• At the end of the emergency, the Director or staff member in charge will radio
that the Alert is clear and all campers and staff may return to their normally
scheduled activity.
Missing Camper: •
• A Missing Camper Alert will be called in the event a camper cannot be located
on land.
• The counselor of the lost camper, or the counselor nearest to the radio will
transmit over the radio "Code Green, This is (location), lost camper, Code
Green, [camper's name if know or"unknown camper"] Over"
• Lifeguards should immediately split up into their Code Green groups and head
to designated beaches with a radio and start searching. If there is a suspicion
of the camper being in the water, a Code Blue should be called.
• Group leaders will immediately stop their activities and take attendance of their
group, and begin to move their group to one of two meeting places: everyone
from mid-island/office area towards the main lodge and beyond should report
to picnic grove. Everyone from mid-island towards arts and crafts and beyond
should report in front of the Seal Pup Den. Groups should be kept quiet and
move quickly.
• Assistant Director or Director will call each group over the radio to which the
group's counselor will report "all here" or"camper missing."
• Once name of missing camper is known it should be transmitted over radio by
Assistant director, or Camp Director. Any identifying features should be
transmitted as well.
• If the lost camper is not found during the check, specified instructions from
the Director to search for the camper will be administered.
Pool/Beach Rescue: •
• Guards will perform rescue according to their training and situation.
• Non-lifeguard staff will assist in clearing water; they should follow instructions
of lifeguards at all times.
If medical attention is required, supervising lifeguard will transmit over radio
"Medical Emergency Alert, (beach name/location), Medical Emergency Alert,
[medical attention needed (including if backboard/AED is needed)] [subject's
name and age]"
• Camp Director or Assistant Director will "copy" to supervising lifeguard and
coordinate delivery of needed supplies (backboard/Aed).
• Camp Director will contact emergency services by either marine radio (channel
16) or through 911 call.
Non-lifeguard staff should remove campers from location as quickly as
possible.
Follow procedures for Medical Emergency
• Any rescue performed, no matter the outcome, whether minor or major, must
be reported to camp director and incident report completed.
Kayak Emergency
• In the case of an emergency involving kayak participants Kayak guard should
immediately notify emergency services using marine radio (Channel 16).
•
• • If the kayak guard needs assistance, Kayak guard will use marine radio to
notify Camp.
• Camp Director or Sailing Director or Wakeboarding staff will "copy"
guard.
• In either case:
• Sailing Director or Wakeboarding staff will coordinate a powered boat to assist
Kayak guard.
• Sailing Director will use his/her discretion as to whether or not Sailing
participants will be endangered if the boat leaves. If they are in danger,
have wakeboarding instructor stay with sailing or have Sailing and
Racing Camp head in.
• Camp Director will coordinate work boat assist to Kayak guard.
• If radio fails, kayak guard will sound air horn (3 blasts).
Sailing Emergency
• In the case of an emergency involving sailing participants Sailing Director
should immediately notify emergency services using marine radio (Channel
16).
If the Sailing Director needs assistance, he/she will use marine radio to notify
Camp.
• Camp Director or Aquatics Director will "copy" Sailing Director.
Camp Director will coordinate work boat assist to Sailing Director.
• If radio fails, Sailing Director will sound air horn (3 blasts).
Lost Bather Alert:
Immediately upon suspecting lost bather staff will notify supervising lifeguard.
Guards will immediately clear bathers from water.
Supervising lifeguard will transmit over the radio "Lost Bather Alert, this is
(beach name/location), Lost Bather Alert, this is (beach name/location),
[bather's name if know or"unknown bather"]"
• Guards on location will begin sweeping last known location, or if no location is
known, will sweep from deepest point to shallowest.
• Supervising Lifeguard coordinates search and sweep.
• Buddy Board Staff member coordinates beach/pool deck attendance to
determine identity of lost bather. Buddy board staff remain at location until
dismissed by supervising lifeguard.
• All lifeguards immediately report to location to assist with search.
• If a lifeguard is a group leader, he or she will, as quickly as possible,
locate a non-lifeguard staff to supervise their campers and then report
to location. Lifeguard staff must give non-lifeguard staff an accurate
attendance sheet.
•
If lifeguards are located in another location with bathers, they should as
quickly as possible clear the water and then report to location to assist
with search.
• Group leaders will immediately take attendance of their group, and begin to
move their group to one of two meeting places: everyone from mid-
island/office area towards the main lodge and beyond should report to picnic
grove and await instruction. Everyone from mid-island towards arts and crafts
and beyond should report to the Arts & Crafts building (Sea] Pups to Seal Pup
Lodge). Groups should be kept quiet and move quickly.
• Assistant Director or Camp Director will call each group over the radio to which
the group's counselor will report "all here" or"camper missing."
• Once name of missing bather is known it should be transmitted over radio by
supervising lifeguard, Assistant Director, or Camp Director. Any identifying
features should be transmitted as well.
• Camp director and assistant camp director will coordinate search of buildings
and grounds.
• If after 5 minutes bather has not been located, emergency services should be
notified either calling Salem Harbormaster line or through 911 call.
• Search continues until lost bather is found.
Active Shooter
• In the event that there is an active shooter that approaches or steps onto the
Island, run to outskirts of Island and in opposite direction of shooter.
• When safe, call "Active Shooter" and last known location.
• Hide along outskirts of Island and continue moving if you sense danger.
• Camp will be cleared of emergency by emergency personnel
o Disregard any call on walkie-talkies from camp staff clearing camp.
Last Edited 5/2017 John Brinkman, Darlene Moulton,Jean McCartin
•
LYNCHNAN Or ERL00 YMCA
CHILDREN'S
ISLAND CAMP
l►
PARENT HANDBOOK
• Welcome to Children's Island Day Camp!
This manual is designed to answers many of your questions. Please take some time to read
it over carefully. We are happy to answer any additional questions you may have.
Goals and objectives of Children's Island Day Camp
Camp ,Goal: Children's Island will provide every child with an age-appropriate, safe camp
environment while helping them create memories that last a lifetime.
Children's Island Objectives:
1) To help each camper develop self-confidence and a feeling of self-worth.
2) To assist each camper in developing new friendships and a better understanding of
interpersonal relationships.
3) To help each camper discover and develop their potential, while having fun learning
and stretching skills in a variety of activities.
4) To teach each camper how to work through problems of communication and/or
cooperation with fellow campers, thereby developing their abilities to deal with
similar situations in a positive manner.
5) To provide each camper with opportunities to become physically active and to share
in maintaining good safety standards for the welfare of all.
6) To foster in each camper an awareness of fair play and sportsmanship.
7) To instill in each camper an appreciation of the out-of-doors and the role that each
person plays in maintaining the environment for today and in the future.
•' In accordance with Massachusetts State Law, and to ensure both the safety of the campers and
the highest quality staff, Children's Island and the YMCA perform background checks on all staff
each year. Parents have the right to review these checks and all camp policies upon request.
1
Important Phone Numbers
John Brinkman, Senior Director of Camp Services •
Office Direct Line 781-990-7013
Camp Phone (summer) 978-360-1948
Note: Camp phone is answered from 7:45 AM until 6:00 PM on camp days. On Overnights
the phone will be answered until 8 PM and will be on again starting at 7:45 AM Wednesday
morning. Please leave a message if not answered so we can return your call.
Getting to Camp
Children's Island is located about one mile outside of Marblehead harbor. Campers are picked
up at the State Street Landing Dock in Marblehead and Pickering Wharf in Salem. They will be
transported via contracted boats to the island. The vessels are inspected by the U.S. Coast
Guard and operated by licensed companies, with safety as their top priority.
Facilities
Facilities on the Island include: the Main Lodge which contains separate areas for boys and
girls to keep their belongings, bathrooms, and a large middle room where the camp can
meet on rainy days, the Ranger Lodge (home base for the Ranger program), the Arts &
Crafts Building, the Seal Pup Den, the Pool and Pool House, the Gazebo (an open air
building at mid-island), and the Camp Director's Office/Infirmary.
Drop-off/Pick-Up
Transportation options are available from State Street Landing in Marblehead and Pickering
Wharf in Salem. Families must select a boat option at the time of registration and abide to
its schedule and route.
Directions to State Street Landing
Follow Rt. 114 into Marblehead (becomes Pleasant St.). Follow Pleasant St. to its end. Take
a left on Washington St. then the first right onto State St. The Landing is located at the end
of State Street.
Directions to Pickering Wharf
Follow Rt. 114 into Salem (Washington St) to Derby St. and then take a right onto Congress
St. Take your first left on Wharf St. into the Pickering Wharf Marina.
Drop-Off
Campers should be dropped off at least 15 minutes before their boat is scheduled to depart.
A counselor will contact you the weekend prior to each session to let you know your camper
group for the week. At drop-off staff will help campers find their groups. Campers and
parents should check in with their counselor immediately upon arrival each morning.
For Marblehead drop-offs it is live drop-off only at the Landing. Parents may not park or
idle cars at the Landing lot. If you wish to see the boat off or need to speak with counselors
or directors, please park in town or at the Old North Church parking lot and walk over. We
may have staff helping to direct traffic to prevent blocking traffic on Front Street. •
Please call and leave a message at 978-360-1948 if your child will not be at camp. In the
event that a camper has not fully completed registration, payment, or does not have all the
2
appropriate medical forms, the camper will not be allowed to attend camp according to our
licensing requirements.
Boat Times (campers must be registered for specific times)
Marblehead Departure: 8:OOam or 9:OOam Marblehead Arrival: 4:OOpm or 5:OOpm
Salem Departure: 7:15am Salem Arrival: 5:45pm
Manchester Departure: 8:30am Manchester Arrival: 4:30pm
Missing the Boat, Absent Campers
Due to maximum capacity limits of our boats, Children's Island cannot guarantee late
campers a spot on a later boat. The boats will leave at the scheduled times, and we are not
able to accommodate campers who miss both boats.
Pick-Up
Counselors/Directors will be available to answer any questions regarding your camper's day
or experiences:All campers MUST be signed out by an authorized contact with a photo ID in
order to leave the dock or parking lot. Campers cannot be released to anyone that has not
been authorized by a camper's legal parent/guardian. Further, campers cannot walk
home without a signed note stating that fact.
Boats generally run close to schedule, depending on weather/traffic, etc. If a boat is going
to be excessively late parents at the pick-up points will be notified by YMCA staff.
Pick up for Marblehead boats is located at the Old North Church Parking lot, about a block
from the Landing (off of Stacey Street). Parents should park in marked spaces towards the
rear of the lot (not along the roadways) then walk to the sign-out point. You will receive a
pick-up ticket for each camper you sign-out. Parents must wait for the campers to arrive at
the lot, give the counselors their ticket(s), and then counselors will release the children.
Late Pick-up
If you think you are going to be late, please call the Camp Phone as soon as possible (978-360-
1948); After one hour from the closing of the program if the staff has not been able to contact
any individuals on the authorized release AND the parent has not notified camp of their
tardiness, the YMCA is mandated to contact the Department of Children and Families (DCF) to
report,the situation. Consistent late pickup can lead to suspension from the program.
Changing Boat Times
To make a change in your child's boat time:
Two weeks prior to your child's session: Call the YMCA at 781-631-9622 and ask for
the Camp Registrar.
During your child's session: Any request for a boat change, even for one day, must be
approved by the Camp Director and accompanied by a parent's note. Certain boats during
some sessions are filled to capacity so be aware that boat switching is not always possible.
These policies are designed with camper safety in mind. Without a note, campers will be
sent home on the boat they are confirmed for.
Refunds and Credits
• All camp cancellations must be done in writing and submitted to the camp registrar at
Ivocamps(anorthshorevmca.oro. All cancellations accompanied by a doctor's note any time
prior to the start of your child's camp session will receive a full refund.
3
Camp Change/Cancellation Policy:
Please keep in mind that a camper's place is reserved for the entire period of enrollment. To
provide the service that we promise, Children's Island obligates itself for the entire season's
expenses. As a result, after June 1st, we cannot refund payments, issue credits,
make changes, switch weeks or cancel obligations.
Financial Assistance
The YMCA summer camps are for everyone - regardless of income. The YMCA provides
financial assistance for those who unable to pay a full camp fee. Subsidies are available
thanks to the general support of our Annual Campaign, Marblehead Rotary, and the
Marblehead Public Schools. Pick up an application for our Access Program at the YMCA or
download one from our website www.northshorevmca.oro.
Processing financial aid applications can take up to two weeks and thus should be completed
at least two weeks prior to registering for camp. A copy of your award letter must be
attached to your camp registration packet in order to receive reduced rates.
Camp Programming
The possibilities for activities on Children's Island are endless! Some of our regular
programs include:
Sports: A combination of both traditional (soccer, softball, volleyball, etc.) and non-
traditional activities (unique tag games, team building activities) will be run. The
program's goal is to have something for everyone, regardless of how athletic they •
are during the school year.
Rangers: Using a progressive patch system, this program teaches respect for the
environment, instills a love of the outdoors, and teaches new skills while building
self-confidence (See Patches and Awards for the extended explanation). Ranger
activities include: exploration walks around the Island, snorkeling, rowing,
orienteering, campfire building, craft making, and more. This program is designed for
the older youth for safety reasons.
Aquatics: In addition to several beaches, Children's Island has chlorinated, salt-
water pool offering groups the chance to work on their swimming skills through
organized lessons, playing games, and having fun with their friends. Always staffed
by trained lifeguards, the pool is a great place to cool down on hot summer days!
Kayaking: Aquatics staff, along with Group Counselors, teach the basic skills of
kayaking to the campers from two secluded beaches.
Arts and Crafts: From tie-dyeing, to gimp, and projects that make use of the
unique Island environment, Arts and Crafts has a little bit of everything. The
program gives every camper a great way to express themselves creatively and to
bring something of their own home from camp.
Archery:
Campers learn the basics of archery and how to safely shoot a bow and arrow.
Sailing: Programs from novices to the more experienced, the sailing program is for
every camper.
4
Patches and Awards
• Every year the one question we hear from parents more than any other is some form of
"How does my child earn a Ranger patch?" All main program areas at camp (Rangers, Arts
and Crafts, Sports, Sailing, Archery, Kayaking, and Aquatics) have opportunities for
campers to earn patches. Rangers, Sailing, and Kayaking have programs for advancement,
with several patches in a specific order of difficulty. Patches (with some exceptions) are
distributed at Final Flagpole (camp meeting) at the end of each session.
Rangers - Rangers has the most popular and most involved patch system. The main
program at Rangers consists of six color-coded patches. In the order of increasing difficulty
the patches are Blue (candidate) Green (novice) Brown (intermediate) Orange
(experienced). Yellow (advanced), Red (staff). At the beginning of each session new
campers are given a booklet at Rangers that explains the requirements of each patch. Many
of the upper level patch requirements can only be earned by participating in the Ranger
overnight (on Thursdays of even sessions). To stay on the Ranger Overnight a camper must
be ten years old and have completed all requirements for the blue patch. If you would ever
like a copy of the Ranger Patch booklet, ask either the Ranger Unit Leader or the Camp
Director during Family Night and we'll be glad to get you one. In addition to the color
patches at Rangers campers can earn patches for: rowing skills, skin diving skills, and
orienteering.
Archery - An Archery patch is awarded to anyone who hits and sticks a bulls-eye at
archery. A Yellow Bead is awarded for anyone who hits and sticks an arrow anywhere in a
target at archery.
In addition to the patches and awards described above there are patches to reward campers
• who show caring and respect for the Island environment and each other, for being involved
in Flagpole with creative skits or original songs, and for being leaders in their group.
Family Nights/Overnights
FamilyNight
Family nights are an exciting opportunity for campers to show the camp to their family and
friends and for parents to meet and talk to the staff. Family nights take place on the
Wednesday of each even-numbered session (4,6,8). Families of campers are welcome to
bring dinner to camp or to purchase a hotdog dinner on the Island. Boats leave from the
Landing at 4:15pm, 5:15pm, & 6pm and the last returning boat arrives back around
7:15pm.
Overnights
All campers (with the exception of Seal Pups) have the opportunity to stay for the Camp
Overnight. After all family and friends leave, campers will take part in campfire, then sleep
in tents or in the lodge depending on the weather. Camp provides breakfast and lunch on
Thursday. An overnight permission slip with a suggested packing list will be sent home
during the session and available on the website.
What to Bring to Camp
LUNCH: Each camper should bring his or her own lunch labeled with their name. Campers
• should bring full water bottles to camp each day. We have water coolers available to refill
them throughout the day. Due to camper allergies (especially peanuts), we kindly ask
parents to be considerate when packing camper lunches. We recommend avoiding peanut
5
butter or packing hand-wipes to help campers clean-up potential allergens. Also, make sure
to pack several snacks for your camper in addition to lunch.
CLOTHING: Campers should wear appropriate outdoor attire. Keep in mind that the •
Island is typically 100 cooler than the mainland. Please send a sweatshirt or jacket daily.
Please consider appropriate footwear for your child. Campers should arrive in sneakers
(something good to run in) and pack sturdy water-type shoes for exploring the oceanfront.
Flip-Flops are not appropriate for most activities on the island.
SWIMMING GEAR: All campers will swim daily. Please pack a bathing suit and towel
every day. Campers may also want swim goggles or swim cap as well.
SUNSCREEN and BUG SPRAY: Please send your child to camp with his/her own
sunscreen (SPF 15 or higher). There are multiple times built into the schedule every day to
re-apply sunscreen and counselors may assist children in re-apply sunscreen, especially
after extended water activities. If you believe that your child is getting too much sun please
speak to his or her counselor so we can address the problem. If you choose to send insect
repellent (the Island has few bugs or mosquitoes) please instruct your child in its
application.
Please send everything in a labeled backpack with your child. Please make sure to label all
belongings. This will significantly reduce the number of lost items and ensure a safe return.
Please do not send your child to camp with toy guns or knives, jewelry, POKEMON-style
cards, dolls, radios, gum, bags of candy, walk-men, disc-men, cameras, game boys, CELL
PHONES, other electronic devices. We have phones and other communication systems in
the event of an emergency. The YMCA cannot be responsible for items that are lost,
broken, or stolen. •
PFDs (Lifejackets)
ALL campers, Teens, and CITs are REQUIRED to have a United States Coast Guard
approved type I, II, or III PFD (lifejacket) to come to camp. This PFD is worn on the
boat ride to and from the Island as well as on sailboats, rowboats, kayaks, and for some
swimmers, on all beaches. The Island does not provide PFD for campers for the summer. If
you need assistance purchasing a PFD please contact the Camp Director.
Each child's PFD must be labeled with their full name and contact information for
their parent or legal guardian (i.e. phone number).
Lost and Found
Island Staff will make every attempt to return all lost items on a weekly basis. To increase
the chances of getting back an item of clothing we recommend that you LABEL ALL ITEMS
WITH YOUR CHILD'S NAME. At the end of each session all unclaimed clothing will be
brought to the YMCA for two weeks after which time we will donate all items to charity.
If an item is missing please look through Lost and Found box located in the Main Lodge
room during Family Night.
Rainy Days
We travel to the Island EVERY DAY unless it is unsafe to travel to or dock at the Island. •
(Alternate location would be found on our website or by calling the Island phone) It is
6
possible that weather might prevent certain activities, e.g. sailing, kayaking, but the staff
have rain day plans in place to keep the camp day fun!
• It is very important to make sure that campers are prepared for inclement weather.
Appropriate rain gear (LABELED WITH THEIR NAMES) should be provided in addition to a
dry change of clothes for later in the day.
If there is a lightning storm camp moves into buildings until it is safe. The camp
administration monitors weather radios and suspends any water programs at the first sign
of dangerous weather. If a weather system interferes with the loading of the afternoon boat
runs, the trips are delayed until it is safe to travel.
Swimming
Since camp is on an island, camp places high importance on strong swimming skills. On
each camper's first trip to the pool he/she will take a short swim test across the shallow end
to determine his/her swimming ability. This test is mandated by State law and is a good
way for the aquatics staff to know the swimming levels of the campers.
After the first day at the pool all campers will take part in swim lessons based on YMCA
Swim levels to help build and strengthen their skills. If campers are already in a YMCA
swim level they will be in the same level at Camp. If you have any questions please speak
to the aquatics director.
Group Placement
• All groups/teams are formed by age with an eye towards keeping each team and group a
similar size. Many requests are satisfied through the natural group formation process. If you
have a'request that is not met with the grouping system, please speak to the camp
administration. In the interest of maintaining balanced groups we cannot guarantee that
requests will be granted.
Children's Island Day Camp is a great place for campers to meet children who are not from
their neighborhoods or schools, some campers come from other states and even foreign
countries! Learning to meet and interact in a new setting is both a useful and healthy skill
and our goal on the Island is to make this process easy and fun.
Camper Adjustment
While rare, sometimes campers, especially younger campers, are challenged by the
transition from school to day camp. The staff welcomes each camper to the program and
tries to make them feel comfortable and at home. If after the first day your camper is
apprehensive about camp please speak with the Camp Director.
Behavior Management Policy
The Children's Island Day Camp Behavior Management policy is formed around the core
idea of"safety and respect for ALL". Discipline and guidance will be consistent and based on
• the understanding of the individual needs and development of the camper. Rules are
constantly explained and reinforced with the campers. Campers are encouraged to work out
minor disputes by themselves according to their abilities. Counselors will intervene as
needed.
7
Repeated infringement of the rules or disruptions of the group by a camper will result in a
short time-out. This will be followed by a talk with the Group Counselor about better ways •
to handle difficult situations. If the child continues to create a problem for the group the
camper will be escorted to the Camp Director.
Progressive methods of discipline for Children's Island are as follows:
Step 1: Talk through the problem with the camper. The camper is encouraged to suggest
alternative solutions and assist in implementation. A warning may be given to the camper
explaining consequences for continuance of their behavior.
Step 2: A break from an activity. The YMCA staff will ask the camper to sit down and help
the camper regain control of himself/herself. Campers will be provided an opportunity to
resolve the situation by talking with staff and peers. If an agreeable solution is reached, the
child may return to the activity.
Step 3: If the disruptive behavior continues the Camper will be brought to the Camp
Director. Depending on the severity of the behavior the director will either send the child
back to the group with the clear message that further disruptive behavior will mean that the
child's parents will be called or the parent may be called immediately and asked to pick up
their child.
Camp Director will IMMEDIATELY contact the parent and have the child sent home when
these situations warrant:
1. Physically fighting with another child
2. Habitual use of swearing/foul language
3. Hitting and/or kicking a staff member/another child •
4. Inappropriately touching of staff member/another child
5. Stealing
Camp Rules
Camp rules are designed to maintain a safe, fun, and respectful environment for all
campers, staff, and guests.
Camp Rules:
1. ALWAYS treat others the way you want to be treated!
2. Shoes must be worn at all times.
3. Campers should always be with their group and in sight or sound of their counselors.
4. Respect the Island environment: Put trash in its place.
5. Lifejackets are on and fastened on all boats and on the dock.
6. Only appropriate language will be used at camp.
7. Keep your hands and body to yourself at all times.
8. Girls and boys will stay on their side of the Main Lodge.
9. Instructions from Counselors keep people safe. Always follow them!
10.Alcohol and Drug use is prohibited.
11.Animals and items that could in any way be considered dangerous to others will not
be allowed.
Health Policy
8
Children's Island Day Camp has a health care consultant on call in addition to key staff
people trained in emergency care and first aid. Each child must have a completed and
• signed medical form and immunization record at camp prior to admittance.
Participation privileges will not be extended to campers whose forms are not on file.
Parents should not send sick or infectious children to camp.
Parents whose children need medication during the camp day should provide the medication
in the original container with the original prescription attached. A medication consent form
must be completed prior to any medications being dispensed. Non-prescription medication
must be accompanied by a parent's note as well as a physician's note. All medications
should be given to either the Camp Director or Assistant Camp Directors and will be locked
up throughout the day. Medications will be dispensed by authorized YMCA personnel.
If the Camp Director and/or Health Supervisor deem a child ill, parents will be contacted to
arrange for pick-up.
Emergency Procedures
The trained staff will handle minor injuries or illnesses. In the event of a minor accident or
illness, the camp staff will contact the parent/guardian or an emergency contact person. In
the case of serious illness or accident, the YMCA camp staff will utilize appropriate police,
fire department or ambulance transportation. If this action is taken, the camper will be
taken to North Shore Children's hospital. Parents will be notified in all cases.
More specific details about contingency plans, emergency procedures, and health care
information are available in the Children's Island Health Care Policy.
•
We'll See You At Camp!
We hope that this parent handbook has answered your questions and given you valuable
information about your child's upcoming experience on Children's Island!
Sincerely,
John Brinkman Damien Reynolds
Sr. Director of Camp Services Camp Director
Amanda Haley Samantha Claveau Trevor Ward
Program Director Assistant Camp Director Assistant Camp Director
NOTE:
This camp must comply with the regulations of the MA Department of Public Health and be
• licensed by the Salem Board of Health. Copies of staff background checks, healthcare policy,
discipline policy and grievance procedures are available upon request. CORIs and SORIs are
a part of our background checks on all employees.
9
Children's Island Day Camp ®o
2017 Health Care Policies and Emergency Plans the s
1. Health Care Consultant: Marc Sibella, DO
Telephone: 781-631-5126
Address: 1 Widger Road, Marblehead, MA 01945
Health Care Supervisor: Camp Nurse, Camp Directors
2. Emergency Telephone Numbers
Salem Harbormaster 978-741-0098
Salem Fire: 978-744-1234
Salem Police`. 978-744-1212
Poison Prevention Center: 1-800-222-.1222
Marine: VHF Channel 16
3. Hospital Utilized for Emergencies
Name: North Shore Medical Center Salem Hospital
Telephone: 978441-1200
Address: 81 Highland Avenue, Salem, MA 01970 .
4. Emergency Procedures
In the event of an emergency,a staff member will call the Salem Harbormaster viacell phone
or VHF radio and their directions followed until the crew arrives. A second staff person will
contact a parent at their emergency phone number (on file in Camp Office) immediately. -
•
S. Emergency Procedure If Parents Cannot Be Contacted.
If a.parent cannot be contacted, a staff person will.accompany the camper to the hospital with
their emergency information (on file in Camp Office) in hand.A second staff person will
continue to try to contact a parent by calling them at home and at work (numbers on file in
Camp Office and in YMCA registration computer program).
6. Off-Premise Emergency Procedures -in the event of a medical emergency, the child is taken to the closest hospital and the
parent/guardian and/or the emergency contact person is notified.Emergency procedures will
be followed. The child's emergency information,will accompany them.
7. Procedures for Utilizing first Aid Equipment
1. Location of First Aid Kit(s) Infirmary, Main.Lodge, Pool House
2. Location of AED Camp Office
2. Location of First Aid Manual Infirmary
3. First Aid is administered by First Aid-certified counselors or
Camp Directors
4. First Aid Kit is maintained by Camp Directors, Aquatics Supervisor
5. Contents of First Aid Kit
• Non=.perfumed soap • Sterile gauze squares
• Compresses • Adhesive tape
• Bandage scissors • Triangular Bandages
• Rolled bandages • One=way Valve mask
• Tweezers Cold Pack
Barrier Gloves
8. Plan for Injury Prevention and.Management
Daily checks are made of the camp area, bathroom facilities, outdoor play areas.and
,• swimming areas by staff prior to camper use. Any problems found are reported to the
maintenance staff and a work order is issued for immediate attention. Camp property and
• facilities are monitored daily for removal and/or repair of hazards.
9. Procedures for Reporting Serious Injury, In-patient Hospitalization, Death of a
Camper or Staff Person to the Department of Public Health
Immediately following any type of serious accident, the MDPH Injury Form will be filled out
and filed with the Town of Salem and the YMCA of the North Shore. A copy of the form will be
mailed to the Department of Public Health within one day of the incident.
10. Procedures for Informing Parents of First Aid Administration
For minor injuries requiring first aid, a First Aid Administration Form is filled out in duplicate.
Upon picking up the child from camp, the parent or guardian receives a copy of the form.
11. Head Injury Procedures
For any injury involving the head, immediate evaluation of injury will take place by First Aid
certified staff. If signs of serious injury exist, EMS will be called. If it is deemed there is no
immediate danger, a phone call will be made to the Emergency Contact person informing them
of injury and allowing them to evaluate injury and/or request additional medical attention.
Upon signing Accident report, Emergency Contact must note their assessment of the injury.
12. Plan for Infection Control and Monitoring
Hand sanitizing and personal hygiene are strictly enforced. Food and drink are brought from
home and are not shared. Bathroom and changing rooms are attended daily by maintenance
staff. Spray bleach/water solution is used daily on all surfaces as needed.
13. Procedures for the Clean-Up of Blood Spills
Area immediately evacuated, clean up using the Bloodborne Pathogen kit. Staff will use
gloves, eye shield, mask and if necessary, a protective gown & cap. ILSC powder will be put
on the blood and it gets scraped into a Bio-Hazard bag for disposal.
• 14. Emergency Plan for the Evacuation of the Program or Facility
Evacuation plans are posted next to building exits. Camp Counselors lead children out of
buildings/structures/woods to designated areas. Camp Directors and Unit Leaders check for
stragglers. Camp Directors ensure children in attendance equal the number of children safely
evacuated. Camp Directors conduct evacuation drills at Camp Director's discretion, a surprise
to the counselors, and documents effectiveness.
For emergencies during transportation to and from the Island, Camp Counselors will cooperate
with boat captains and crew and assist campers in following the appropriate emergency
protocols.
15. Plan for Administering Medication (Prescription and Non-prescription)
In order for a camper to be administered medication, an authorization form must be
completed by the parent. This is kept on file and a log of the administration of medication is
kept.
Medication must be in original containers with the pharmacy label, date of filling, pharmacy
name and address, filling pharmacist's initials, serial number of the prescription, name of the
patient, name of the prescribing physician, name of the prescribed medication, directions for
use and cautionary statements, if any, contained in such prescription or required by law. If
capsules or tablets, the number in the container. All over the counter medications shall be
kept in the original containers with the original labels.
All medicine brought to camp must be given to a camp counselor immediately for safe storage
in a locked medicine cabinet or box. Locked medicine storage is located in the infirmary.
Medicine will be stored according to its labeled directions.
• The Health Supervisors may administer medications. Only oral and topical medicines will be
administered, with the exception of Epi-Pens for campers with known allergy or pre-existing
medical conditions. All medications dispensed at the camp will be recorded in the Daily
. Medication Log noting the date, time and dosage of medication given.
16. Plan for Recording of the Disposal of Medication
Unused medicine will be returned daily or at the end of the week to the adult supervisor to
whom the camper is released. If the medication cannot be returned, it will be destroyed by the
Health Care Supervisor, witnessed by a second person and recorded in the Medication
Destruction Log.
17. Plan for the Care of Mildly III Campers
First Aid will be provided by a staff certified in First Aid. Steps may include:
• Separation from larger group
• Rest in a shaded, quiet area
• Water to drink (unless contraindicated)
• Additional steps according to specific complaints
Parents will be notified if the condition continues, worsens, or upsets the camper. Camper will
be taken to the infirmary located in the Camp Office and made comfortable until being
transported back to their pick-up location.
18. Medical Log
If any camper has a health complaint, it will be entered in the camp Medical Log using the
next available line with the entry in ink. Any communicable disease or unusual prevalence of
any disease occurring in camp will be reported by the Camp Director/Nurse immediately to the
Board of Health.
19. Procedures for Identifying and Protecting Children with Allergies and/or Other
Emergency Medical Information
All parents/guardians must complete a Camper Information form (part of the Parent Packet)
before their child may attend camp. Allergies, medications, and special conditions are
• specifically asked to be listed. This information is kept in a log and at the beginning of every
day, the Camp Director reviews the information with camp counselors. For children with
extreme allergies, the parent must provide the camp with an Epi-Pen prescribed to the child
before the child may attend camp.
20. Exclusion Policy for Serious Illnesses, Contagious Disease, Reportable Diseases to
Board of Health
Children with known serious illnesses or contagious diseases will not be permitted in the camp
from the first day they are known to have the illness/disease until they can provide a doctor's
notice saying they are no longer a threat to other persons. A report of the disease or illness
will be completed and filed by the Camp Director with the Board of Health the same day the
illness or disease is identified.
21. Location of Staff Smoking Area
Smoking is not allowed anywhere on the camp property.
22. Policy for Use of Bug Spray, Sunscreen, Lip Balm and Reducing Exposure to Sun
Parents are asked to apply appropriate sunscreen and bug-spray before child enters camp.
Additional bug spray, sunscreen, and lip balm are applied as needed at the discretion of the
Camp Leadership Team.
23. Grievance Policy
Should a camper or their guardian have a grievance, it should be reported first to the Camp
Director. The Camp Director will document the grievance, alert the Senior Director of Camp
Services (Executive Director if Sr. Director is unavailable) and all steps will be taken to correct
the grievance immediately.
•
24. Prevention of Abuse and Neglect
• In the event that it is suspected a child is being abused or neglected, staff are required by MA
State Law to immediately report the suspected abuse/neglect to the Camp Director. The Camp
Director will then report it to the MA Department of Children and Families.
In the event that a 51A Report alleging abuse or neglect of a child while in the care of the
camp is filed, the Camp Director must notify the Board of Health immediately. The staff
person accused in the report will be kept from working directly with campers until the
investigation is completed. The staff will cooperate in any official investigation concerning the
report.
The YMCA will cooperate in all official investigations of abuse and neglect alleged to have
occurred at the camp, including identifying parents of campers currently or previously enrolled
in the camp who may have been in contact with the subject of the investigation.
The YMCA will ensure that an allegedly abusive or neglectful staff person does not work
directly with campers until MA Department of Children and Families investigation is completed.
25. Discipline
Children are individuals - discipline should maximize the development of the child and ensure
the safety of the child and the group.
Behavior that is considered inappropriate:
• Behavior that could cause physical harm to themselves or anyone else.
• Refusing to comply to the staff or facility rules.
• Verbal abuse, degrading comments, inappropriate language.
• Inappropriate physical touching of staff member or another child.
Acceptable Forms of Discipline:
• Removal from stressful situation.
• Limiting participation in certain activities.
• Time Out in designated location for up to 5 minutes.
Send to Camp Office
(If deemed necessary by the Camp Director, the offender's parents may be
called and the child removed from the camp.)
Unacceptable Forms of Discipline:
• Corporal punishment including spanking.
• Cruel or severe punishment, humiliation, verbal abuse.
• Denial of food or shelter.
• Punishment for soiling, wetting or not using the toilet.
Discipline Documentation
• Camper actions and discipline taken by staff will be documented. Persistent
problems will be identified to the Camp Director and discussed with camper's
parents.
26. Fire Drills
Fire Drills will be held the first day of camp and once a month thereafter. Campers follow the
posted emergency procedures for exiting the camp grounds in a calm and orderly fashion.
Groups will meet at their designated evacuation areas.
27. Emergency Communication
Walkie-talkies are provided for each director, unit leader, and/or program area. In addition,
whistles are provided for each lifeguard (which includes a number of counselors) and should
be used sparingly to get campers attention. See CIDC Communication Plan.
28. Disaster Plan
If advised by authorities to evacuate an area, all campers will follow the posted emergency
evacuation procedures. In the event transportation is required, emergency boat pick-up will
return campers to the Landing in Marblehead, and if necessary, transported by bus to the
• Lynch/van Otterloo YMCA.
29. Tornado or High Winds
• In the event of a tornado or high winds, without time for Island evacuation, campers will
immediately go to the Seal Pup Den or cellar or the Main Lodge. Crouch down against the floor
by the center walls and cover the back of their head and neck with their hands.
30. Flash Flood
In the event of a flash flood, all campers will immediately go to their designated shelters
(Sailors Lodge or Main Lodge). Do not try to walk through flowing water more than ankle
deep.
31. Lightning
If lightning or thunder is in the area, swimming areas will be closed immediately and remain
closed until at least 30 minutes after the last sighting of lightning or last clap of thunder. All
campers will immediately report to their indoor meeting spaces. Avoid using electrical
appliances. Do not use the running water.
32. Wildfire
Follow the instructions of local officials. Wildfire can change direction and speed suddenly.
Local officials will advise of the safest escape route. If trapped, enter the swimming area.
Campers cannot outrun a fire. Breathe the air close to the ground through a wet cloth to avoid
scorching lungs or inhaling smoke.
33. Swimming
All campers must be tested prior to being included in the camp swim time by the lifeguard
staff. The swim test consists of submerging completely, swimming 25 yards on your front and
treading water for 30 seconds. All campers will be designated as either swimmers or non-
swimmers and noted as such in the Swim Log. At risk swimmers will be considered non-
swimmers. Non-swimmers must wear ATTACHED, properly fitting flotation (PFD Type I,II or
III) and may only wade in the water up to waist deep.
Swimmers may,move freely in the designated swimming area. All camp swimmers must stay
in the area designated for swimming at all times. There will be a minimum of 1 camp
counselor per 10 swimmers present for swimming (5 for children age 6 and under). There will
be a lifeguard present at all times when swimming. Campers not swimming during the
scheduled swim time must sit on the beach away from the water.
To come to Children's Island, campers are required to bring a properly-fitting USCG-approved
PFD Type I, II or III. A Camper who forgets to bring their PFD may be provided one from Mahi
Mahi Cruises and Baker's Transport for the boat ride to the Island. The Camp will provide a
PFD to the Camper if they are a non-swimmer. Campers who repeatedly forget or lose their
PFD may be billed by the YMCA for a replacement one.
See Children's Island Day Camp Christian's Law policies for further information regarding PFDs
and swim tests.
34. Buddy System
Each camper must choose a fellow camper to be their Buddy while swimming. Buddies must
be of the same swimming classification. Head Camp Counselor must note how many sets of
Buddy's are going to the pool. Buddy checks are done at regular intervals (not more than 20
minutes apart) by the camp counselors and/or lifeguard. At the Buddy check, Buddies must
hold hands up in the air and be counted.
35. Missing Swimmer Plan
In the event that one buddy or a set of buddy's are missing at the Buddy Check, the camp
counselor should immediately signal the lifeguard. The lifeguard will empty the swimming area
with three sharp whistle blasts and check for swimmers in the water. If the buddies are not
located in the water, then it is the Camp Counselor's responsibility to check the surrounding
• areas including play areas and bathrooms for the missing children while the Camp Directors
supervise the rest of the campers. If the campers are not found, enact Missing Swimmer Plan.
36. Missing Camper Plan
In the event that a camper becomes lost, the camp counselor must immediately report to the
Camp Director the name, description and last known location of the missing child. The Camp
Directors are then in charge of the search.. Gather all campers in their evacuation areas and
take roll call and double-check rosters to confirm that child was at camp. Camp counselors
search the bathrooms, camp buildings, play areas and swimming area (including if necessary
removing everyone from the water). If the child is not found there, then search the outlying
and coastal areas of the Island. Within five minutes of beginning the search, if the child still
hasn't been found, the Camp Director will contact the Executive Director of the YMCA and
Salem harbormaster. Once they have been alerted, the Camp Director will call the
parent/guardian at their emergency phone number on file, then continue the search.
For a lost camper at a pick-up/drop-off point, Camp Staff follow same procedures and search
the surrounding areas accordingly.
37. Plan for When A Registered Camper Does Not Arrive
Double check attendance and roster. Alert the Camp Director(s) immediately. Camp Directors
will call the parent/guardian of the registered camper both at home and at their emergency
contact number to try to identify where the camper is and make the necessary adjustments to
the camp schedule. If there is no response, the Camp Directors will leave a message.
38. Plan for Arrival of Non-Registered Camper
Should a camper arrive who is not registered, alert the Camp Directors immediately for
verification. We cannot accept them into camp this session. Camp policy states that all paper
work and balances for the upcoming session are due prior to the child's first day of camp.
Alert the adult attempting to drop off the camper that we will not be able to take them today
and inform them of the Camp's registration policy.
39. Camper Not At Pick-Up Point
Double check attendance and roster, confirm that the camper was not already picked up by
parents or sent on the wrong boat. Alert the Camp Director. The Camp Director will contact
other Camp Directors and Counselors to determine the location of the camper. If the camper is
not immediately located, then enact the Lost Camper Plan.
40. Camper Dining Plan
All campers must be seated while eating. Only camp counselors may distribute drinks, food,
etc. after sanitizing hands by washing or with hand-wipes. The sharing of utensils, food or
drinking cups is not permitted. Campers will be encouraged to eat, but cannot be forced to
eat. Campers are recommended to bring their own food, but in event of a lost or missing
meal, one will be provided for them by the Camp Leadership team. No camper will be denied a
meal for any reason other than medical written direction.
41. Traffic Control Plan
Pick-up and drop-off for camp will follow specific procedures for each location (see Pick-
Up/Drop-Off Plans). All vehicles must proceed with caution in parking lots, park in an orderly
fashion, and follow all staff directions when picking up or dropping off children. Parents or
guardians who fail to follow procedures and staff directions, resulting in safety hazards, may
receive written warnings from the YMCA and/or have their child unenrolled from the remaining
camp session.
42. Camp Organization
Camps are offered for children ages 5-15, on a Monday through Friday basis. The Camp Day
on Children's Island runs from approximately 9 AM-3:30 PM (not including transportation).
43. Chain of Command
All staff will report to the Camp Leadership Team (Program Director, Assistant Camp Directors,
Unit Leaders reporting to Camp Director). The Camp Director reports to the Senior Director of
Camp Services,
44. Camper to Counselor Ratios
(All ages are determined as of the actual calendar date)
Ages six and under require one camp counselor for every 5 children.
Ages seven and over require one camp counselor for every 10 children.
45. Required Counselor Information
All counselors must have completed an extensive background check including prior work
history, three reference checks, juvenile CORI checks and SORI checks. Kept on file are a
Health History and Emergency Contact Form, a report of Physical Examination in the last 24
months and a complete record of immunizations. Counselors must also attend a staff
orientation before working.
46. Required Camper Information
All campers must have completed and on file BEFORE attending camp a Camper Information
Form, Liability Release, Health Record Form, a report of Physical Examination in last 24
months and a certificate of immunization. If medication is to be administered to the camper,
they need to have in addition an Authorization to Administer Medication form and a record of
dosages kept in the Daily Log for Medication Administration.
47. Telephone Usage
Camp Counselors may have access to one of the camp cell phones at all times for emergency
use. Emergency numbers are posted in each building,
48. Personal Hygiene/Behavior Expectations for Staff and Campers
. • Hands must be cleaned with soap and water or hand wipes before eating and after using the
restrooms.
• Campers will always visit the bathroom before swimming.
• No sharing of towels, campers provide their own towels.
• Campers will be encouraged to reapply sunscreen/bug spray throughout the day.
• No sharing of cups, food, or eating utensils.
• No use of drugs or alcohol. Tobacco use by staff is not permitted.
• Nothing that could be construed as a weapon (pocket knives, personal bows, rifles, etc.) is
allowed on camp property.
• All poisonous/hazardous chemicals must be kept in designated, locked areas.
• Surfaces should be disinfected daily.
49. Camp Philosophy - The YMCA of the North Shore is committed to the values of Caring,
Honesty, Respect and Responsibility. Our YMCA provides all children, adults and families,
regardless of income, with opportunities to develop a healthy spirit, mind and body.
This camp must comply with the regulations of the MA Department of Public Health and be
licensed by the local Board of Health.
Written Orders
YMCA Summer Camps
I, Marc Sibella, acknowledge that I serve as the Health Care Consultant for the
Lynch/van Otterloo YMCA Summer Camos. As such, I hereby authorize the
following listed medications to be administered to campers as prescribed, provided
that, the medications are delivered to the camp, maintained by the camp, and
administered in accordance with Commonwealth of Massachusetts Regulations at
105 CMR 430.160 and that the parent/guardian of the camper has provided written
permission for the administration of the medication. I am not the prescribing
physician for these medications. My signature indicates only that I have reviewed
the listed medications and associated potential side effects, adverse reactions and
other pertinent information with all personnel administering medications to campers
and not that I have reviewed or determined the appropriateness of the medications
for the camper. My signature further acknowledges that all personnel listed below,
who administer medications at the camp, are either licensed health care providers
authorized to administer medications or designated health care supervisors who are
appropriately trained to and are doing so under my professional oversight.
1. Personnel will follow ASH] standards for Basic Life Support.
2. Health care supervisor, camp director or designee, will document, in
accordance with written policies on file. All.medical incidents will be
documented. All incidents reports will be kept on file, and the health
supervisor will provide the legal guardian with a copy of the written
report within 24 hours.
r A Liz pJ�Z
Physician Signature bate
Day Camps. Children's Island.•
Willow Osgood, R.N. Melissa Wilson, R.N.
Marianne Baker Damien Reynolds
Gabrielle Claveau Amanda Haley
Tyler Madden Samantha Claveau
Thomas McEnaney
Kyle Cannon
David St. Pierre
Malin Segal
Brendon Graffum
Jennifer Barletta
Margaret Buehler
Jane Rizza
HEALTH CARE CONSULTANT AGREEMENT
Summer camps at the Lynch/van Otterloo YMCA 40 Leggs Hill Road,Marblehead,MA 01945
NAME OF CAMP ADDRESS OF CAMP
The Massachusetts Department of Public Health regulations for recreational camps for children, 105 CMR
430.000,require that all recreational camps for children have a health care consultant. The regulation and
responsibilities of this person are described below.
430.159(A)Health Care Consultant A designated Massachusetts licensed physician,nurse practitioner or
physician assistant with pediatric training as the camp's health care consultant. The consultant shall:
1. Assist in the development of the camp's health care policy as described in 105 CMR 430.159(B);
2. Review and approve the policy initially and at least annually thereafter;
3. Approve any changes in the policy;
4. Review and approve the first aid training of the staff;
5. Be available for consultation at all times; and
6. Develop and sign written orders to be followed by the on-site health supervisor in the administration
of his/her related duties.
If the health supervisor is not a licensed health care professional authorized to administer prescription
medications, the administration of medications shall be under the professional oversight of the health care
consultant. 105 CMR 430.160(C)
430.159(B)Health Care Policy A written medical policy, approved by the local board of health and by the
camp health care consultant. Such policy shall include,but not be limited to, daily health supervision, infection
control,handling of health emergencies and accidents, available ambulance services,provision for medical,
nursing and first aid services,the name of the designated on-site camp health supervisor,the name, address
and phone number of the camp health care consultant required by 105 CMR 430.159(A)and the name of the
health supervisor required by 105 CMR 430.159(E), if applicable.
430.160(C)Administration of Medication The health care consultant shall acknowledge in writing a list of all
medications administered at the camp.
I meet the requirements of the health care consultant as described in 105 CMR 430.159(A). I have reviewed
theses referenced regulations and understand the responsibilities of the position and agree to assist this camp
regarding the same.
/%a r-e, P'(Ar//o
Print Name Title
x'70 �, ✓>n� '233A 4 �2
Signature MA Li-c7ense/Registration Number
el-
Address Telephone Number
Date
Camps located at the Lynch/van Otterloo YMCA
Small Fry Mini Sports Mania Rising Stars Gymnastics Princess Power
Explorers Sports Mania Shooting Stars Gymnastics Young Scientists
Junior Leaders Super Stars Gymnastics Discover the Artist
Soccer Competitive Team Camp Superheroes Jr. Adventure
Nerf Blasters Book Cooks Star Wars Adventure
Skateboard Chefs Lego Builders
Archery Biking Iron Chef Science Discovery
Wilderness Flag Football/Baseball Surfing Harry Potter
Camps located on Children's Island
Children's Island Day Camp
Seal Pups
Islanders
Counselor-in-Training
Sailing
Race Sailing
Wakeboarding
Rangers
Rowing
Lynchfvan Otterloo YMCA Summer Camps
�. the Emergency Authorization Form
as
Campers Name: DOB
Address
Town:
Parent/Guardian Name:
Phone Numbers: Cell Work
Parent/Guardian Name: -
Phone Numbers: Cell Work
EMERGENCY CONTACTSIALITHORIZATION FOR RELEASE
give the Lynch/van Otterloo YMCA Summer Camp programs permission to contact in an emergency and/or
release my child to the following peopled
Name: Relationship to child:
Phone Numbers: Cell Work
Name: Relationship to;chiId:
Phone Numbers: Cell Work :
FIRST AID CONSENT
I authorize the;LynchNan Otterloo YMCA Summer Camps Staff;who are trained in the basics of first aid and7thestaff
administer first aid and/or CPR,to my child when appropriate. Lunderstand that every effort will be made to
event of an emergency requiring medical attention for my child. However, if I cannot be reached; I hereby auof the YMCA of the North Shore to call an ambulance to transport my child to the nearest hospital and to se
necessary medical treatment for my child.
f f
Parent/Guardian Signature Date .
ALLERGIES/MEDICALCONDITIONS
CHECK ITEM THAT APPLIES TO YOUR CHILD:
o MY CHILD HAS NO KNOWN ALLERGIES AND/OR CHRONIC HEALTH CARE CONDITIONS
o MY CHILD HAS-ALLERGIES AND/Ok CHRONIC HEALTHCARE CONDITIONS
Name of Allergy/Chronic-Health Care Condition:
if your child has an allergy or chronic health condition you will need your child's physician complete an
Authorization for Medications
f .. . l
Parent/Guardian Signature Date
HEALTH CARE PROVIDER INFORMATION
Name of Provider. Address:
Phone:
PHOTOGRAPH CONSENT FORM
1,.give-.permission for my child,to be photographed while attending the Lynch/van.Otterloo YMCA Summer Camp Programs to
appear in the following items: Camp Newsletters and/or YMCA promotional-materials including Fundraising
f
Parent/Guardian Signature Date
Lynchlvan Otterloo YMCA : 40 Leggs-Hill Road . Marblehead;MA 01945 . 781-631-9622.
- _ - ..ivwuwx ononoo rru
CHILDREN'S
ISLAND CAMP
Staff Color War!
Wednesday; May 31 st, 6:30-9:00pm.
Lynch/van Otterloo YMCA backfield
Drop-off & Pick-up Training
Wednesday, lung 7th, 6:15-8:00pm
State Street Landing, Marblehead
"Come dressed for our annual Holiday Photo!'
Child Abuse Prevention & Paycom
Wednesday,June 141h, 6:30-8:30pm
lynch/vanOtterloo YMCA
CIDC ".1-low we make the Magic" Training
Saturday, ]une 17th, 8:15am-3:00pm
Children's Island (meet at State Street Landing)
CID{ "Game On" Final Training
Saturday,June 24th, 8:45am-1 :30pm
Children's island (meet at State Street Landing)
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Hello friends,
I would like to take this opportunity to welcome you to the Lynch van Otterloo Y camp
experience!Whether your child will be sung sail to Children's Island or partaking in
camp here at our main campus,our team is looking forward to providing a summer
camp experience for your camper that is filled with positive memories that will surely
last a lifetime.Our campers will try-newhing s and find new interests,develop skills
(both physical and emotionaW and form bonds and friendships that will undoubtedly
carry onlong after our time together has concluded.
Our camp philosophy is simple:Great Experience for Every Family, EveryTime.You will
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rl notice it says"Family"instead of"Camper ;we believe that a strong camp experience
involves both children and parents/guardians.We view our relationship with you
as a partnership;one that we cherish and value immensely.Tobe successful,
communication is essential.We will be doing everything we canto provide you with as
IlFmucff information as we can,using as many outlets as possible.please do not hesitate
to contact any of our directors(or myself)if we can be of any assistance.
Most importantly, I want to thank you.Entrusting your child with us is a big
commitment,and one we take very seriously.We will do everything in our,power to
provide a tasting positive experience in an empowering,nurturing and inclusive
rn environment for your camper.
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Children's Island Day Camp" 7-11 1-9 $335 $385 ?
Seal Pups Camp 5-6 1-9 $350 $400 '
Islanders Camp" 12+ 1-9 $335 $385
Counselor-In-Training Camp' 14-15 1-9 $205 $255
_. _ _t_— -- -- -__ _ >...
Rangers Camp` 9+ 3 8 $335 $385
Sailing Camp" 8+ 3-8 $335 $385
W Race Sailing Camp' 10+ 3-8 $335 $385
Wakeboarding Camp 10+ 3-9 $375 $425
Rowing Camp 10+ 5-8 $375 $425
EMM MM MM i I
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Marblehead(State Street Landing) 8:00am 4:00pm Included
NOTE: Marblehead Pickup at 9:OOam 4:00pm Included
.. end of day takes place at the ------ -- - ----_ -__ _
Old North Church Parking tot 9:00am 5:OOpm Included
(Stacey Street) 8:O0am 5:0Opm $75
Salem (Pickering Wharf) 7:15am 5:45pm $75
"Manchester (Tuck's Point) 8:3Oam 4:30pm $75
• 'Weeks 5-8 only
Week 1 Week 4 Week 7
June 26-30 lune 17-21 August ?-11
Week 2 Week 5 Week 8
July Ju
Camp use
Id July 4 y 24-28 August 14-18
• Week 3 Week 6 Week 4
July 10-14 July 31-August 4 August 21-25
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Lynchfvan � � erloo YMCA "_
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CAMPS9OOam 1 0 m '
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CAMP NAME ' AGES,"� ' z' WEEKS -13tPRICE PER WEEK
'3,4 S DayOptionsAvatlable� �2{ ' ' �; • MemberFee '` Community Fee;; Z
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SPECIALTY CAMPS: 9:00am-1:00pm _ 0
CAMP NAME AGES WEEKS PRICE PER WEEK D '
Member Fee Community Fee Z
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EXTENDED DAY OPTIONSx �� A GESS s !WEEKS 1PRICE PER DAY
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j4730900am : 6"113
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100pm 430pm 'a3��a23#r�6zts'jl ru•falr9x $25 I
�� '"�r� ms`s ri�'� � &'�k� 31�s°�f�`�;5+� '•
In 100pm 600pma $
THEATER CAMPS: 9:00 m-4:30pm i =
CAMP NAME AGES WEEKS PRICEPERWEEK
Member1Fee Comm unity, ee
Spectacle
- -
Cinderella $525 -i i
Summer Broadway :1 O
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Visit our website to view our Parent Portal, including full camp descriptions and camper file forms.
0
Lynch/wan U lerloo YMCA
m ;• x t' *+- SPORTS CAMP �2,, ( '
Z i � t;� MORNING CAMP5:�9:OOam 1.00pm s"�� " � t�-:
ICAMP,NAME AGES WEEKS PRICE PER WEEK r,.,�,88
�; 3;4,S,Da'y Options Available Member,Fee Community Fee
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EXTENDED DAV OPTIONS AGES WEEKS PRICE
Z PER DAV
730am900am 4-11 1-9 $10III�
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D 00pm 4-330pm�, 4-11 9 $25
iav„aimY
Z1 OOpm 600pm �,� 4-11 1-9 $35
v .,. FULL DAY1SKILL DEVELOP_MENTjCAMPS
CAMPNAME AGES WEEKS PRICE PER WEEK
��EMember Fe Community Fee '
,
,N. • Football& Basketball . r
LA
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Nerf Blasters Camp
— EXTENDED DAY OPTIONSM WEEKS PRI DAY
730am 900am�'"� 5-11
V �M 430pm600pm 5-11
w AFTERNOON
Jm
CAMP,.NAMEyS` y �� AGES WEEKS PRICE PER
-WEEK "
Members Feeffi Commumty,Fee %'.
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GYMNASTICS CAMP
MORNING CAMPS: 9:OOam-1:OOpm
CAMP NAME AGES WEEKS. PRICE PER WEEK
N `3,4,S,Day Options Available Member Fee Community Fee
EXTENDED DAV OPTIONS AGES WEEKS PRICE _
PER DAV
7:30am-9:OOam 4-11 1-9 $10 w
1:OOpm-4:30pm 4-11 1-9 $25 a�
1:OOpm-6:OOpm 4-11 1-9 $35
FULL DAV SKILL DEVELOPMENT CAMPS: 9:00am-4:30pm
CAMP NAME AGES WEEKS PRICE PER WEEK
Member Fee Community Fee '
1•'F EXTENDED DAV OPTIONS AGES WEEKS PRICE
PER DAY
1 7:30am-9:OOam 5-11 1-9 $10 i
430pm-6:OOpm 5-11 1-9 $10
O
M EXTENDED DAV OPTIONS AGES WEEKS PRICE
PER DAY
.3 7:30am-9:OOam 7-13 3,4,5,8 $10
4:30pm-6:OOpm 7-13 3,4,5,8 $10
.EVENING CAMPS: 3:OOpm-8:OOpm
O CAMP NAME AGES WEEKS PRICE PER WEEK
1 Member Fee Community Fee !
1
Lynch/van Otterloo YMCA
the SUMMER CAMP REGISTRATION FORM 2017
Child's Name: DOB Entering Grade:
Address: City: Zip:
Phone: Email Address:
Children's)Island and Y Camp 2017 Schedule Please Note
Session 1: 6/26-6/30 Session 6: 7/31-8/4 • Not all camps are available each session,
Session 2: 7/3-7/7 Session 7: 8/7-8/11 please see camp guide for specifics.
Session 3: 7/10-7/14 Session S: 8/14-8/18 • Children's Island campers must choose a boat
Session 4: 7/17-7/21 Session 9: 8/21-8/25 option, (circle arrival and departure times next
Session 5: 7/24-7/28 to available boat locations).
CAMP NAME:
Session: 1 2 3 4 5 6 7 8 9
Camps at LVO Location: Children's Island Boat Times:
Days: All / M T W TH F
(Early and Extended Day options must Marblehead: AM 8:00/ 9:00 PM 4:00 / 5:00
accompany a camp day registration
Early Drop Off(7:30-9:00): Salem: AM 7:15 PM 5:45
Extended Day'(1:00-4:30): Manchester: AM 8:30 PM 4:30
Extended Day (1:00-6:00):
Extended Day'(4:30-6:00):
CAMP NAME:
Session: 1 2 3 4 5 6 7 8 9
Camps at LVO Location: Children's Island Boat Times:
Days: All / M T W TH F
(Early and Extended Day options must Marblehead: AM 8:00 / 9:00 PM 4:00 / 5:00
accompany a camp day registration)
Early Drop Off (7:30-9:00): Salem: AM 7:15 PM 5:45
Extended Day(1:00-4:30): Manchester: AM 8:30 PM 4:30
Extended Day (1:00-6:00):
Extended Day (4:30-6:00):
CAMP NAME:
Session: 1 1 2 3 4 5 6 7 8 9
Camps at LVO Location: Children's Island Boat Times:
Days: All / M T W TH F
-(Early and Extended Day options must Marblehead: AM 8:00 / 9:00 PM 4:00 / 5:00
accompany acamp day registration
Early Drop Off(7:30-9:00): Salem: AM 7:15 PM 5:45
Extended Day(1:00-4:30): Manchester: AM 8:30 PM 4:30
Extended Day(1:00-6:00):
Extended Day (4:30-6:00):
Camp Deposit and Balance:
A $50 Non-Refundable Deposit is due for each week of camp at the time of registration. The deposit will be applied
to the registered week of camp. The balance of camp fees will be due 7 days prior to the start of each registered camp
week. Automatic drafts will occur on Sundays one week in advance from the credit card on account.
Parent/Guardian Signature: Date:
Payment For-Mailed Registrations
CNECK # - CREDIT-CARD Name ori Card:-
LynchAian Ottendo YMCA
CHILDREN'S ISLAND &Y CAMP
40 Leg gs HIII Road t
Marblehead;MA 01945
(PHONE)7816319622
(FAX) 781639 0 90
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All Childrens Islandd d LynchAran Otterloo YMCA Camps are licensed by the Salem Board of Health.
-�TH15 SUMMER, SUPPORT A CAMPER .
I A fun and educational outdoor adventure should be something EVERY child experiences during the summer.Unfortunately,for many children
from lo•.v`-income fes'amiIies'w'eek at summer camp isout of their financial reach.To heT'j hese"deserving children,we a for your
support through an Annual Campaign Camp Scholarship ori campership":W.1_ ith a gift to our Annual Campaign today,you can help ensure that all
,-�— r.- .�-., - l ter« -
children in need of a camp scholarship receive access to a summer full of amazing friends and memories.
A Y camp�day isis fillefun,activity an`d I� e�ar�ing.We invite you to follow the"path"'below to learn more about the typical day our campers
enjoy.When you reach the endof the trail,we hope you will consider visiting www.northshoreymca.org/campership�an make a gift in support of
`a-,al'Mummer camper.
www.northshorI Mca.org
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r G� CI'lY OF SALEM, MASS ACHUSKITS Q
_x
lioARD or HEALTH
120 WASHINGTON STREET,4 FLOOR rP, ith
TEL. (978) 741-1800 K: x(978) 745-0343
KIMBERLEY DRISCOLL tramdinc,salem.com
LA1tR]' R+IMDIN,Rti/RI.1IS,CI K),l,P-F5
MAYOR H13:V.:l I I A( ];NT
May 26, 2017
I, Suzanne Doty, certify that the Children's Island YMCA camp is authorized to receive a
license to operate a recreational camp for children in the city/town of Salem, Massachusetts.
The local board of health for Salem,hereby exercises its discretion authorize the
Children's Island YMCA camp to operate a recreational camp without a prior inspection
based on the following (all must be check to waive the pre-inspection):
VasThe recreational camp submitted a timely application for renewal of its license.
YThe recreational camp is under the same ownership and directorship as the prior camping season_
I/The recreational camp is located at the same site as the prior camping season.
r/
"/.The recreational camp had a sat'isfact'ory inspection report during the prior camping season.
—/Based on a review of the recreational camp record, thereis no evident risk to health and safety.
The local board of health will inspect the recreational camp during the 2017 camping season.
Sign rre of esignated Authori y of L cal Board of Health Dat
LJUZ�ifl 1yl P CI RAJ
Printed Name & Title
CI'l'Y OF SALFI\l, MASS ACHUSI "l't'S L!
BOARD OF Hr.-jl,Tx
120 WASHINGTON STREET 4'1" FY,00R Pith
ablicTiea
TEL. (978) 741-1800 F_.x<)78) 745-0343
KIMBERLEY DRISCOI„L Iramdin&salent.com
L9R2Y RA Nil)IN,Bti/RISLIS,Cl 10,(Al-FS
MAYOR HEALTH AGHN"1'
May 26, 2017
I, Suzanne Doty, certify that the Lynch Van Otterloo YMCA camps are authorized to
receive a license to operate a recreational camp for children in the city/town of Salem,
Massachusetts.
The local board of health for Salem,hereby exercises its discretion authorize the
Lynch Van Otterloo YMCA camps tooperate a recreational carnp without a prior inspection
based on the following (all must be check to waive the pre-inspection):
The recreational camp submitted a timely application for renewal of its license.
//The recreational camp is under the same ownership and directorship as the prior camping season.
✓
The recreational camp is located at the same site as the prior camping season.
11<e recreational camp had a satisfactory inspection report during the prior camping season.
`� BasBased on a review of the recreational camp record, there is no evident risk to health and safety.
'! 'lhe local board of health will inspect the recreational camp during the 2017 camping season.
1
tgna of Designated A hority of Local Board of Health Dat
Printed Name & Title
Massachusetts Department of Public Health
Community Sanitation Program
Recreational Camp Injury Report Form
In accordance with M.G.L. c. 111, §§ 3 and 127A and 105 CMR 430.000: Minimum Sanitation and Safety Standards for Recreational
Camps for Children (State Sanitary Code Chapter IV), 105 CMR 430.154 specifically requires that a report be completed, on a form
prescribed by the Massachusetts Department of Public Health, for each fatality or serious injury as a result of which a camper or
staff person is sent home,or is brought to the hospital or a physician's office and where a positive diagnosis Is made. Such injuries
shall include, but shall not necessarily be limited to,those where suturing or resuscitation is required, bones are broken,or the child
is admitted to the hospital. A copy of each injury report must be sent to the Massachusetts Department of Public Health within
SEVEN(7)days of the occurrence of the Injury.
PLEASE PROVIDE A COMPREHENSIVE AND THOROUGH RESPONSE TO EVERY QUESTION.
1. Name of Camp: Gh n h �'t t EJ ,DO LIQ
2. Street Address(please indicate the camp's in-session,physical address):
NO j,evi 32 14. 1l P" .
City/Town: M&r!>JLInL&,A Zip Code: ol9 'f J
3. Name of Camp Director: .IA&rr d.AyAt_ t1,S. d_%C P_r /� 4.Telephone: ' 211 - 190 - '7OO 17.
S. Name of Person Completing Form: l 6V,) 1.. S q� X
� lz�ji Pmlo- (_ 4 �
b. Today's Date: Z(- a - 7. Date of injury: 2 S 20 - 8.Time of Injury: Z '3 J El ErPM
9. Enter the number of campers and staff who were injured: I CamperQStaff member
Note:Fill out a separate form for each injured person
10. a)Age of person whose injury is described on this form: b)Gender: CJ M 13f
11. Where did the injury occur? Irl On camp property ❑ Off camp property
12. Please specify the type of facility where the injury occurred:
❑ Athletic or recreational facility & Pool
❑ Dorm or sleeping quarters ❑ Other water body(not pool)
❑ Motor vehicle ❑ Other,please specify:
13. What
was the incident outcome?Please check all that apply:
1J Injury ❑ Illness ❑ Death
14. Explain in detail how the injury occurred(e.g.what type of activity was the injured person engaged in when the injury occurred)
and describe the nature of the injury.Do not include names or other personal identifying Information regarding the injured
person or other involved parties.
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Report ID#(internal use only):___ (continued over)
Cross-reference It(internal use only):__-_ Revised October 2014
15. Type of injury.Please check all that apply:
❑ Alleged abuse or neglect ❑ Allergic reaction ❑ Bite or stin
�,/ g ❑ Bruise or contusion
❑ Burn ❑ Concussion t)d" Cut or laceration ❑ Drowning
Heat or cold (e.g., heat
❑ Fracture or dislocation 13 Heat
hypothermia) ❑ Muscle strain ❑ Near drowning
❑ Psychological or mental ❑ Undetermined ❑ Viral or bacterial
health issue infection
❑ Other,please specify:
16. What body part(s)were injured?Please check all that apply:
D Head,neck,and/or face
❑ Torso,please specify:
❑ Abdomen ❑ Back ❑ Chest ❑ Hip
❑ Upper extremity,please specify:
❑ Arm ❑ Fingers ❑ Hand ❑ Shoulder ❑ Wrist
❑ Lower extremity,please specify:
❑ Ankle ❑ Foot ❑ Knee ❑ Legs ❑ Toes
❑ Internal
❑ Other,please specify:
17. Where was the person treated?Please check all that apply:
❑ Admitted to hospital
-site medical facility(e.g.,emergency room, �n-site medical facility
physician's or dentist's office) (e.g.,clinic or infirmary)
❑ Other,please specify:
18. Was injured person sent home? Vyes ❑ No
19. Did your camp change equipment, policies,or procedures as a result of this incident? ❑ Yes No
20. If yes,please check all that apply:
❑ Activity removed or ❑ Changes to equipment ❑ New safety procedures ❑ Safety education updated
forbidden implemented implemented
❑ Venue changed or altered ❑ Other, please specify:
21. Briefly explain changes implemented as a result of this incident.If no changes were made, please explain why not.
VJc e_l �v� 1ht e� �r wQSa �r ew ' n !'ham b
Wgs d- 1 ^1 Y1 Fr ' I T� e— ed L eo Q — -�k
is En 440,( a✓L C art cvr
PLEASE MAIL, FAX,OR EMAIL CAMP INJURY REPORTS TO:
MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH
BUREAU OF ENVIRONMENTAL HEALTH
COMMUNITY SANITATION PROGRAM
250 WASHINGTON STREET-7th FLOOR
BOSTON,MA 02108-4619
TELEPHONE(617)-624-5757 FAX(617)624-5777
ce I estine.payne @state.ma.us
Revised October2014