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SCHOONER FAME DAY CAMP 2016Schooner Dai CAMP a 011 wiversal, www.myuniversalop.com phone: 1-86&756-4676 UiNV12110 MADE IN USA 3 G, 16 2 `aLI/it I I r i , I , i . i I oN a ;,,, ­ ..'i¢: :g - . I/it 014 0" Of 2 14 i 21 ti 16 IN 'ovlit o\ ;e' 'lop 1 0 20 ml. IV' 1 -.4 i17 sa&'Withus - on our re lica, of thl6"JNI ro aleeF"SCH JU IEJO - ee�- K-"r 14' , P9_� V - �.Slo I. -.- 7f N\\\� ic R�iilspZenld a week aboard FAME, learning sail?h traditional sch'66fi experiencmg dife was 4ikefor 'fh6fishernich 7..... .. ��'% Roll, ' d' built 'm, ,privateers L o t10 North She-- S6 fund, re isl s; . ........ 28 of a'fl"a' I f &UN_a 164, 3 : tl`�swihi in secluded S!" J 4 .. l ...... 28 23 30 25 32 24 s�iiing. expneii 10 29 W" 33. ------ --- ---- 34 26 34 G'. 34 1�9 "G August 15-19, 2016 9 45 4 37 36 40 3 —'3:45 OM Daily 28, 35 8:45 AM 3E , ' . '25 - --24: tl $1 od/ camper IA 4ld 40 361 with Marine Society Scholarship M 32 31 32 26 — 1�0 _.. ZI ' 11.7 19 ..... — 722 3 - 3 40 2 �� a 27 R 31 36 br0shouId:b'rihg,;J digh0snack, 3 hydratiDg,"'2' "�i 32R 16. '4 2 . Xz 48 �64 S)" 33 26;_ 39 40 F1 �R js, 16' FAME of SALEM id'.*abag'lunch.�Cafnp.',ei�s'should .,--.always -z��'ear. 20 4Q2 O�M/ - , ' 17 '26 Q screen and'britig a Wib4IJr'e_a'k*(Fi.and Hit 29733 13 SALEM 4P 26 27 '; 'if; C -A ru:% ... 41 RV 40 Hands,On,.Uurricfllum�. 37 Our Fame is a full-scale replica of a privateer that PI, 30 2 Dropoff-.Daily 54:00'. -A -M 29 5 n 14 8:4;. 2a-.:;.16lRhFkrdrt6r:'.".;I 4 sailed out of Salem during the War of 1812. The origi- 53 A?Q at i'c�hssennal_&notsf___L - T.21 29 L 42-- nal Fame was a 'Chebacco' schooner built for fishing Ft '16U.151. _172 N"4' 23 ti if Farts orthe vessel by Epes Davis of Gloucester around 1811. Converted . ..... 20. �35...2o 43 54 7f vnckup Uaily,�-i_-'30 PM zl.­'�f4t zQ /,\"// , 41i- -1 .�� ", 1� :.' . . s I ver, ancilreet all,saim to privateering when war broke out, Fame captured at 6 '�A I f _.. :. . .'.. sails to'the'wihd7 44 least 21 vessels before being lost in the Bay of Fundy i"�Wm�riiidN , .' .. I Rk are.based.at Pickering ... v "-:,. . , :._ '4, ., �&. : M 54 i 23 4 -4, 4 in 1814. The 11'1�4'oz " q A .... 3wn-SaIern. Thb mdinenfia:ticelto*'th�6rhAriira-- 2 t tiller All points of-sailOP. ...... 14 4 Our replica was launched in 2003 by local boat- .... . 4 48 41 f .. / !11� '_ dock 1111cs,ful. MIIVW � 4 -victoria mati , �P G next to,the restaurant 27 :17 1 17 builder Harold Burnham of Essex, MA. The new Fame 4 MI Is X % tC ApplyRules of ad,,Reail Cha 17 C '5 is a Coast Guard -certified vessel which offers public 16 i . iz. '13 49 sails on historic Salem Sound from May through 4 V in .7 47 I'V . ampterg Will.be divid di h O-eY Ledge October and is also available for private charters. watc esije ICC e into, two groups or 1, 10 ;IYro I I�y . t�' 'j + z 7 (Sli '.',sa A13y�ages. and abilit�l`and issued a colbrdoded t'shifL.' 0 For more information on the schooner and its pro - 2. -14f you want yourchmper to'..b6placed inthe sa-a6 jr6itp 9. 43 grams, visit our website at www.SchoonerFame.com. '.' l, *' - 50 W4"a§L7a�qoth&r camper-6i,carri6ers,116i'd3s kiiowiait"' the' tfrnc;�. '45 �'47 2' Fame Specifications y3 f �3 stration and W6',WiU�.fry2to'acdoinoddte.you� 33 registration . " . 45 .......... 'KW j-, . 14Passenger Capacity 40 + 4 Crew r .21 23' r 38 46 Spurred Length 70 feet of sh at MLI_ ...... .. A), Beam 15 feet 37 dd a c6ur�e-cpNnpletion c* 'fi Qs 1 2§41 7 W "';_ rope for k'Rot,,�Y�ctice, a erti i t 6 feet 4 inches 43 a. t • 30 torts 37 Displacement SwImm] tg:,WejNdl­telF, ents'in&adva: 'elif r Sail Area 1,200 square feet V we Power 160 HP diesel 33 need 10�1)rmg swimsuits and/or Wit shoes 51 M 5 Ttl_� 29 - 15 j 39 44 :27 46 .22. A 34 45-t- 'if -11 . 42 9 24 f7l 5 4 / . .. I '�'_ 40 i f� 3 _�,� ✓ t� vti.%"''�� / 1� t t `! 1 a,l �,r� /" 1l`+.. rli,�r J�/ fl,.� r ,,..r1' ��'�\/\ (` �1 �i -� (' . 2; 14 2/�^\ it'' l Y�..�,� : & I6 Sample Daily Scheduler p ''' aep . .. J{ MAH /.FAX` ��e� . 6 x / s�'�� r��� RESERVATION: FORM4`,�� �/�-. JBlue Watch �``\Gold!Watch i<t? 1✓ � - o t"...,.,; `,nr-- ^� 1 I t 171 1 8:45 — 9:00 DROPOFF : is �, n �P�easenclude x$1'00 check or, money order made out Bn gg V 141-W, "\�\ to. Pennant Enter rises or ll out the-credtt card„ '* LT L. Y li 1 l.. A7 -�- er, 1 t ,l� p,.r J �w / _.-i-.:+uc ^� .authorization below. When our reservation is received A:00 9:15 Attendance Leamin the Ropes Y s i0. a g pes yZzllto,t n t ly lt" / sia ne ^ Gethng=Undetay �^ we will malGyou a registration package �; .. " .-.........:.4.��rC:.+ :r. 23 �,` Departure Equipment Check Lines & Signals n,«a xx d 20 - r z6 1 sor Mainsail Fore &Jib * :Name of Camper s 2E rRr p $ nT�� t' 23 _ / n� 25 '. o i .' 4 r 6 „; 30 .. tJrZu,'9;30�r110 30� 'On;Watch o.F+. Off Wateh� i ! R 1 32 _ li 26 .19 h !a 0 i 1 1 .. 24 10.30` ftraftryProjects gro ec SNACK Lo books 4F �rt6 Ca State n 5 3tF. FIG+-- rev 32 j� i 1�: i , 2or Z3.-.. 7 I l a Prof s * .t s "I � 15. ... tate /.ZIP: 26 34 G 13' 34 _ .-�- �'+. _. _.... °` J g ..__.. 9 Y ae _. 45 s 10` ���., 5 1'1 36 35 _ ,+. 11,00 1200Exploring tiSwimnung 9 � 'y < c 1s'36 36 6Fi, jlr� St /a+Q: R 33 31 - 2 f; 29 O G 25 . 24 Q`! .L+.6;d - O^'v �. ....Y2 .1� 4SCSS10Il:r t c 5 rcJ �F h!*+ 4C 61 sn y 36 :JU: � :00 LUNCH. bit 6 li, 3z _ ... 33 zf.. Craft Projects *Knots *Logbooks ar 7 Age during camp. session u8 ,9 10 mLl+ 12 '13 14e 3."`e"3„""=�'7�','n' "'d"�`+. z[ . : '�,y:12 3S 4t.. I. 2S'�. � 33 q0 40 40 42 21 26'.. W .y .. _.' j t ,, sx 22 29 tr Circle camper's-sex: M -F 36 s 9' 1245, ,145 Chart Talk Privateers v, i : 14 - ^r 23 Schooner Day Camp `t` E.r s &, rt it ly 5: ` 32R +6:3 2q hro L6 30 39 a8 ,�4 Y2 t z 3o Credit Card Informatuion 44 0if. _ { : 145 300 Off Watch OWatch �'3Visa or _6 27 (MasterCard):6 c q atcOn z .y Oas/t ,t C^]^tll .� A L L'. Il'f i I L9 yii 4 _ AmvalR • Maznsail 5 `Fore &Jib e9 0%p� Jo 2Charges will appear.as `Schooner Fame" 14 rr �` on our credit card bilkr-�,, a o, 2 * Haiidle'Lmes '' ;; > eanUpG 1 -rr za ' .. ,x�e 4"4 l la- 7 n,,.k xk , 42 Sailing on, a Salem PI'1Vatle 37 53 ..,j„�..n.�2, - L-=- 42 ya. 3:30 PICKUP- j1 2 a oto , 12u 33s s August 15-19, 2016 s4N 4 27 Card Number rbL. 6 20. 43 i� 448:45 AM-3:45 PM Daily a rp1Rk 4 OUR STAFF 3 Expiration Date to tz 4 * 3 4s t $100 / camper 54 6 9 cr, 4 �, 9 34 `a 45 17 with Marine Society Scholarship 5.3 R� �• (( Fame is certified to carry passengers by y '�Y ° ` - n�k I, authorize a charge of $100�as a non refundable deposit. �5 51 ' the US Coast Guard. As such, she is commanded * +t' . r `,010 ,. Q :a ?' 13 14 1 49 47 2 to 0'3 ?° T� at all times b a USCG licensed captain. i4e Signature 15 `o' p 1"i2 + a,kaCaa<y Ledge P .O .. Y P r to , y 13 5. xk tl __ y S 3 is isl5V s. ' 4 5 40.."(978):T29-i-7600 � / mss, During camp sessions the vessel is crewed Rt n " ' S 49 3: hra ; 39 3 * K -..r^ 420 ;4 by the Camp Coordinator as well as a "mate" �,� nk o 25. 23 z0 i I y' 5 ' R 7 t a 2 ' `29 »3 WWW+SchlT9 rFame.eom= 5o Q or counselor for each of the two "watches" a 23 6�' ' 4 E 45 45 c2 ''- "' 1i4P ! C i'V l a7 F,7 I 2I Mail to( __ . a Schooner Camp 2 ,t 47 3;,p Q and a certified lifeguard. The ratio of campers h3, 20 ° ' q b 73'Middleton lioad3 i 44 45 © to crew is roughly 4:1. All crew have first-aid .l. Ja I 15 isy i5 RW R 1" s: s * , Iso R :Boxford, MA-01921. 21 qr 4, *• certification and have undergone the required 'fe. P. J y"'°^'R+ 3g a6 �,,, , -� q , '`J'iF yt 44 ;hatMLL C's A CORI and SORI background checks. yFor more info contact CaputMtke Rutsfein ;:i ;..,,, ;'"2 37 4 This camp must comply with regulations5d� rt JJ 't 4s l4 , 2 of the Massachusetts Department of Public Health �`4i ti /fes 4 Schooner FAME of Salem ' q { , 37 ' S and be licensed by the Salem Board of Health. I Lzaoln:-� ,1(,-50 !< 73 Middleton Road 4 ' q k 33 Boxford, MA 01921 +RR2.Ss ~�• 2�^"'kri"X35 !F'u'y P'- I " tl�" ' J -! SchoonerFameC!�gmail.com "t,;; 70_ jYsl RBO.R / z 5 29 33� zi } 4 6i d 13 :8 1 < .1` L / 9. IS . 22 23' 'O 44 5 ,I r ,3 { ':.'"��. .�'� yi - • :;i ,r 33 o-r 4 rt.Z i! 2I r, ,7 26' N39 35 n C'. .. /`7r'"�`1�'t i, , 1... ._ 18 a+ __ 24 ✓ ms )a+. nr. 'x•44 _ Children's Island Day Camp 2016 Health Care Policies and Emergency Plans the aF 1. Health Care Consultant: Marc Sibella, DO Telephone: 781-631-5126 Address: 1 Widger Road, Marblehead, MA 01945 Health Care Supervisor: Camp Director, Associate Camp Directors, Aquatics Supervisor 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 Emergencies VHF Channel 16 3. Hospital Utilized for Emergencies Name: North Shore Medical Center Salem Hospital Telephone: 978-741-1200 Address: 81 Highland Avenue, Salem, MA 01970 4. Emergency Procedures In the event of an emergency, a staff member will call the Salem Harbormaster via cell 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. 5. 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) 2. Location of AED 2. Location of First Aid Manual 3. First Aid is administered by First Aid Kit is maintained by Contents of First Aid Kit • Non -perfumed soap • Compresses • Bandage scissors • Rolled bandages • Tweezers • Barrier Gloves Infirmary, Main Lodge, Pool House Camp Office Infirmary First Aid -certified counselors or Camp Directors Camp Directors, Aquatics Supervisor • Sterile gauze squares • Adhesive tape • Triangular Bandages • One-way valve mask • Cold Pack 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 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 designated by the parent on the Camper Information Form. 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 Executive Director of the YMCA 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. Three sharp whistle blasts signal an emergency. Lifeguards may also have air -horns and/or VHF radios at the pool, water front areas, and on boats. Cell phones may also be used in an emergency to contact the Salem Harbormaster. 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. Lost 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 Lost Camper Plan. 36. Lost 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. Use three whistle or air horn blasts to alert everyone of an emergency. 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 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 entering Kindergarten through grade 10, 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 Lifeguards and camp counselors will report to the Camp Director. The Camp Director reports to the YMCA Executive Director. 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. KIMBERLEY DRISCOLL MAYOR Permit # CA -16-20 Date of Print 8/11/2016 Permit Issued 7/11/2016 Permit Expires 8/19/2016 Permit Fee $10.00 Late Fee $0.00 CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4"' FLOOR Ta- (978) 741-1800 FAX (978) 745-0343 health&salem.com CAMP PERMIT License For : Granted To: Address: Pickering Wharf Marina Salem Location of Establishment: Restrictions: Notes: Recreational Camps Schooner Camp V PuiblicHetth Prevent. Promote Protect. L -ABBY RAMIAN, RS/RFi.1 IS, CIfO, Cl) -FS HI-,AI;CII (;FN'f WHARF STREET MA 01970 This permit or license is granted in conformity with the statues and ordinances relating thereto, and expires on 8/19/2016 unless sooner revoked or suspended. E -^` Department of Public,Health - Division of Community Sanitation STATE SANITARY CODE: CHAPTER IV, MINIMUM SANITATION AND SAFETY STANDARDS FOR RECREATIONAL CAMPS FOR CHILDREN, 105 CMR 430.000 NAME OF CAMP: Schooner ADDRESS: building inspector for sleeping/assembl areas 8 -� P�/ / p� 1 '� d �/ ✓2C I /Gf.Cr nq WF I'IG+INa�W ar OWNER/OPERATOR: OFF SEASON ADDRESS: Sc..Ie�MOA A D�SQ �tsL CAMP DIRECTOR: DATE/TIME OF INSPECTION: K16- }S et DM(031)0110 9 r 0Oa m PHONE #: TYPEOF.CAMP: WATER SOURCE: INSPECTEDBY: Er ca. RimP;�a Residential Sport / Non -Sport (� J efi f rel 8 "asy CAMPER CAPACITY: Primitive Travel a')--- ` No" column = ✓ marked below indicates a violation of 430.000. "Yes" column = ✓ marked below indicates compliance with provision of 430.000. "N/A" column = ✓ marked below indicates that the provision of 430.000 is not applicable to this camp. , PERIYIIT5 nt Certificate(s) of Occupancy, from Co- fif ({IL (4f �5'" 7300(A)(2)"' building inspector for sleeping/assembl areas 8 -� en com fiance from local fired t. te water supply (a) DEP approval (>25 people, >60 days/yr) 300(A)(2) Private water supply (b) BOH approval, chemical & bacterial analyses <25 M21e, <60da s/ P NS':AND POLICIES -WRITTEN Procedures for Background Review of .090(A) Staff/Volunteers Staff- CORI and SORT p� plo {¢cJ GU0 .090(0 - Previous Work History - 3 References - Out-of-state/Intemational Criminal Background Checks Volunteer Staff- CORI and SORI .090(D) - Previous Work History - 3References - Out-of-state/Intemational Criminal Background Checks .0900 All Background Info - Received, reviewed, & made determination requiredpursuant to .090 C&D .091 Staff/Volunteer Orientation Plan & Review .093 Abuse & Neglect Prevention/Report procedures Discipline Policy: Appropriate Discipline Methods & .191 Prohibitions: (1) Corporal Punishment, including spanking, is (B) prohibited; (2) No camper shall be subjected to cruel or severe (C) punishment, humiliation, or verbal abuse; (3) No camper shall be denied food or shelter as a form of punishment; (4) No child shall be punished for soiling, wetting or not using the toilet .210(A) Fire Evacuation Plan and Drills .210(B) Disaster Plan . .210(C) Lost Cam er Plan / Lost Swimmer Plan .210(D) Traffic Control Plan 430 -Inspection Sheet5-10-16.docx Page 1 430 -Inspection Sheet5-10-16.docx Page 2 _,. CONTINGENCY -PLANS :DAY CAMP:: .211(A) Camper doesn't show up for day .211(B) Camper doesn't show up at point of pick u .211(C) Child not registered arrives ✓ Promotional Literature/General R uirement Copy of Policy (Parents/Staff): Care of Mildly ill .159(B)(2) Campers, Administration of Meds & Emergency Health Care Provision Camper released only to Parents or Parent - .190(B) Designated Individual in writing Statement: Regulatory Compliance & Licensing .190(C) "This camp must comply with regs of the MDPH & be licensed by the LBOH" .190(D) Inform parents of right to review background (at time of check, health care, discipline policies and application) grievance procedures u on r uest CONTINGENCY P ANS - PRIMITIVE TRAVEL AND TRIP: .212(A) Daily Itinerary - Copy to Parents .212(B) Source of Emergency Care Contingency Plans (natural disasters, missing campers, .212(C) lost swimmers, illness and injury) shall Travel with Cam ers & Staff a i, SPORTATION, Vehicle must comply with MGLc.90 s7B&7D: <14 passengers & driver is camp coach, director, etc. private .250 vehicles may be used >14 passengers, vehicle must be school bus All vehicles must be RMV compliant .253 Proper automobile insurance .251(C) Seatbelts must be worn Camper <7yrs not transported longer than 1 hr to .251(11) cam Camp vehicle drivers: 18yrs, 2yrs driving experience, 60j 1 . Lic .252 current license for type of vehicle wb Aji 40 Scur 1( First Aid certified if no other trained staff aboard. rw...f. ;,.,.�STA$E,4QUAI IFICATIONS „ { Camp Director: (� Residential Camp: 25 yrs, completed course in .102(A) camp administration or at least 2 seasons experience UA .102(B) Day Camp: 21 yrs, completed camp administration course or 2 seasons experience .102(C) Primitive, Travel, Trip: 21 yrs & proof of experience. esignated Substitute: when director off-site >12 hrs. (sub must meet criteria above) Counselors/Junior Counselors .100 Day Camp, Non -Sport: Counselor— 16 yrs. Junior Counselor= 15 yrs. .100 Other camps: Counselors= 18 yrs or graduated from high school. Junior Counselors= 16 yrs .100 All counselors 3 yrs older than campers 430 -Inspection Sheet5-10-16.docx Page 2 Required Counselor Ratios _ Residential / Day Camps: / 5 SCS as ca per, .101(A) 1 staff per 10 kids over 6 yrs 1 staff per 5 campers 6 yrs and under .101(B) Primitive,Travel, Trip: I counselor per 10 campers. 2 counselor min. Special Needs: r'\ .101(C) 1 counselor per 4 mildly disabled campers (Z�u�t v\P�u aA A,-& 1 counselor per 2 severely disabled campers k s Aquatics Dal n ector_��.YLt (0 t 1 q _ fP.0. American Red Cross Lifeguard Tmg cert, CPR .103 for Professional Rescuer & First Aid Cert. or their equivalents. if su ising 2+ staff, must be 2I & m 'encs w/ management Lifeguard: �� - _ _ _r771 American Red Cr ss / Lifeguard Tmg cert. / CPR .103 for Professional Rescuer cert. & First Aid Cert. or their equivalents. MEOW' DI__ E O- /RE ORDS W (1hT1IESti = Health Care Consultant: S I NP PA(w/pediaVic training) .159(A) *Chet or Health Care Consultant Agreement* Lincense#: 3g,-1 tlo C Health Supervisor: n r n G{' -onsite atalltimes .159(C) MD PA NP RN LPN or... 18yrs, Fust Aid & CPR certified .159(B) Health Care Polic ✓ .160(A) ALL Medications stored in Original Containers m c } -Al,; -iL Meds stored in Secured Cabinet .160(B) & if necessary refrigerated in box affixed in refri erator (if no seconds lock) .154 Injury Reports completed for fatality or serious injury. Copy sent to MDPH. 160(C) Medication administered by Health Supervisor or Licensed Health Care Professional .160(C) Written list of all meds administered at camp ho , (if H.S. not a L.H.C.P. auth'd to admin Rx, meds)N(Yk lr .160(B) Refrigerator temperature 38 to 420F I1 t.o Vel bt'� W. GJ-1w�1 Medical Log Book .155 bound, pre -numbered pages, ink entries, no skipped lines. .161(A) Day / Residential Camps - Infirmary provided ✓ Residential Camps - Exterior light .453 Lighting provided in infirmary .161(6) Residential Camp - Area for isolation of ill child N((a First Aid Kit: non -perfumed soap, sterile gauze .161(C) squares, compresses, adhesive tape, bandage scissors, triangular and rolled bandages, CPR mask, tweezers, cold pack, gloves. 430 -Inspection Sheet 5-10-16.docx Page 3 �I( .ERSONNLLF/RECORDS/FXC-lE TIES ` . Health Record for each Camper & Staff: Staff/Camper > 18 yrs - Emergency Contact Info .150 Camper < 18 yrs must have Written Parental Permission for Meds/Emergency Care _ _ IMMUNIZA_TIONS Campers and Staff under 18yrs: Number of records checked: MMR: I� dose =12 mos or older, Measles: 2"d dose = grades K-12 or age equiv Polio: 3 doses IPV or OPV, or 4 doses mix IPV/ OPV Diphtheria and Tetanus Toxoids and Pertussis*: 4 doses DTaP/DTP/DT or, .152(A) 3 doses of Td (persons 7 years or older needing additional vaccines to comply with above, Td is to be used) *Booster dose of Td: -grades 7-10 need booster if>5yrs since last dose of DTaP/DTP/DT -grades 11-12 need booster if more than 10 yrs since last dose of DTaP/DTP/DT/Td He B: 3 doses if bom on or after l/1/92 Campers and Staff over 18yrs: Number of records Measles: 2 doses (exempt born before 1957) checked: S S Iz« Mumps: 1 dose (exempt born before 1957) Rubella: 1 dose .152(B) Diphtheria and Tetanus Toxoids*: 3 doses DT/Td *Booster dose of Td required if more than 10 yrs since last dose. -A lIVtTIE Activities and physical environment meet the .190 needs of campers; do not pose hazard to health/safety. .163 Operator encourages sun protection for all -___ AQUATICS Swimming Pool: in compliance with 105 CMR .430 435.00 - permit posted **VBG Compliance Letter** Bathing Beach: in compliance with 105 CMR .432 445.00 - weekly water sampling conducted. Proper supervision at swimming venue: .103 1 lifeguard per 25 campers 1 counselor per 10 campers Plan to check swimmers- "buddy system" .204(B) Swim test to classify swimmers by ability. U" 4)� d f Gck-0 cm& Swimming areas clean and safe, no swimming at .204(A) undesignated sites or at fright without lighting. .204(E) Piers and floats in good repair. 430 -Inspection Sheet 5-10-16.docx Page 4 430 -Inspection Sheet 5-10-16.docx Page 5 Nil 11,111 V'l AQU_ATICS_, Watercraft: equipped with USCG approved .204(G) flotation devices and worn by all campers and staff participating in watercraft activities. Campers must be certified by ARC level 3 .204(II) swimmers or equivalent for white water, hazardous salt or fresh water activities. Minimum 2 counselors in separate watercraft .103(0 supervising white water, hazardous salt or fresh water activities. CRAFTS Equipment in good repair, safety precautions .205 taken. J PLAYGROUND/ATHLETIC EQUIPMENT Equipment properly maintained, fields/surfaces .206 free of holes/accident hazards .206 Playground equipment secure, no concrete under/around it, pliable swing seats. FIREARMS NamesCerts: .201 Single shot rifles only .201 Shooting range away from other activity areas r/ Firearms in good condition, stored in locked .201 cabinet. Ammunition locked in separate cabinet Certifications for other high-risk activities, eg: .103 NRA Instructor Certification for Firearms ARCHERYNames/Certs: .202 Equipment in good condition, stored locked Range away from other activity areas, clearly .202 marked as danger area. Must have common firing line and 25 yards clearance behind each target. 203 Personal weapons, bows, rifles allowed w/camp operator's written permission HORSEBACK RIDING ames/Certs: .103(G) I Certified Instructor per 10 campers (minimal 2 counselors .103(G) Riders must wear hard hat .103(G) Licensed stable Day Camp provides shelter for on-going camp' 457 activities .216 Residential - Smoke detectors provided VA .456 Adequate egresses free from obstruction .453 Lighting provided for stairways .454 Floors maintained. 430 -Inspection Sheet 5-10-16.docx Page 5 430 -Inspection Sheet 5-10-16.docx Page 6 Provide adequate space: 458 40sgft /person in single bed; 35sgft/person in bunk bed; 50sgft/person in sleeping area requiring special equipment Provide bed/cot per person with 6 feet between .470 sleeper's heads and: 3 feet between single beds/ 4'rz feet between bunks Campers and staff with limited mobility housed on .459 ground level; egresses leading to grade or ramp provided. .452 Screens provided. Screen door self-closing. .454 Floors maintained. _ TENTS 217 Fire -retardant and non-toxic. No open flame nearby. TOILETS/SHOWERS 360 Proper sewage disposal 301 Plumbing in good working order Adequate # of toilets: All camps: 2 toilets/privy seats for each sex 370 Day Camp: >60 of one sex, provide 1 additional toilet per every 30 people of that sex Residential: >20 of one sex, provide additional toilet per every 10 people of that sex. Toilet less than 200 feet from sleeping rooms. 372 Toilet paper provided. Windows/ openings screened. Screen doors self-closing. 373 Adequate # of sinks: Day / Residential Camp: 1 per every 30 people Adequate # of showers: 374 Residential Camp: i shower/tub per 20 people 378/380 Special needs campers provided facilities that / meet their needs v .453 Lighting provided 375 Toilets and Shower rooms ventilated to outdoors Hot water at sinks, showers/tubs not more than 376 112°F Sanitary facilities maintained in clean condition 377 Shower room floors washed daily LAUNDRY .162 Residential Camp: Laundry facilities provided .472 Bedding and towels laundered; no common towels 430 -Inspection Sheet 5-10-16.docx Page 6 430 -Inspection Sheet 5-10-16.docx Page 7 LIM�v 300 Potable water provided Adequate and centralized drinking water facilities (c "Pers asked +o briA' own wafv✓. 300/304 - No common drinking cups t✓ 1��e1 �� rov" Day / Residential Camps: Telephone readily Cell phon�S /n .209 available with #s of HCC, Local Hospitals, Police, Fire, Ambulance VHF V H F Pi do ai .213 Emergency Communication System/Procedure JO ��� ria �o*nu1 }o beVHFp,�/,a Tobacco use restricted to designated areas not .165 accessible to campers. 350/355 Proper storage and disposal of solid waste .207 Proper storage and operation of power equipment Flammable and hazardous materials labeled and .214 stored in locked unoccupied building. .400 Rodent and insect control .401 Weed and noxious plant control .450 Site location does not cause undue traffic hazards and is accessible at all times `:r k" `.er FOOD`SERVICE Food service in compliance with 105 CMR 320 590.000, Minimum Standards for Food Establishments. Permit posted in food service facility. 330 Nutritious meals that include a variety of foods served. Menus posted. Residential camps — Provide at least three 331 nutritious meals. Foods must meet Recommended Dietary Allowances (RDA) 332 Day camps — Each meal provided must meet 1/3 of the RDA requirements. Adequately trained staff and equipment provided 334 to ensure handicapped campers are eating nutritious meals. Proper methods for storing meals brought from i' I(aIs iAD v�q/�nGl, 335 home. Meals provided to campers who arrive v/ I IOVetn fii without a bag lunch. .452 Screening provided for food preparation and food service areas. Screen doors must be self-closing. 453 Lighting provided m kitchen and dining area. 471 Sleeping prohibited in food areas. 430 -Inspection Sheet 5-10-16.docx Page 7 430 -Inspection Sheet 5-10-16.docx Page 8 r, 430 -Inspection Sheet 5-10-16.docx Page 8 430-Inspection, Sheet5-10-16.docx Page 9 430-Inspection Sheet5-10-16.docx Page 10 430 -Inspection Sheet 5-10-16.docx Page 11 430-Inspection Sheet5-10-16.docx Page 12 430 -Inspection Sheet 5-10-16.docx SCX\OJn 9_r Ca*kf O _ 3 _ Page 9 �,N.4 s�E S4.al hcw a 4 C b..> CwG� C� m Huta 1 Mv�wn�ca�-�snS. so2\ -fb a s 1u CJ -0F C� p Svc e ve 3 -L- t 6 430 -Inspection Sheet 5-10-16.docx SCX\OJn 9_r Ca*kf O _ 3 _ Page 9 430-Inspection Sheet 5-10-16.docx Page 10 Ailenf* 34 Elm Street - 22 School Street Camden, ME 04843 Rockland, ME 04841 Insurance l Financial 31 Chestnut Street 94 High Street 150 YEARS -1666.2016 Camden, ME 04843, Belfast, ME 04915 July 12, 2016 Pennant Enterprises, Inc Michael Rutstein 73 Middleton Road Boxford, MA 01970 RE: Commercial Hull Policy Number: CHA5210007-11 Effective Date: 07/08/16 to 07/08/17 Dear Mike: 339 Main Street Southwest Harbor, ME 04679 111 Commercial St, 5th Floor Portland, ME 04101 We are pleased to enclose your Commercial Hullpolicy written with Acadia Insurance Company for the above -captioned policy term. The premium includes a slight charge for foreign and domestic terrorism in accordance with the Terrorism Risk Insurance Act. If you do not want this coverage, please sign and return the enclosed terrorism coverage form. Please reviiw your policy carefully for details of your coverage as there are several expressed warranties which may Omit or void coverage. Your policy Is restricted to Passenger day sails. The company is requiring a Condition and Valuation survey due to the age and length of the vessel. Please forwarded this to us as soon as possible. If anything changes, please let us know at once. Abiding by the expressed warranties in the policy is important to the continuation of your insurance coverage. Please remember that Rebecca Robinson and I handle your account as a team and you may call either of us if you have any questions or wish to make any changes. Thank you for your continued confidence in Allen Insurance and Financial. Sincerely, DInsuratl and Financial Chris Richmond, AAI, AINS Commercial Lines CR/sc/Enclosure AIIenlF.com 1 (800)439-4311 Securities and Advisory Services offered through (ommonraealth Financial Network', Member FINRA, SIPC, a Registered Investment Adviser. Fixed Insurance products and services offered through Allen Insurance and Financial or (ES insurance Agency. An Employee -Owned Company MC. 150 YEARS • 1866-2016 34 Elm Street Camden, ME 04843 31 Chestnut Street Camden, ME 04843 22 School Street Rockland, ME 04841 94 High Street Belfast. ME 04915 COMMERCIAL HULL INSURANCE CHECKLIST PREPARED FOR Pennant Enterprises, Inc. 339 Main Street Southwest Harbor, ME 04679 111 Commercial St„ 5th Floor Portland, ME 04101 It is important you review the following aspects of your policy. There are several expressed warranties which may limit. or void coverage. Name of Vessel: Fame Hull Limit and Deductible: Hull Limit: $500,000 Deductible: $25,000 Lay-up Warranty: From 12/01 to 05/01 You have this warranty, it states that if your boat is in its lay-up period, it must be stored on dry land or connected to dry land. For example, if a boat were winterized and tied to a dock, this dock must be connected to dry land for coverage to apply. If your boat is moored or tied to a float not connected to dry land, you may not have any coverage. Year -Round Navigation: No Navigation Warranty: New England Coastal waters not to exceed 50 miles offshore Trading Warranty: Passenger Day Sails - Hull Protection & Indemnity (P&I) Limits: $1,000,000 Bodily Injury Deductible: $1,000 Property Damage Deductible: $25,000 Crew Coverage: 2 Maintenance & Cure Coverage: No Breach of Warranty Coverage: No Loss of Income Coverage: $50,000 limit with.3 day deductible Other Limits: AIIenlF.com 1 (800)439-4311 Securmes and Advisory Services offered through Cammanwalth Financial Netxrork', Member FINRA, SIM, a Registered Ir vesiment Adviser. Fixed Insurance products and services offered through Allen Insurance and Financial or CES Insurance Agency. An Employee -Owned Company NAME OF CAMP ADDRESS OF CAMP S �� 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 healthcare 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 healthcare 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,f rst aid training. of the staff;_ . _ - . 9. 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 limitedto, 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. Print Name � Title Signa Address Date: Febmary 24, 2000 �SS 7 e- zo R MA License egistration Number 0)/0 Telephone Number To Whom It May Concern: I, Dr. James Higgins, delegate to Michael Rutstein, Heath Care Supervisor at Schooner Camp, the duties of administration of medication. He is authorized to administer oral medications only, with the exceptions of EPI -pens. The policies for administration of medication and procedures in the event of omission to take medication, errors, and/or allergic reactions have been reviewed by the Heath Care Supervisor and myself. Michael Rutstein has assured me that the Schooner Camp will at all times have the required number of crewmen with valid First Aid and CPR certifications on board, and that the schooner itself is in all ways compliant with applicable Salem Board of Health and US Coast Guard regulations. Signature & Date I3 KIMBERLEY DRISCOLI, MAYOR LARRY RAbIDIN, RS/REHS, CHO, CP -FS ACTING HEALTH AGENT CITE' OF SALEM, MASSACHUSETTS BOARD or Harv.Trt 120 WASHINGTON STRI-T-F, 4"' FLOOR Tu (978) 411800 1 �Y(97H) 745-03431 45 0343 6: i RVVII).�laJS 1[[11(Okl L c MAY Ae0 �g �� e 16 G q% opq,14 �� Ty APPLICATION FOR LICENSE TO CONDUCT A RECREATIONAL CAMP Name of Camp: S�%�bti[E2 ��P Tel# Address of Camp: Camp Website: S��ODn'"- �rn Fax# Name of Camp Director: //�//� �r�TT /�/ Tel# 4-7o' 72`� '76-10 Camp Director mailing address: 73 Email: S Nr=2 -.17WA�- For The Emergancy Telephone Notification System: Emergency contact name: / d�/A-,-- ��TS" �^� Tel#: q-70' Dates of operation: From: -7111116 To: / / 571 1& Type of Camp: Day: r/ Recreational: Sports: Travel: Trip: Approximate # of campers: 22 Campers Ages:�' -/`� # of counselors: S # of volunteers per season 0 - 2 Please attach the followiy(q information Medical consultant agreement and camp medical policy. Certificates of compliance from Salem Fire Prevention and Salem Building Department. M/#- Check payable to the City of Salem ($10). ✓ Written copies of your Emergency, Special Contingency and Staff Orientation plans. I/ 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. Pursua L Chapter 63C, Section 49A, I certify under the penalties of perjury that I, to my best knowledge d bell ,have filled all state tax returns and paid all state taxes required under the law. p2 Signature Date SS# or Federal Identification Number Updated 5/23/11 reccamp app. Check# & Date S,0 KIMBERLEY DRISCOLL MAYOR Permit # CA -16-20 Date of Print 8111/2016 Permit Issued 7/11/2016 Permit Expires 8/19/2016 Permit Fee $10.00 Late Fee $0.00 CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH IV 120 WASHINGTON STREET, 4"' FLOOR Pr�enYY. Promote. Protect. TEL. (978) 741-1800 FAx (978) 745-0343 health@salem.com LARRY RAMUIN, RS/RMS, CHO, CP -FS H A . -. CAMP PERMIT License For: Granted To: Address: Pickering Wharf Marina Salem Location of Establishment: Restrictions: Notes: ------- LAl.11-I GLN1. Recreational Camps Schooner Camp WHARF STREET 01970 This permit or license is granted in conformity with the statues and ordinances relating thereto, and expires on 8/19/2016 unless sooner revoked or suspended.