Please circle the day or entire week that your child will attend

PLEASE CIRCLE THE DAY OR ENTIRE WEEK THAT YOUR CHILD WILL ATTEND.

Week 1 –GREAT OUTDOORS June 17-21 M T W TH F $________

Week 2 –SUMMER FUN June 24-28 M T W TH F $________

Week 3 –PATRIOTIC July 1-5 M T W TH F $________ Week 4 – WATER July 8-12 M T W TH F $________ Week 5 – SYMPHONY OF SENSES July 15-19 M T W TH F $________

Week 6 –AMAZING ANIMALS July 22-26 M T W TH F $________

Week 7 –BEACH PARTY July 29- 2 M T W TH F $________

Week 8 – EXTREME ADVENTURE August 5-9 M T W TH F $________

Week 9 – THEATRE August 12-16 M T W TH F $________

Total $________

Deposit Due ($20/week) $________

Balance $________
Payment Schedule: Due to the number of persons wishing to take part in the summer recreation program reservations will only be made with a deposit and/or payment. A $20 per week deposit is required.
Refunds: Cancelations must be in writing, and must be received in advance of cancelation in order to receive a refund.
Scholarships: Will be available to those who meet the financial guideline requirement. All application will be considered. We would like to include all children in this program. ONE SCHOLARSHIP PER FAMILY

I_______________, have read and understand the 2010 payment and policy plan as stated above.

Print Name
______________________ _________________

Parent Signature Date

SMOKEY WATERS

Day Camp

2013


T
For Office Use Only

Date Received: ___/___/___

Received By: _____

Paid: CASH CHECK

Amount: $________
OWN OF WEST YELLOWSTONE PARKS AND RECREATION AGREEMENT TO PARTICIPATE AND RELEASE FORM

______________________has permission to participate in the 2013 Smokey Waters Day Camp.

Agreement to Participate Statement

I am aware that participating in the above program can be a dangerous activity involving RISK OF INJURY, including but not limited to: Sprains, strain, fractures and broken bones, bumps, bruises, contusions, burns, bites and weather related injuries.

Because of the danger of participating in this program, I recognize the importance of following the instructors’ instructions regarding techniques, rules, and precautions. I hereby agree to follow and/or reinforce those instructions.

I hereby voluntarily and expressly assume all risks associated with participation in the above program and agree to exonerate and save harmless the Town of West Yellowstone, its volunteers, servants, employees and trip leaders from any and all liability, claims, causes of action or demands of any kind and nature whatsoever which may arise by or in connection to participation in the above program.

The terms of this agreement shall serve as a release and my assumption of the risk shall be binding on my heirs, estate, executor, administrator, assigns and all of my family members.

Solely the laws of the State of Montana shall govern this agreement and any matter in any way related to participation in the above program.

_________________________

DATE Participant’s Printed Name

___________________________________

Participants Signature (if not a minor)

_______________________________________

Guardian’s Signature (if participant is a minor)

As a parent or guardian, I do herewith authorize the treatment by a qualified and licensed medical doctor of the following minor in the event of a medical emergency which, in the opinion of the attending physician, may endanger his or her life, or cause disfigurement, physical impairment, or undue discomfort if delayed. The authority is granted only after a reasonable effort has been made to reach me.

This release form is completed and signed of my own free will with the sole purpose of authorizing medical treatment under emergency circumstances in my absence.
Dates when release is intended _________________________

___________________________ _______________

(Father/mother/legal guardian) Signed Date
Physical Address P.O. BOX # ________

Home______________ CELL _______________ WORK _______________

Email _______________________________________________________
Other contact in case of emergency:
Name Relationship

Home______________ CELL _______________ WORK _______________

Presently under the following medication__________________________________

___________________________________________________________________

My child is covered under medical insurance Yes No
Please list any physical impairments and/or allergies that we should know about___

___________________________________________________________________

___________________________________________________________________
AGE ______________ BIRTHDAY __________________

Important Camp Dates

Week 1 – The Great Outdoors June 17- 21

AA. Fishing at Duck Creek June 19
Week 2 – Summer Fun June 24–28

AA. Blast Off June 26
Week 3 – Patriotic July 1-5

AA Sphire Climbing July 3
Week 4 – Water Week July 8-12

AA. Rexburg Rapids July 10
Week 5 – Symphony of Senses July 15-19

AA. Rocky Creek Farm July 17
Week 6 – Amazing Animals July 22-26

AA. Bear World July 24
Week 7 – Beach Party Adventure July 29-Aug. 2

AA. Cliff & Wade Lakes July 31
Week 8 – Extreme Adventure August 5-9

AA. Whitewater Rafting August 7

Week 9 –Theatre Week August 12-16

ALL CAMPERS NEED TO WEAR ORANGE SHIRTS ON AWESOME ADVENTURE DAYS.

Date: June 17 - August 16, 2012
Location: Povah Community Center
Time: 9am – 3:30pm
Age: 5-12 yrs
Rates: $80/WEEK

$20/DAY

$35/AWESOME ADVENTURES

Minimum/Maximum #: 36 per day,

Enrollment will be first come first serve basis. Payment IN FULL must be made in ADVANCE of participation.

REGISTRATION: Registration begins May30, 2013 at the Povah Community Center. You can register any time after June 10th during regular Office Hours at the Town Offices.
PAYMENT SCHEDULE: Reservations require a per week deposit of $20. Payments can be paid at the Town Offices during office hours.
REFUNDS: In order to receive a refund for your deposit or payment you must give a week notice of cancellation. Cancellations must be in writing.
SCHOLARSHIPS: Are made possible from the West Yellowstone Foundation. All applications will be considered. Scholarships are limited to one week per family. Application will be available when you register.
DROP OFF & PICK UP: Parents need to make sure the child gets signed in with a counselor. If your child needs to leave early or is leaving with someone other than a parent please provide a signed note for the counselor, explaining the situation and/or whom they will be leaving with.
SWIMMING: Our swim day this year will be Thursday. All campers MUST bring their own towels, swimming suits and life jackets. Floatation devices do not replace a life jacket.

Your child must pass a swim test to be able to swim without a lifejacket.
AWESOME ADVENTURES: Field trips will be on Wednesday’s. We will be leaving at 8:30am sharp and returning as close to 4:00pm as is possible. You will be notified of any cancellation or changes. All children must be dressed in clothing appropriate to field trip. All campers need to wear an orange shirt on all field trips. Books, personal games devices and PG movies are welcome on awesome adventures.
BIKE RIDES: Please make sure that your child’s bike has been checked by a qualified bike technician. Try one of our local bike shops for service and repair.
Freeheel and Wheel 646-7744

Yellowstone Bicycles 646-7815
WHAT TO BRING DAILY:

-Sack lunch and snacks for snack time

-Water bottle

-Close toed shoes

-Sunscreen

-Bug Spray

-Light jacket (PREFERABLY WATER PROOF)
-Swim Suit and Towel (Thursday)

-Orange Shirt (Wednesdays)

-Bicycle & Helmet (Fridays)

WEEKLY SCHEDULE

5-8 year olds

Mondays: Exercises, Arts and Crafts, Group Projects & Free Time.

Tuesday: Grizzly Discovery Center & Group Sports.

Wednesday: Awesome Adventure.

Thursday: Swimming, Nature Journaling & Reading Program

Friday: Biking, Finish Group Project & Presentations.
9-12 year olds

Mondays: Exercises, Team Challenges, Group Project & Arts and Crafts.

Tuesday: Grizzly Discovery Center, Outdoor Explore & Science Experiments

Wednesday: Awesome Adventure.

Thursday: Swimming, Nature Journaling & Reading Program

Friday: Biking, Finish Group Project & Presentations.