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2015 Summer Camp Fun Guide

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A list of our popular Summer Camps at the River Forest Park District

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  • good things to knowWest Suburban Special Recreation AssociationWSSRA provides outstanding opportunities through recre-ation for individuals with disabilities. In certain circumstances, additional support staff, called "Inclusion Partners", are recruited and trained to assist an individual with a disability within the Park District setting. All participants must be able to meet the essential eligibility requirements of the particular program or camp, with or without reasonable accommodation. Eligibility requirements can be found in program guides, registration ma-terials, codes of conduct, on the website, and through various other means of communication. You are encouraged to call the Park District with any questions on essential eligibility criteria. Families registering participants with disabilities and special needs should make sure to timely identify any special needs or request for reasonable accommodation on the registration form. WSSRA requires a 2 week minimum notice for requests to facil-itate successful inclusion. Brochures with more information can be picked up at The Depot, 401 Thatcher Avenue. If you have any questions regarding the Inclusion Process, please feel free to contact WSSRA's Inclusion Coordinator at 847-455-2100

    Code of Conduct: 4-Point Discipline PolicyIt is our intention to provide your child with a safe and secure environment. We attempt to create a warm, comfortable, and fun atmosphere that will make your child look forward to coming to camp each day. In order to ensure the quality of this pro-gram and safety of the campers, each participant must follow program rules. 4-Point Discipline Policy Campers are encouraged to practice those social skills that will allow them to resolve conflicts and meet their needs without the use of harmful or destructive behaviors. When disciplinary situations occur that require intervention, an adult provides the child with clear explanations as to why specific behavior is inappropriate. They then help him/her find alternative behavior that fits within the camp guidelines of appropriate behavior. These guidelines revolve around concerns for the safety of all participants in camp. If the camp staff encounters behavior problems with any participant, he/she will first attempt to resolve the problem with the camper, if this fails, the Camp Supervisor will be consulted, followed by the parents. There is a strict 4-Point Discipline Pol-icy. If a camper gets 2 Written Warnings during the summer, he/she will be dismissed from the program. Every parent/guardian is required to read the following information to his/her camper and sign and return the 4-Point Discipline Policy Form to camp. (This must be on file prior to the start of camp.)

    Camp Refund Policy1) Refund requests for camps must be received one week before the camp meets to be eligible for a refund 2) A $10 can-cellation fee will be applied to any refunded amount per child/per camp

    NUT-FREE ZONEAll camp sites have been designated NUT-FREE. We are requesting your cooperation in partnering with us to ensure a safe environment for children with nut allergies. Parents with children that have a nut allergy are requested to notify the Park District as soon as possible by completing an Allergy Action Plan Form

    OTHER ALLERGIESIf your child has any other known allergies, please fill out an Allergy Action Plan From to keep on file

    1

    Camp Staff and Training

    Register online at www.rfparks.com Call us at 708-366-6660

    A qualified adult Camp Director supervises each camp. Counselors at each camp are mature and enthusiastic college-aged students. All camp staff complete an extensive training program that includes supervision and safety techniques, activity development and first aid. Camp Directors are also certified in CPR, First Aid, and AED.

  • half day camps

    Resident registration begins March 9 for all campsNon-Resident registration begins March 30 for all camps

    2

    tot campCampers will be grouped by ageAges: 3-5 (Camper must be 3 by 6/22/15 & toilet trained) Campers can look forward to a wide variety of activities at this fun-filled camp. Our adventures will include arts and crafts, sports and games, storytime visit from the River Forest Public Library, imaginative play, outdoor activities, weekly age-appropriate themes, and a weekly water day where campers run and jump through the sprinkler, and play with bubbles, buckets, and beach balls! Each camper will receive a t-shirt. Min 10/Max 48

    Leader: Trained RFPD StaffLocation: Willard SchoolDays: Monday-FridayTime: 8:45am-12:15pmBring: NUT-FREE snack and labeled water bottle; Water Day:

    Swimsuit, Sunscreen, Towel, Waterproof Shoes

    kidz campCampers will be grouped by age and ability.Ages: 6-10 (Entering 1st through 5th grade)Kidz Camp thrills kids with a variety of fun-filled activities. Enjoy arts and crafts, theme days, sports and games, cookouts, water days, and much more! Each camper will receive a t-shirt. Min 10/Max 38

    Leader: Trained RFPD StaffLocation: The DepotDays: Monday-FridayTime: 8:30am-12:30pmBring: NUT-FREE snack and labeled water bottle; Water Day: Swimsuit, Sunscreen, Towel, Waterproof Shoes

    ultimate sports campCampers will be grouped by age and ability.Ages: 6-10 (Entering 1st through 5th grade)Boys and girls can fill their days with action packed, high energy sports. Each week our staff will organize games and contests focusing on a different sport. Our experienced staff will provide fundamentals for each sport. Sports for this summer will include flag football, basketball, floor hockey, baseball, soccer, dodgeball, and more. Each camper will receive a t-shirt. Min 8/Max 40

    Leader: Trained RFPD StaffLocation: Keystone CenterDays: Monday-FridayTime: 8:30am-12:30pmBring: NUT-FREE snack and labeled water bottle; Water Day: Swimsuit, Sunscreen, Towel, Waterproof Shoes

    thrill zoneCampers will be grouped by age and ability.Ages: 10-14 (Entering 5th through 8th grade)This camp is perfect for older kids to hang out with their friends in a fun summer atmosphere. Mondays and Wednesdays are water days at Forest Park Aquatic Center. Every Tuesday and Thursday brings a field trip! Fridays will be adventure-packed with sports, water games, and more! Each camper will receive a t-shirt.Visit www.rfparks.com for a complete listing of weekly field trips. Min 10/Max 32Leader: Trained RFPD StaffLocation: Priory CenterDays: Monday-FridayTime: 8:30am-2:30pmBring: NUT-FREE snack, sack lunch, and labeled water bottle; Water Days: Swimsuit, Sunscreen, Towel, Waterproof Shoes

    Session Date R/NR Fee Code

    Week 1 June 22-June 26 $80/$96 2200.121Week 2 June 29-July 2* $64/$77 2200.122Week 3 July 6-July 10 $80/$96 2200.123Week 4 July 13-July 17 $80/$96 2200.124Week 5 July 20-July 24 $80/$96 2200.125Week 6 July 27-July 31 $80/$96 2200.126Week 7 August 3-August 7 $80/$96 2200.127Week 8 August 10-August 14 $80/$96 2200.128

    ENTIRE SUMMER June 22-August 14 $562/$674** 2200.120

    Session Date R/NR Fee Code

    Week 1 June 15-June 19 $80/$96 3602.116 Week 2 June 22-June 26 $80/$96 3602.117 Week 3 June 29-July 2* $64/$77 3602.118 Week 4 July 6-July 10 $80/$96 3602.119 Week 5 July 13-July 17 $80/$96 3602.120 Week 6 July 20-July 24 $80/$96 3602.121 Week 7 July 27-July 31 $80/$96 3602.122 Week 8 August 3-August 7 $80/$96 3602.123Week 9 August 10-August 14 $80/$96 3602.124 ENTIRE SUMMER June 15-August 14 $634/$761** 3602.115

    Session Date R/NR Fee Code

    Week 1 June 15-June 19 $165/$198 3603.136Week 2 June 22-June 26 $165/$198 3603.137Week 3 June 29-July 2* $132/$158 3603.138Week 4 July 6-July 10 $165/$198 3603.139Week 5 July 13-July 17 $165/$198 3603.140Week 6 July 20-July 24 $165/$198 3603.141Week 7 July 27-July 31 $165/$198 3603.142Week 8 August 3-August 7 $165/$198 3603.143Week 9 August 10-August 14 $165/$198 3603.144

    ENTIRE SUMMER June 15-August 14 $1307/1568** 3603.135

    Session Date R/NR Fee Code

    Week 1 June 15-June 19 $80/$96 3601.121 Week 2 June 22-June 26 $80/$96 3601.122 Week 3 June 29-July 2* $64/$77 3601.123 Week 4 July 6-July 10 $80/$96 3601.124 Week 5 July 13-July 17 $80/$96 3601.125 Week 6 July 20-July 24 $80/$96 3601.126 Week 7 July 27-July 31 $80/$96 3601.127 Week 8 August 3-August 7 $80/$96 3601.128 Week 9 August 10-August 14 $80/$96 3601.129

    ENTIRE SUMMER June 15-August 14 $634/$761** 3601.120

    * No camps on Friday, July 3.**Reflects a 10% discount.

    Due to this discount, there will be no prorations or refunds.

  • lunch club/ kick off camps

    3

    Session Date R/NR Fee Code

    Week 1 June 15-June 19 Week 2 June 22-June 26 Week 3 June 29-July 2* Week 4 July 6-July 10 Week 5 July 13-July 17 Week 6 July 20-July 24 Week 7 July 27-July 31 Week 8 August 3-August 7 Week 9 August 10-August 14

    ENTIRE SUMMER June 15-August 14 $119/$142** 3604.135

    3604.1363604.1373604.1383604.1393604.1403604.1413604.1423604.1433604.144

    $15/$18$15/$18$12/$14$15/$18$15/$18$15/$18$15/$18$15/$18$15/$18

    Register online at www.rfparks.com Call us at 708-366-6660

    lunch club

    NEW!baby animal games campAges: 3-5Find out all about animals, as we use bean bag babies to discover what makes each animal so special. Learn about animal protection, homes, body coverings, and more!Min 8/Max 16

    Leader: Hightouch HightechDays: Monday-FridayWeek: June 8-June 12Time: 12:30pm-3:00pmFee: R$119/NR$143Location: The Depot Bring: Labeled water bottleCode: 2201.158

    lil ARTitects campAges: 3-5Lets take a journey and learn about different iconic landmarks and museums! Explore the world of architecture as mini ARTitects! We will learn about buildings and museums by taking an observing eye to these famous structures. Using various art mediums, we will create our own unique structures by letting our creativity guide us to higher heights! Min 6/Max 16

    Leader: Easel Art StudioDays: Monday-Friday Week: June 8-June 12Time: 8:30am-10:30amFee: R$159/NR$191Location: The DepotBring: Labeled water bottleCode: 2213.106

    NEW!

    kidz camp & ultimate sports campAges: 6-10 (Entering 1st-5th grade)Lunch Club was created to provide our campers/parents the ease of transitioning from half day morning camp to afternoon specialty camp without leaving camp! Campers will eat lunch under the supervision of our camp staff in a safe environment. Min 8/Max 38

    Location: The DepotDays: Monday-FridayTime: 12:30pm-1:00pmBring: NUT-FREE sack lunch and labeled water bottle

    * No camps or lunch club on July 3** Reflects a 10% discount. Due to this discount, there will be no proratations or refunds.

    chicago edge soccer academy campAges: 5-7, 8-14 The Chicago Edge Soccer Academy presents a soccer camp created to teach both novice and more experienced soccer players. Using fun exercises and games, fundamental skills such as dribbling, passing, ball control, shooting, and exciting new moves will be taught. Campers will grow as athletes and people as they learn about teamwork and sportsmanship. Each camper will receive a t-shirt. Min 10/Max 60

    Leader: Chicago Edge Soccer StaffDays: Monday-FridayWeek: June 8-June 12Location: Keystone Park EastBring: NUT-FREE snack & labeled water bottle

    Ages Fee Time Code5-7 R$133/NR$160 12:30pm-2:30pm 3501.114 8-14 R$196/NR$235 12:30pm-3:30pm 3501.115

    all star basketball campAges: 6-12 The All Star Basketball trainers will focus on individual skills, as well as team play. Camp will begin with speed and agility drills, which will enhance each players ability to get up and down the court quickly, generate rapid change of direction, and create explosion to the basket. Camp will cover ball handling, proper shooting technique, footwork, and defensive/offensive strategies. Small-sided competitions and game play will enable each player to focus and work on learned skills. Min 10/Max 20

    Leader: All Star Sports Instruction, Inc.Days: Monday-FridayWeek: June 8-June 12Time: 8:30am-12:30pmFee: R$186/NR$223Location: Keystone CenterBring: NUT-FREE snack & labeled water bottle Code: 3111.101

    NEW!

  • Resident registration begins March 9 for all campsNon-Resident registration begins March 30 for all camps

    sports camps

    4

    flag football camp Ages: 3-5, 6-12 Enjoy a week of action-packed football in a fun and safe environment. This is a great chance for children to learn the game without pads and helmets. No tackling allowed! We will cover positioning, catching, throwing, patterns, footwork, offensive strategies, and defensive strategies that keep campers thinking and moving. Min 10/Max 20

    Leader: All Star Sports Instruction, Inc.Days: Monday-FridayWeek: June 22-June 26Location: Keystone Park East Bring: Labeled water bottle

    Ages Fee Time Code3-5 R$47/NR$56 3:00pm-4:00pm 3301.102 6-12 R$93/NR$112 1:00pm-3:00pm 3301.103

    baseball campAges: 5-6, 7-8, 9-12 Sean Bieterman, Head Baseball Coach at Aurora Central Catholic High School, and staff, will be hosting a four-day baseball instructional camp in River Forest. Instruction will include: hitting, fielding, pitching, and base running. This camp will also include competitions and game play. For Ages 5-6, the drills will incorporate an introductory approach to the game. For Ages 7-8 & 9-12, increased drill precision and baseball challenging skills will be applied. Min 6/Max 20 per age group

    Leader: Sean Bieterman & StaffDays: Monday-ThursdayWeek: June 29-July 2Time: 1:00pm - 4:00pmFee: R$127/NR$152Location: Keystone Park East Baseball FieldBring: Glove & labeled water bottle

    Ages Code5-6 3203.1157-8 3203.1169-12 3203.117

    dodgeball campAges: 3-5, 6-12 This fast-paced camp will get your kids moving and dodging like never before. We will teach kids the rules of dodgeball and the strategies to beat the toughest players. Come and learn to dodge, dip, duck and dive. Min 10/Max 20

    Leader: All Star Sports Instruction, Inc.Days: Monday-FridayWeek: June 15-June 19 Location: Keystone Park EastBring: NUT-FREE snack & labeled water bottle

    Ages Fee Time Code 3-5 R$47/NR$56 3:00pm-4:00pm 3910.102 6-12 R$93/NR$112 1:00pm-3:00pm 3910.103

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    NEW!racquet campAges: 6-12Campers will have the opportunity to play three racquet sports which utilize hand eye coordination and large motor skills...Platform Tennis will cover basic skills of scoring, serving, court strategy with on court game play. Ping Pong will incorporate scoring and fun competitive play with a challenge ladder league to encourage competitive play among campers. Tennis will cover the fundamentals of ground strokes, racquet grip/preparation, serve, volleys, point of contact and shot selection. Campers will be taught to rally back and forth with consistency and learn to keep score.Min 10/Max 16

    Leader: Bernard MurrayDays: Monday-FridayWeek: June 22-June 26Time: 1:00pm-4:00pmFee: R$186/NR$223Location: Keystone Center Bring: Tennis racquet & labeled water bottleCode: 3701.103

    NEW!

  • Register online at www.rfparks.com Call us at 708-366-6660

    sports camps

    5

    boys lacrosse campAges: 8-15 The River Forest Park District is proud to present the community with a lacrosse camp based on the needs of lacrosse players. Ante-Ups mission is to introduce the game and prepare young lacrosse players for their future high school career. We teach sound fundamentals through competitive, team-based lacrosse. This model ties leadership, sportsmanship, and helps build a players character, as well as improving his skills. Min 10/Max 50

    Leader: Ante-Up LacrosseDays: Monday-FridayTime: 1:00pm-3:30pmFee: R/NR$176Bring: Water bottle, stick, helmet, gloves, elbow pads, shoulder pads, & mouth guard

    chicago bulls basketball campAges: 6-12 The Chicago Bulls are coming to your neighborhood! Coaches will divide the campers based on age and ability level. Younger children (ages 6-8) will focus on building fundamentals with fun drills to understand the game and improve their play. For the older kids (ages 9-12) , coaches work on the team concept and refining and advancing the skills for the serious or soon-to-be serious player. You are sure to improve your ball handling, passing, shooting, rebounding, and footwork! Each camper will receive a Chicago Bulls duffel bag, indoor/outdoor basketball, t-shirt, evaluation report, and graduation certificate. Min 8/Max 40

    Leader: Chicago Bulls/White Sox Training AcademyDays: Monday-FridayWeek: July 20-July 24Time: 1:00pm-4:00pmFee: R/NR$228Location: Trinity High School New GymBring: Labeled water bottle Code: 3303.102

    Week Location CodeJuly 6-July 10 Priory Park 3911.111July 27-July 31 Taylor Park O.P. 3911.112

    floor hockey camp Ages: 3-5, 6-12 Our floor hockey camp is designed to teach the rules and mechanics of this fast-paced game without the skates. No checking will be allowed, but everyone must come prepared to play hard. This camp will challenge campers to improve their stick work, teamwork, and overall knowledge of the game. We will cover the mechanics of passing, shooting, puck control, defense and offense, in a fun and safe environment. Min10/Max 20

    Leader: All Star Sports Instruction, Inc.Days: Monday-FridayWeek: July 13-July 17Location: Keystone Park Tennis CourtsBring: Labeled water bottle, hockey stick, hockey helmet or bike helmet, hockey gloves, knee and elbow pads. (Optional: mouth guard, shin pads, wrist pads.)

    Ages Time Fee Code3-5 3:00pm-4:00pm R$47/NR$56 3401.1006-12 1:00pm-3:00pm R$93/NR$112 3401.101

    archery campAges: 8-12This 5-day camp includes Archery 1: an introduction to archery that teaches range safety, proper shooting form, and other skills necessary to be proficient at archery. Also included is Archery 2: that builds on skills learned in Archery 1 and introduces new skills and techniques to become a better archer. In addition to this, archery camp adds new activities from USA Archerys new interactive program called Explore Archery that involves fun, exciting, challenging individual and team-building activities that focus on fundamental skills, competitive edge, and creativity versus ability and scores. Earn award medals each day for each new skill learned. All equipment and activity supplies are provided. NO OUTSIDE EQUIPMENT IS PERMITTED.Min 6/Max 12

    Leader: Northern Illinois Archery OrganizationDays: Monday-FridayWeek: July 6-July 10Time: 1:00pm-4:00pmFee: R$166/NR$199Location: Keystone Park West Bring: Labeled water bottleCode: 3402.105 girls lacrosse campAges: 6-12 This camp is run by an experienced and skilled coaching staff, including women with high school, collegiate, and post collegiate playing experience, current college athletes, and current varsity high school athletes. Quality coaching is our #1 priority. Registration is a two-step process:1. Register and pay through the River Forest Park District2. Fill out the Camp and Clinic Registration form on IGLAs website (www.iglax.org) under the Get Ready to Play tab Min 10/Max 50

    Leader: Illinois Girls Lacrosse Association Days: Monday-FridayWeek: July 6-July 10Time: 1:00pm-3:00pmFee: R/NR$138Location: Priory Park EastBring: NUT-FREE snack, labeled water bottle, goggles, stick and mouth guard. Sticks and goggles are available to borrow at no charge; you will need to email [email protected] ahead of time.Code: 3912.100

  • Resident registration begins March 9 for all campsNon-Resident registration begins March 30 for all camps 6

    sports campsvolleyball campAges: 6-12 Our volleyball camp is designed to equip our campers with the essential fundamentals that are needed to succeed in this fast-paced game. Passing, setting, serving, defensive and offensive strategies are all covered. Join us as we work on improving our footwork, teamwork, and the fundamentals of volleyball, taking skills to the next level. Min 10/Max 20

    Leader: All Star Sports Instruction, Inc.Days: Monday-FridayWeek: July 27-July 31Time: 1:00pm-3:00pmFee: R$93/NR$112Location: St. Luke School GymBring: NUT-FREE snack & labeled water bottle Code: 3922.105

    baseline2baseline tennis camp Ages: 6-12 We teach the whole concept of tennis from baseline to baseline. Tennis students learn the fundamentals of ground strokes, racquet grip/preparation, serve, volleys, point of contact, and shot selection. Students will be taught to rally back and forth with consistency and learn to keep score during round-robin and challenge matches. Min 10/Max 16

    Leader: Bernard MurrayDays: Monday-FridayWeek: August 10-August 14Time: 1:00pm-4:00pmFee: R$186/NR$223Location: Keystone Park Tennis CourtsBring: Tennis racquet, NUT-FREE snack & labeled water bottle Code: 3701.136

    NEW! full-day multi-sports campAges: 6-12This camp is for the all-around athlete who wants to take a shot at different sports! Stay active and work on balance, motor skills, and hand-eye coordination, while learning the rules of baseball, football, floor hockey, soccer, basketball, and more! We will focus on a new sport each day and work on basic rules and mechanics, while we play games that keep everyone moving. Theres no reason to pick one sport when you can play them all! Min 10/Max 20

    Leader: All Star Sports Instruction, Inc.Days: Monday-FridayWeek: August 17-August 21Time: 8:30am-2:30pmFee: R$239/NR$287Location: Keystone Center Bring: NUT-FREE snack, & sack lunch, labeled water bottleCode: 3502.110

    chicago edge soccer academy campAges: 5-7, 8-14 The Chicago Edge Soccer Academy presents a soccer camp created to teach both novice and more experienced soccer players. Using fun exercises and games, fundamental skills such as dribbling, passing, ball control, shooting, and exciting new moves will be taught. Campers will grow as athletes and people as they learn about teamwork and sportsmanship. Each camper will receive a t-shirt. Min 10/Max 60

    Leader: Chicago Edge Soccer StaffDays: Monday-FridayWeek: August 3-August 7Location: Priory Park EastBring: NUT-FREE snack & labeled water bottle

    Ages Fee Time Code5-7 R$133/NR$160 1:00pm-3:00pm 3501.116 8-14 R$196/NR$235 1:00pm-4:00pm 3501.117

    NEW!

  • arts & fun campsarts & fun camps

    7

    csi campAges: 6-12 Learn what forensic scientists and crime scene investigators do! Receive hands-on training by collecting evidence, dusting for fingerprints, searching for blood stains, analyzing DNA evidence, interpreting DNA profiles, crime scene photography, crime scene synopsis, jury deliberations, mock trials and more! Wilkins & Associates collaborates with experienced, current and former law enforcement personnel, forensic scientists, and attorneys, to conduct or advise the actual crime scene collection, processing, investigations, mock trials, and more. NEW MOCK CRIME SCENES! Min 8/Max 20

    Leader: Wilkins & Associates, Inc.Days: Monday-ThursdayWeek: June 29-July 2Time: 1:00pm-3:00pmFee: R$94/NR$113Location: The DepotBring: NUT-FREE snack & labeled water bottleCode: 2201.100

    super science campAges: 3-5, 6-12 Become a Super Scientist as you try all the amazing types of science. Day 1: Cool Chemist Day - try cool chemical concoctions and keep what you make. Day 2: Biologist Day - take a closer look at plants, animals, insects, plant seeds, and make insect habitats to keep. Day 3: Geologist Day - crack rocks, find gems and minerals to keep. Day 4: Meteorologist Day - make clouds, snow, tornadoes, and more. Day 5: Engineer Day- build machines and design a prototype to test and keep it. Min 8/Max 16

    Leader: Hightouch HightechDays: Monday-FridayWeek: June 22-June 26Location: The DepotBring: Labeled water bottle; NUT-FREE snack for ages 6-12

    Ages Time Fee Code3-5 3:15pm-4:30pm R$73/NR$88 2201.1596-12 1:00pm-3:00pm R$113/NR$136 2201.160

    NEW!

    Register online at www.rfparks.com Call us at 708-366-6660

    STEM science campAges: 3-5, 6-12 STEM Science Camp will explore areas of Science, Technology, Engineering, and Math. Each day will include new challenges and experiments. Campers will design experiments to test reaction rates, build machines and mechanical robots, test prototypes and gadgets to keep, and much more!Min 8/Max 16

    Leader: Hightouch HightechDays: Monday-FridayWeek: July 6-July 10Location: The DepotBring: Labeled water bottle; NUT-FREE snack for ages 6-12

    Ages Time Fee Code 3-5 3:15pm-4:30pm R$73/NR$88 2201.161 6-12 1:00pm-3:00pm R$113/NR$136 2201.162

    NEW!NEW!monochromatic summer art campAges: 3-5, 6-12 Have you ever wanted to create blue period masterpieces like Picasso? Join Easel Art Studio as we create works of art, one color at a time. Colors create and impact our mood, appetite, and energy level. By using different tones and hues for each color, we will paint, sculpt, and draw our way through the color wheel. Our hands will get messy from creating and learning how to mix and apply colors every day. Min 8/Max 16

    Leader: Easel Art StudioDays: Monday-FridayWeek: June 15-June 19Location: The DepotBring: Labeled water bottle, dress for a mess; NUT-FREE snack for ages 6-12

    Ages Time Fee Code3-5 3:15pm-4:30pm R$99/NR$119 2213.1046-12 1:00pm-3:00pm R$159/NR$191 2213.105

  • Resident registration begins March 9 for all campsNon-Resident registration begins March 30 for all camps

    arts & fun camps

    8

    space campAges: 3-5, 6-12 Travel through space as we explore our solar system. Discover how cool the sun really is by making a solar clock and solar photos. Have a real impact, as we become crater makers. Learn about our planets, dwarf plants, moons, eclipse and much more. Take a ride on a human gyroscope and become an astronaut and eat astronaut ice cream. Make a real telescope to keep. Launch and test rockets and make a rocket to keep. Min 8/Max 16

    Leader: Hightouch HightechDays: Monday-FridayWeek: July 13-July 17 Location: The DepotBring: Labeled water bottle; NUT-FREE snack for ages 6-12

    Ages Time Fee Code3-5 3:15pm-4:30pm R$73/NR$88 2201.1636-12 1:00pm-3:00pm R$113/NR$136 2201.164

    NEW!

    chess wizards campAges: 6-12 Energetic Chess Wizards will lead you through an array of games and activities. Activities include: Chess, Lessons, Puzzles, Wizard Says, Bug House, Mirror, Fisher, Take Me, Charades, Basketball, Soccer, Dodgeball, and more! Each camper will receive a trophy, a Chess Board, a Chess Wizards t-shirt, plus a folder containing all of the puzzles they completed at camp.Min 8/Max 18

    Leader: Chess WizardsDays: Monday-FridayWeek: July 20-July 24Time: 1:00pm-4:00pmFee: R$148/NR$178Location: The DepotBring: Labeled water bottle; NUT-FREE snack is providedCode: 2210.100

    NEW!video game robotics campAges: 8-10Love building with LEGO? Love video games? It all comes together with TechStars! You and your partner will create video games and then use LEGO Robotics kits to build a controller for your Scratch game. This special course lets you build robots with sensors that communicate and control your games. Build alligators, magic wands, and watch as you bring them to life onscreen! Min 6/Max 12

    Leader: Computer ExplorersDays: Monday-FridayWeek: July 27-July 31 Time: 1:00pm-3:00pmFee: R$159/NR$191Location: The DepotBring: NUT-FREE snack & labeled water bottleCode: 2201.133

    minecraft + inventors lab campAges: 9-13 TechStars will start your week by granting you access to a PROPRIETARY Minecraft world you cant get on your own! Learn fundamentals of computer networking through this unique Minecraft experience that also allows you and your friends to work in multiplayer mode as you mine, craft and build together to survive. Working with a partner, use your skills to explore. No matter whether you are new to Minecraft or already love the program, this is for YOU! Next, we will become inventors as we let our imaginations turn everyday objects into keyboards or computer controllers. Prepare to stretch your imagination as you and your partner morph objects around you. Min 6/Max 10

    Leader: Computer ExplorersDays: Monday-FridayWeek: July 27-July 31Time: 4:30pm-6:30pmFee: R$159/NR$191Location: The DepotBring: NUT-FREE snack & labeled water bottleCode: 2201.135

    NEW!

  • Register online at www.rfparks.com Call us at 708-366-6660

    arts & fun camps

    9

    NEW!programming with bee-bot + gears campAges: 5-7 Our robot friend, Bee-Bot has a lot to share with us. Young programmers will work in teams to write their own programs to send Bee-Bot through a number of courses and missions on the computer. We will then program a real Bee-Bot to do the same thing on the floor! We will also spend time learning about gears like in Bee-Bot using LEGO to build our own robot.Min 6/Max 10

    Leader: Computer ExplorersDays: Monday-FridayWeek: July 27-July 31Time: 3:15pm-4:15pmFee: R$80/NR$96Location: The DepotCode: 2201.148

    fairytale storyacting campAges: 3-5If your child loves fairytales and enjoys performing, they will love Fairytale Storyacting! In this camp, we will introduce a different fairytale each day to act out with the campers. As the teacher narrates the story in her own words, the campers take on a variety of roles to make the story come to life. Campers will be able to choose from a variety of costume pieces, scarves, props, and trinkets as they play out the story several times. Campers will get the opportunity to try on many characters and broaden their scope on role-playing. Stories will include popular fairytales that are best suited to the group. On the last day of camp, we will do excerpts from some of our favorites to share with our family and friends. You wont want to miss this energetic and engaging camp! Min 8/Max 14

    Leader: Paddy LynnDays: Monday-FridayWeek: August 10-August 14Time: 3:15pm-4:30pmFee: R$66/NR$79Location: The Depot Bring: Labeled water bottleCode: 2104.111

    storyacting drama daze campAges: 6-12 This is a highly interactive camp that incorporates the engaging aspects of storytelling with the fun and excitement of putting on a play. The beauty of this combination is that it comes from books! Campers are actively a part of each story, and if time permits, we switch characters, allowing them to try out a variety of roles. Campers will be able to pick out colorful costumes and props from a large trunk to perform onstage. Everyone gets involved! This camp is a wonderful way to introduce children to the wonders of theatre. Using creative drama, basic acting techniques and improvisation, the campers will explore their own creativity and uniqueness. Min 8/Max 20

    Leader: Paddy LynnDays: Monday-FridayWeek: August 10-August 14Time: 1:00pm-3:00pmFee: R$106/NR$127Location: The DepotBring: NUT-FREE snack & labeled water bottleCode: 2104.110

    dance campAges: 3-5, 6-12 Campers will learn 2 dances during this one week camp. One jazz dance and one ballet dance will be taught, as well as dance terminology and technical skills. Have fun dancing to the latest music in an energizing and exciting camp. Campers will make a craft and a t-shirt to take home. There will be a 15 minute performance on the last day of camp. Min 6/Max 14

    Leader: Carolyn Rogers, Certified Dance Instructor (LPCW)Days: Monday-FridayWeek: August 3-August 7Location: The DepotBring: Labeled water bottle; NUT-FREE snack for ages 6-12 Ages Time Fee Code 3-5 3:15pm-4:30pm R$66/NR$79 2450.130 6-12 1:00pm-3:00pm R$106/NR$127 2450.131

    NEW!

  • Resident registration begins March 9 for all campsNon-Resident registration begins March 30 for all camps

    June 15-June 19

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  • registration form - summer 2015F

    AM

    ILY LA

    ST

    NA

    ME

    : __________________________________________________________________

    CREDIT CARD

    Credit Card # Exp. Date (mo./yr.) V-Code

    CASH CHECK DATE TOTAL FEE $ # $ $ # $

    I have read the program waiver stated on the back and understand that my signature is required in order to participate in any program.

    _________________________________________________________________________________________________________________ Participant/Parent/Guardian Signature Date

    Return form to the River Forest Park District 401 Thatcher Avenue, River Forest, Illinois 60305, Phone 708.366.6660

    Name on Credit Card __________________________________________________________________________

    PARTICIPANT INFORMATION

    Family Last Name _____________________________________________ Parents First Names______________ / ______________

    Street Address________________________________________________ Home Telephone _________________________________

    City ____________________________ State _____ Zip ______________ Father Cell/Work Phone ___________________________

    Email __________________________________________________________ Mother Cell/Work Phone ___________________________

    Describe any known food restrictions, allergies, or current health conditions that will affect participation:

    Check if you need accommodation, in accordance to the ADA, to effectively participate in any programs.

    Describe requested accomodation: PAYMENT INFORMATION

    PROGRAM WAIVER

    Visa MasterCard Discover American Express

    AE

    Payable to: River Forest Park District

    $$

    Return form to the River Forest Park District 401 Thatcher Ave, River Forest, IL 60305

    Register online at www.rfparks.com Call us at 708-366-6660

    CODE NO. PROGRAM NAME PARTICIPANTSFIRST NAME SEX

    BIRTHDATEMM/DD/YY

    GRADE IN FALL SCHOOL FEE

    TOTAL REMITTANCE $ _____________

    SUMMER CAMPS at a glance...

  • REGISTRATION INFORMATION - 3 Easy Ways to Register!Sorry, no telephone registrations accepted. The waiver on all registration forms must be properly signed to be processed. If the registration form is not signed, it will be returned to the individual, unprocessed, to be signed.

    Waiver and Release of all ClaimsPlease read this form carefully and be aware in registering yourself or your minor child/ward for participation in the above program/programs, you will be waiving and releasing all claims for injuries you or your minor child/ward might sustain arising out of your participation in the program/programs you have registered for.

    I recognize and acknowledge that there are certain risks of physical injury to participants in the above program(s) and I agree to assume the full risk of any injuries, damages or loss regardless of severity which I or my minor child/ward may sustain as a result of participating in any and all activities connected with or associated with such program(s), including transportation services and vehicle operations, when provided.

    I agree to waive and relinquish all claims my minor child/ward or I may have as a result of participating in the program against the River Forest Park District and its officers, agents, servants and employees.

    I do hereby fully release and discharge the District and its officers, agents, servants and employees from any and all claims from injuries, damage or loss which I or my minor child/ward may have or which may accrue to me or my minor child/ward and arising out of, connected with, or in any way associated with the activities of the program(s).

    I further agree to indemnify and hold harmless and defend the District and its officers, agents, servants and employees from any and all claims resulting from injuries, damages and losses sustained by me or my minor child arising out of, connected with, or in any way associated with the activities of the program(s).

    In the event of any emergency, I authorize District officials to secure from any licensed hospital, physician and/or medical personnel any treatment deemed necessary for me or my child/wards immediate care and agree that I will be responsible for payment of any/all medical services rendered.

    As a participant in a program or activity of the District (or as the parent or guardian of a participant), I hereby grant the District permission to use my or my childs image, video form, or voice in photographs, videotapes, Internet website or other materials prepared or released by the District from time to time, for promotional, safety or instructional purposes. I understand that such materials will be used and shown in whole or in part as the District sees fit. By this permission and release, I hereby release and discharge the District, its officers, employees and agents from any and all claims or actions resulting from the use of such materials by the District.

    When registering by fax or online at the River Forest Park District, it is mutually understood that the facsimile or online signature and registration document (including the Waiver and Release of All Claims) shall substitute for and have the same legal effect as the original form signature.

    I have read, understand and agree to the terms of the River Forest Park District Cancellation and Refund Policy.

    I have read and fully understand the above Program Details, Waiver and Release of All Claims and Permission to Secure Treatment.

    The River Forest Park District does not carry accident or hospitalization insurance on any program participant. It is recommended that participants review their own personal insurance policy for adequate coverage during all program activities.

    General Information 1. Carefully complete the River Forest Park District registration form. Enter the code number

    on the left-hand column of the registration form. (Example of code number: 1234.100) Use the form for all free and paid Park District programs. Please print and make sure all information is correct.

    2. THE WAIVER FORM MUST BE SIGNED FOR THE REGISTRATION FORM TO BE PROCESSED.

    3. Add up the fees and write the total amount in the appropriate space. Checks or money orders may be made payable to the River Forest Park District. Please include your telephone number on your check.

    4. YOU ARE REGISTERED UNLESS WE INFORM YOU OTHERWISE. 5. Program registration is monitored throughout the season, and programs will be cancelled

    if there is insufficient enrollment at least two days prior to the start date. The River Forest Park District maintains the right to open and close classes at its discretion.

    6. If you register for a class but cannot attend, please notify the Park District at 708-366-6600 to cancel your registration as soon as possible. Other patrons are waiting to participate. 7. Please do not bring your children to programs that you are participating in. 8. If a program reaches its maximum in enrollment, the class will be closed. A waiting list is

    then started for those still interested in registering for the program. When and if an opening occurs in the program, the first person on the waiting list will be contacted. We will continue down the list, as more vacancies become available. Do not include payment with your registration form if you are put on a waiting list. The registration fee will be collected if you are able to participate.

    9. If a participant registers for a program, drops out of that program, and it has a waiting list, the participant cannot give their spot to a friend. The River Forest Park District reserves the right to assign participants to the program in the order they are listed on the Park Districts waiting list.

    10. The Park District is not responsible for any omissions or typographical errors.11. The River Forest Park District does not carry accident or hospitalization insurance on any program participant. It is recommended that participants review their own personal insurance policy for adequate coverage during all program activities.12. If registering online for a FREE program/event, a $2 service charge will still be assessed.

    Registration ProcedureResident registration for any Summer program will be accepted on March 9, 2015. Any registration forms received by mail, internet, or in person will be held until March 9, 2015. All received registrations will then be processed at random. Any registration received after 4:30pm on March 9, 2015 will be processed by date/time received. Non-resident registration will not be processed until March 30, 2015.

    Proof of residency may be requested. Items listed will be accepted. Most recent real estate tax bill Drivers license Lease agreement for currently occupied residence with building owners certification of the

    names and birthdates of your resident children (required by River Forest Village Code) Closing statement from the purchase of your home (which includes the address, as well as

    buyers and sellers signatures Unpaid utility bill (payment stub attached) naming you the responsible person at the River

    Forest address Automobile registration and automobile insurance Corporate Residents must verify employment within River Forest area. A letter on company letterhead from a human resources representative verifying employment. Verification must be provided annually.

    Cancellation & Refund PolicyA $10 service charge will be applied to each Camp cancellation and must be received one week before the camp meets. A $5 service charge will be applied to each Program cancellation and refunds will only be given if a participant withdraws before the 2nd meeting of a class, unless the participant has a signed note from a physician. All refunds will be processed at the beginning of the following month in which the cancellation/refund is requested, and if online registration, at the beginning of the following month in which the Park District has received payment from the online registration provider. If payment is made with credit card, refund will be issued directly to credit card used.

    DROP-OFF / WALK-INDrop off a completed registration form with payment during regular business hours at the Administration office.

    River Forest Park District The Depot, 401 Thatcher Avenue , River Forest, IL 60305 Office Hours: Mon-Fri, 8:30am-4:30pm

    For convenient after-hours registration, a drop box is located outside of the administration office door.

    MAIL-INSend your completed registration form and payment (check, money order, credit card, no cash accepted) to:

    River Forest Park DistrictThe Depot401 Thatcher Avenue

    River Forest, IL 60305

    MARK YOUR CALENDAR!We do not send confirmations or reminders. A representative from the River Forest Park District will contact you in case there is a wait

    list for the program for which you registered. Otherwise, you may assume your registration has been processed as requested.

    ONLINEVisit www.rfparks.com to register online.

    PLEASE NOTE: WE NOW ACCEPT CREDIT CARD PAYMENTS

    No additional fee when paying with a credit card online or at The Depot.

    Resident registration begins March 9 for all campsNon-Resident registration begins March 30 for all camps

    registration form

  • CONFIDENTIAL CAMPER DATA FORM

    CHILDS NAME: DATE: CAMP ATTENDING: WEEK(S): Parent/Legal Guardian allowed to pick-up: Parent/Legal Guardian #1: Home Phone: Cell Phone: Parent/Legal Guardian #2: Home Phone: Cell Phone: Additional people who are authorized to pick-up my child: Drivers license or state ID will be required. Name #1: Relationship: Home Phone: Cell Phone: Name #2: Relationship: Home Phone: Cell Phone: I, authorize the following people to pick up my child and be contacted in the event of an emergency from the River Forest Park District Summer Camp Program. In doing so, I relieve the River Forest Park District of all responsibility for my child after he/she has been released from the program. Attempts will be made to reach the parent/legal guardian first.

    *CHILDREN WILL NOT BE RELEASED UNTIL THE PARENT/CAREGIVER COMES TO THE SITE WHERE THE CHILDREN WILL BE WAITING WITH CAMP STAFF*

    Unauthorized pick-up: People who CANNOT pick up your child from Summer Camp: Name #1: Relationship: Name #2: Relationship: Permission for child to leave without Parent/Legal Guardian/Authorized Person: YES NO Parent/Legal Guardian Signature: Date: *By signing this, I acknowledge that once discharged, my child will go directly home from camp, and I relieve the River Forest Park District of all responsibility for my child after he/she has been released from the program. A late fee will be charged if you are late to pick up your camper, $15.00 for every fifteen minutes. Time is measured by the watch/clock of the counselor doing sign out. Parent/Legal Guardian Signature: Date:

  • CONFIDENTIAL CHILD INFORMATION

    This form is designed to improve communication between the camp staff and the families we serve to ensure your child is having a great summer. Please take time to complete the questions below carefully.

    CHILDS NAME: NICKNAME: List any specific disabilities, allergies, or special health conditions of your child: What are your childs interests or hobbies? Is there an activity your child particularly wants to do at camp? Does your child have any fears? If so, please tell us about them. Does your child have any communication difficulties? YES NO If yes, please explain. Are there any problems that may confront your child while at camp (homesickness, anxiety, etc.)? Are there any special behavioral concerns we should be aware of? YES NO If yes, please explain. What is your childs usual personality/behavior? If your child has a current behavior plan, please provide us with a copy. Please list the rewards your child receives for appropriate behavior. Please explain the discipline your child receives for inappropriate behavior. Does your child qualify to receive special education services through school? YES NO What type of classroom is your child in during the school year (nonspecial education, special education, inclusion, etc)? Please provide any other information you feel may put us in a better position to understand your child and his/her needs. Parent/Legal Guardian Signature: Date:

    G:\Rec Programs\PROGRAM SUPERVISOR\Camps\2014

  • 4-Point Discipline PolicyThank you for enrolling your child in the Summer Camp Program. It is our intention to provide your child with a safe and secure environment. We attempt to create a warm, comfortable, and fun atmosphere that will make your child look forward to coming to camp each day. In order to ensure the quality of this program and safety of the campers, each participant must follow program rules.

    4-Point Discipline Policy

    Campers are encouraged to practice those social skills that will allow them to resolve conflicts and meet their needs without the use of harmful or destructive behaviors. When disciplinary situations occur that requires intervention, an adult provides the child with a clear explanation as to why a specific behavior is inappropriate. They then help him/her find an alternative behavior that fits within the camp guidelines of appropriate behavior. These guidelines revolve around concerns for the safety of all members in camp.Behavior Problems: If the camp staff encounters a behavior problem with any participant, he/she will first attempt to resolve the problem with the camper. If this fails, the Camp Supervisor will be consulted, followed by the parents. There is a strict 4-Point Discipline Policy. If a camper gets 2 Written Warnings during the summer, he/she will be dismissed from the program. Every parent/guardian is required to read the following information to his/her camper and sign and return the 4-Point Discipline Policy Form to camp. (This must be on file prior to the start of camp.)

    General Summer Camp Program Rules

    1. Safety2. Show respect to all campers, staff, Park District patrons, equipment and property.3. Keep your hands, feet, head and other body parts to yourself. Fighting, hitting, theft, destruction of property, etc. WILL NOT BE TOLERATED.4. Appropriate language and dress at all times.5. Cooperation and participant involvement both in group activities and with other campers.

    4-Point Policy

    1. Verbal Warning (Parent/Guardian will be notified at pick-up)2. Time Out/Activity Privilege Withheld. (Parent/Guardian will be notified at pick-up.)3. 1st Written Warning (Parent/Guardian will be contacted to pick up their camper immediately, and the child will be removed from camp for the remainder of the day.)4. 2rd Written Warning (Parent/Guardian will be contacted to pick up their camper immediately, and the child will be removed from the camp program and will NOT be eligible to return during the same season.

    Immediate Dismissal

    1. Any child who runs away from the staff will be removed from the program for the remainder of the program. If staff cannot convince the child to return, the police will be called. The staff is not permitted to chase after children or leave the site.2. Any child who harms himself or another will be removed (physical and/or verbal abuse).3. Any child who abuses staff will be removed.

    Physical Violence is not tolerated in this program. The Park District reserves the right to dismiss a participant whose behavior endangers the safety of themselves or others.

    Code of Conduct-Parent

    Parents are expected to follow the program rules and treat the staff with respect. All program and/or staff issues, comments or concerns should be directed to the Camp Director or Recreation Supervisor, not the camp counselors. A child whose parents verbally abuse staff will be removed from the program. This includes sarcasm, criticism, yelling, screaming and/or negative comments directed at staff and/or other parents. The police will be called to remove any parent who appears out of control.

    I have discussed the rules and consequences of the 4-Point Discipline Policy with my camper, and they understand what is expected from them at camp.

    Campers Name (Print) Campers Signature

    Parent/Guardian Signature Date

  • River Forest Park District Allergy Action Plan

    DATE FORM FILLED OUT: _____________________

    Participants Name: D.O.B: ____________ ALLERGIC TO: Asthmatic Yes * No * Higher risk for severe reaction Yes * No * Step 1: TREATMENT Symptoms: Give Checked Medication**: (To be determined by parent or physician authorizing treatment)

    If an allergen has been introduced, but no symptoms: Epinephrine Antihistamine

    Mouth Itching, tingling, or swelling of lips, tongue, mouth Epinephrine Antihistamine

    Skin Hives, itchy rash, swelling of the face or extremities Epinephrine Antihistamine

    Gut Nausea, abdominal cramps, vomiting, diarrhea Epinephrine Antihistamine

    Throat Tightening of throat, hoarseness, hacking cough Epinephrine Antihistamine

    Lung Shortness of breath, repetitive coughing, wheezing Epinephrine Antihistamine

    Heart Thready pulse, low blood pressure, fainting, pale, blueness Epinephrine Antihistamine

    Other ________________________________________________ Epinephrine Antihistamine

    If reaction is progressing (several of the above areas affected), give Epinephrine Antihistamine

    The severity of symptoms can quickly change. Potentially life-threatening. DOSAGE Epinephrine: inject intramuscularly (circle one) EpiPen EpiPen Jr. Twinject 0.3 mg Twinject 0.15 mg (see reverse side for instructions) Antihistamine: give____________________________________________________________________________________ medication/dose/route

    Other: give___________________________________________________________________________________________ medication/dose/route

    IMPORTANT: Asthma inhalers and/or antihistamines cannot be depended on to replace epinephrine in anaphylaxis.

    EVEN IF PARENT/GUARDIAN CANNOT BE REACHED, DO NOT HESITATE TO CALL 911. Unless otherwise arranged, ONLY paid and trained park district staff

    will be allowed to dispense medication.

  • STEP 2: EMERGENCY CALLS 1. Call 911 - State that an allergic reaction has been treated, and additional epinephrine may be needed. 2. Dr. Phone Number: 3. Parents: Phone Number(s): 4. Emergency contacts:

    a. NAME: Phone Number:

    b. NAME: Phone Number:

    EVEN IF PARENT/GUARDIAN CANNOT BE REACHED, DO NOT HESITATE TO CALL 911. Unless otherwise arranged, ONLY paid and trained park district staff will be allowed to dispense medication.

    TRAINED STAFF MEMBERS

    1. Trained Staff Name Parent Signature 2. Trained Staff Name Parent Signature Parent/Guardian Signature_________________________________________________ Date_______________ EpiPen and EpiPen Jr. Directions Pull off gray activation cap. Hold black tip near outer thigh (always apply to thigh). Swing and jab firmly into outer thigh until Auto-Injector mechanism functions. Hold in place and count to 10. Remove the EpiPen unit and massage the injection area for 10 seconds. Twinject 0.3 mg and Twinject 0.15 mg Directions Pull off green end cap, then red end cap. Put gray cap against outer thigh, press down firmly until needle penetrates. Hold for 10 seconds, then remove.

    SECOND DOSE ADMINISTRATION: If symptoms dont improve after 10 minutes, administer second dose: Unscrew gray cap and pull syringe from barrel by holding blue collar at needle base. Slide yellow or orange collar off plunger. Put needle into thigh through skin, push plunger down all the way, and remove.

    -Once EpiPen or Twinject is used, call 911 -For children with multiple allergies, consider providing separate Action Plans for different allergies.

    aschultzCross-Out

  • River Forest Park District Medication Dispensing Information

    This form must be completed for each program session or when medication changes. BACKGROUND INFORMATION: Participant's Name:_____________________________________________________ Age:_______

    Address:_________________________________________________________________________

    Parent's/Guardian's Name(s)_________________________________________________________

    Daytime Phone:___________________________________ Cell/Other Phone:_____________________

    Program Name:___________________________________________________________________

    Doctor's Name:__________________________________________ Phone:___________________

    MEDICATION INFORMATION: 1. Name:______________________________Dose:______________________ Time:____________

    Dispensing & Storage Instructions:___________________________________________________

    _______________________________________________________________________________

    Possible Side Effects:______________________________________________________________

    2. Name:______________________________Dose:_______________________ Time:__________

    Dispensing & Storage Instructions:_______________________________________________

    ________________________________________________________________________________

    Possible Side Effects:_________________________________________________________

    OTHER INFORMATION:________________________________________________________

    _____________________________________________________________________________________

    I understand that it is my responsibility to give the medication directly to program staff with full instructions in individual dosage containers, clearly labeled envelopes, or in original prescription bottles. In all cases, medication dispensing can only be changed or modified by completing another Permission and Waiver to Dispense Medication Form and Medication Information Form. I hereby acknowledge that the above information provided for the dispensing of medication for my minor child, guardian, ward, or other family member is accurate. I also understand that it is my responsibility to inform the agency if any changes in the dispensing of medication change. ____________________________________________ ____________________ Signature of Parent or Guardian Date

  • River Forest Park District Permission To Dispense Medication

    Waiver and Release of All Claims The River Forest Park District will not dispense medication to a minor child or other participant until the Permission and Waiver to Dispense Medication and Medication Information Form have been fully completed by a parent or guardian. The Park Districts internal procedures on dispensing medication are available for review. NAME OF PROGRAM:_____________________________________________DATE:_____________ I_________________________________________the parent/guardian of _________________________ Give permission to the staff of the River Forest Park District: to administer to my child ____________________________________________________. (Name of Medication) I understand it is my responsibility to give the medication directly to the program staff in individual dosage containers, original prescription containers, or envelopes clearly labeled with the following information:

    PARTICIPANT'S NAME:_____________________________________________________

    NAME OF MEDICINE AND COMPLETE DOSAGE INSTRUCTIONS:

    ____________________________________________________________________________

    ____________________________________________________________________________ In all cases the recommended dosage of any medication will not be exceeded. If after administering medication there is an adverse reaction, I give my permission to the River Forest Park District to secure from any licensed hospital physician and/or medical personnel any treatment deemed necessary for immediate care. I agree to be responsible for payment of any and all medical services rendered. I recognize and acknowledge that there are certain risks of physical injury in connection with the administering of medication to my minor child. In consideration of the River Forest Park District administering medication to my minor child, I do hereby fully release or discharge the River Forest Park District, and its officer, agents, volunteers and employees from any and all claims from injuries, damages and losses I or my minor child may have, arising out of, connected with, incidental to, or in any way associated with the administering of medication. I further agree to indemnify, hold harmless and defend the River Forest Park District, and its officers, agents, volunteers and employees from any and all claims resulting from injuries, damages and losses sustained by me or my minor child and arising out of, connected with, incidental to or in any way associated with the administering of medication. ____________________________________________ _________________________ Signature of Parent or Guardian Date

  • WAIVER & RELEASE OF ALL CLAIMS FOR USE OF INHALER OR AUTO-INJECTOR

    WAIVER AND RELEASE OF ALL CLAIMS AND INDEMNIFICATION

    Please read this form carefully and be aware that pursuant to the Illinois Asthma Inhalers at Recreational Camps Act, 410 ILCS 607/1 et seq., you will be expressly assuming the risk and legal liability and waiving and releasing all claims for injuries, damages or loss which you or your minor child/ward might sustain in connection with the possession, self-administration, or use of medication, including, but not limited to the use of an epinephrine auto-injector or inhaler at the camp or at any camp-sponsored activity, event, or program; except for claims arising out of the willful and wanton conduct of the River Forest Park District. As parent/guardian of the below identified participant, I verify and attest that my child/ward has the knowledge and skills to safely possess, self-administer, and use an epinephrine auto-injector or inhaler in a camp setting. I also recognize and acknowledge that there are certain risks of physical injury to participants possession, self-administration, or use of medication, and I voluntarily agree to assume the full risk of any and all injuries, damages or loss, regardless of severity, that my minor child/ward or I may sustain as a result of said possession, self-administration, or use of medication. Such risks include, but are not limited to, failing to properly administer the medication, failing to observe side effects, failing to assess and/or recognize an adverse reaction, failing to assess and/or recognize a medical emergency, and failing to recognize the need to summon emergency medical services. I further agree to waive and relinquish all claims I or my minor child/ward may have (or accrue to me or my child/ward) as a result of or arising out of the possession, self-administration, or use of medication against the River Forest Park District, including its officials, agents, volunteers and employees; except for claims arising out of the willful and wanton conduct of the River Forest Park District. I further agree to protect, indemnify, save, defend and hold harmless the River Forest Park District from and against any and all liabilities, obligations, claims, damages, penalties, causes of action, costs and expenses (including reasonable attorney fees) for which the River Forest Park District may become obligated by reason of the possession, self-administration, or use of medication; except to the extent caused by the willful and wanton conduct of the River Forest Park District. I have read and fully understand the above waiver and release of all claims and indemnification. If registering on-line or via fax, my on-line or facsimile signature shall substitute for and have the same legal effect as an original form signature. PLEASE PRINT Participants Name

    ________________________________

    Parent/Guardians Signature ________________________________

    Date____________________

    PARTICIPATION WILL BE DENIED If the signature of parent/guardian and date are not on this waiver.

    rfpd_summercamp2015_v22015 Summer Camp Guide2014 Camper Data FormsCamper Forms - updated2Camper Forms2Allergy Action PlanMedication Dispensing Information

    920 inhaler or auto-injector waiverWAIVER AND RELEASE OF ALL CLAIMS AND INDEMNIFICATION