Sawgrass Nature Center’s “CAMP WILD” Break Camps 2012-2013 Counselor and Counselor In Training Application Counselor’s Name __________________________________________________ Age: __________ Date of Birth: _______________________________________ School: _______________________________ Grade Completed: _____________ Parent(s)/ Guardian’s Name(s): ________________________________________ Relationship to Child: _______________________________________________ Mailing Address: ___________________________________________________ City: ______________________________ State: ____ Zip code: _____________ Home Telephone: ___________________________________________________ Cellular: __________________________________________________________ Best # to reach you: _________________________________________________ E-mail: ___________________________________________________________ Work Telephone for Mother: __________________________________________ Work Telephone for Father: ___________________________________________ Name of Additional Contact: __________________________________________ Additional Contact Telephone(s): ______________________________________ Do you give permission for your child to come and go from camp on their own?
If no, who is authorized to pick up your child (please include yourself)?
1. _____________________________________________________________ 2. _____________________________________________________________ 3. _____________________________________________________________
How did you hear about Camp Wild? _____________________________________________ MEDICAL INFORMATION Physician and/or Health Care Facility: ___________________________________ Telephone Number: _________________________________________________ Allergies: _________________________________________________________ Special Medical Accommodations or Concerns _________________________________________________________________ _________________________________________________________________ For headaches or insect bites, SNC staff may administer:
Children’s Tylenol Tylenol Topical Benadryl Oral Benadryl Other _______________________________________________________
Prescribed Medications (*see statement titled Health Care Release)
LIABILITY RELEASE (Please Read, Sign and Date)
I, the undersigned, in my individual capacity as parent or guardian of ____________________________________, age, ______ being a minor child, hereby release and hold harmless The Sawgrass Nature Center & Wildlife Hospital, its officers, employees, instructors, and supervisors from any and all liability or damages, both personal and property, arising out of or as a result of said minor child’s attendance at the Sawgrass Nature Center’s Camp. I assume all risks, incident thereto with respect to myself and to any other individuals for whom this registration is made. Signature of Parent or Guardian ___________________________________________________ Date ____________ HEALTH CARE RELEASE I give permission for the Sawgrass Nature Center, its officers, employees, instructors and supervisors to provide routine health care, administer prescribed medications, and seek medical treatment if an incident arises. Signature of Parent or Guardian ___________________________________________________ Date ____________ MEDIA RELEASE
I understand that my child , may be filmed/photographed/interviewed during camp, and give my permission for The Sawgrass Nature Center & Wildlife Hospital to use my child’s photograph/work/voice for promotional and educational purposes. Signature of Parent or Guardian ___________________________________________________ Date __________ Counselor Agreement I ________________________________, (print your name) agree to adhere to all Camp Rules and Regulations and I understand that any infractions may result in me being asked to leave the Camp. Counselor’s Signature ________________________________ Date__________ Please register by circling the days you wish to attend the break camp. CIT slots will not be secured until registration fees are received for all days indicated. The fee is $25/day.
Winter Break Camp:
Dec. 24, 26 - 28 (Circle all that apply)
Dec. 31, Jan. 2 – Jan. 4 (Circle all that apply) M W Th F
Spring Break Camp:
Mar. 25 - 29 (Circle all that apply)
CIT Total $ _____________ CIT’s staying after 3:30pm will need to be pre-approved.
I Prefer to pay by Check - please make payable to the:
Sawgrass Nature Center
I prefer to pay by Credit Card - please provide the following:
Credit Card number _____________________________ Expiration Date___________ Signature ________________________________________ Date__________ Please mail or bring application and payment to the: Sawgrass Nature Center 3000 Sportsplex Drive, Coral Springs, FL. 33065-2140 (954)752-WILD
EVO CUMPLE, ¿BOLIVIA CAMBIA? Luegomado, adonde llegó con un histórico 54%de los votos, cabe preguntarse ¿qué ha cambiado en Bolivia conel arribo al poder de la izquierda nacionalista?, ¿cuál es el balanceentre rupturas y continuidades con el pasado?, ¿correrá elgobierno de Evo Morales la misma suerte que anterioresexperiencias nacional-populares, cuyo intento de construir unEstado “
We had been married six years and five months that Thanks-giving. I savored the crisp autumn morning from our big bed, enjoying the smells wafting up from the kitchen. Lisa sent our four-year-old up the stairs to wake me for breakfast. When I heard her little slippers scraping across the floorboards, I shut my eyes and “Daddy?” her sweet whisper called inches from my ear, “are you I pr