Day Camp 2021 summer Camp Catalog - Programs for girls in grades k-12 - Girl Scouts of Western New York

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Day Camp 2021 summer Camp Catalog - Programs for girls in grades k-12 - Girl Scouts of Western New York
Day Camp
20 2 1 s u m m e r Camp Cat al og
Programs for girls in grades k-12

CAM P : E N DL E S S S U M M E R ADV E N T U R E S
Day Camp 2021 summer Camp Catalog - Programs for girls in grades k-12 - Girl Scouts of Western New York
Girl Scouts of Western New York Mission:                                                                                      Girl Scouts of
                                                                                                               See some of our                                            Western New York
                                            Girl Scouting builds girls of courage, confidence, and
                                            character, who make the world a better place.                      favorite camp
                                                                                                               memories on our
                                                                                                                                                                          @girlscoutswny
                                            gswny.org ▪ 1-888-837-6410                                         social media!

    A MESSAGE FOR YOU                                   Day Camp Locations                                                            Taste of Camp
    Greetings, Girl Scout Summer Campers,
                                                             Girl Scout Office
                                                                                                                                      Recruitment Event
    The joy, friendship circles, closing                                         Niagara        Orleans
                                                          Girl Scout Camp                                                             New to summer camp? Visit us this
    campfires, special camp songs, and                                                                         Monroe
                                                                                                                                      spring to get a glimpse of what your
    creating unforgettable bonds with new                    Piperwood                          Genesee                               summer camp experience will look like.
    and old friends are just a few of the                                            Erie
                                                             Windy Meadows                                                            Informational sessions, tours, and a
    things that make Girl Scout camp life so
                                                                                                                                      sampling of camp crafts will be available.
    special. Summer Camp is an important
                                                                                                Wyoming    Livingston                 You will also have an opportunity to
    part of the Girl Scout experience and I
                                                                                                                                      register for summer camp 2021. Enter your
    want you to know that it is our wish to
                                                                                                                                      name for a chance at a free of week of
    operate summer camp in the outdoors,
                                                                                                                                      camp and other cool camp prizes.
    in-person in 2021. However, we know that                                                           Camp Piperwood
    we face uncertainty given the impacts
    of COVID-19 and our top priority is your
                                                               Chautauqua         Cattaraugus             FAIRPORT, NY
                                                                                                                                      April 17 ◾ 12 to 3 p.m.
                                                                                                     Camp Windy Meadows               Camp Piperwood: 2222 Turk Hill Rd.,
    safety, our camp counselor’s safety, and                                                              LOCKPORT, NY
    everyone involved with camp’s safety and                                                                                          Fairport, NY 14450
    well-being.
    Please know that we are making every
    effort to bring you multiple options for a
                                                        General Information                                              table of contents
                                                        Girl Scout camps are open to every girl in grades K-12.          Day Camp Information  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 2
    summer camp experience and Girl Scouts
                                                        Girl Scouting values inclusiveness and all girls are             GSWNY Day Camp Checklist & COVID info .  .  . 3
    are always prepared. If COVID-19 does
                                                        welcome regardless of race, religion, ethnicity, sexual          Day Camp Schedules  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 5
    impact our plans for the summer, we
    will still offer Girl Scout Summer Camp.            orientation, socioeconomic status, national origin, or           CAMP PIPERWOOD DAY CAMP
    It may be in-person, a hybrid format                physical or developmental disability. Girls attending Girl          Camp Piperwood Introduction  . . . . . . . . . . . . . . 6
    (combination of in-person and virtual               Scout summer camp must register as members of Girl                  Camp Piperwood Programs for:
    camping) or a completely virtual Summer             Scouts of the USA. A Children’s Camp in New York State                Grades K-8 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
    Camp experience. No matter what shape               brochure listing NYS standards for camp operations will               Grades 6-8  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
    the upcoming summer takes, we want                  be available in all Camp Information Packets.                         Challenge Course  . . . . . . . . . . . . . . . . . . . . . . . . 8
    you to spend it with us – come and enjoy            Please read the Camp Information Packets for details on               Leadership Programs  . . . . . . . . . . . . . . . . . . . . 9
    new experiences while connecting and                our refund policy, inclement weather, cancellations, and
    building sisterly bonds that will last a                                                                             CAMP WINDY MEADOWS DAY CAMP
                                                        other relevant camp information. Packets can be found
    lifetime.                                                                                                               Camp Windy Meadows Introduction  . . . . . . . 10
                                                        on our website or by calling 1-888-837-6410.
                                                                                                                            Camp Windy Meadows Programs for:
                                                                                                                              Grades K-12 . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  11
                                                                                                                              Leadership Programs  . . . . . . . . . . . . . . . . . . . 12
                  Alison Wilcox
                  CEO, Girl Scouts of WNY                                                                                Financial Aid, Income Eligibility,
                                                                                                                             and Camp Application .  .  .  .  .  .  .  .  .  . 13-BACK
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Day Camp 2021 summer Camp Catalog - Programs for girls in grades k-12 - Girl Scouts of Western New York
GSWNY SUMMER DAY CAMP                                   GSWNY COVID-19 Guidelines for Summer Camp 2021:
    CHECKLIST                                               This upcoming summer, camp will look different than what we are used to. For example, if we are
                                                            able to run this programming, our camp attendance will be reduced and camp/staff will travel and
    Camp Registration                                       gather in small groups of 5 or 10. Safety for our campers and staff is and always will be our number
    ‰ Start camp registration at gswny.org                  one priority. We want to assure our parents/guardians and all of our camp patrons that we will have
                                                            a safe and effective COVID-19 safety plan in place prior to staff and camper arrival. We are currently
    ‰ Camp registration form done on CampDoc.com
                                                            working on reviewing our camp health safety plan and updating it to reflect strict COVID-19
    ‰ Check drop off times for camp (and bus times, if      guidelines and procedures. We are also creating a robust Communicable Disease Plan that will lay
      applicable) in Camp Information Packet                out the stringent steps of our pre arrival COVID-19 screenings/requirements as well as, the onsite
    ‰ Payment or camp deposit ($25 per session) attached    safety screenings and sanitation regulations that all staff and campers must adhere to. All of our
      or payment online if using CampDoc.com                protocols will follow the guidance set forth by the NYSHD, CDC, WHO, and GSUSA. You will find our
    ‰ Review Camp Information Packet online at gswny.org    full COVID-19 Camp Guidelines and Regulations located on our GSWNY summer camp page found at
                                                            bit.ly/gscamp2021 as well as, in our camp information packets.
    Financial Aid Request
    ‰ Request financial aid on CampDoc.com
                                                            Summer Camp 2021:
    Health and Parent Forms on
                                                            Camping has always been a long standing tradition in Girl
    CampDoc.com                                             Scouts were girls can get outdoors to reconnect and embrace the
    ‰ Health forms                                          wonders of nature. In summer 2021, we look forward to exploring
    ‰ Parent info, emergency contacts, and insurance        and experiencing Camp: Endless Summer Adventures.
    ‰ Diet and activity, health history, allergies          At GSWNY we know how important it is for girls to have a
    ‰ Authorization/pick-up form                            wonderful summer camp experience. We also want to assure you
    ‰ Any other medical/parent forms                        that we have every intention of operating summer camp 2021 in
    ‰ Immunizations - parent scans and uploads to           person while following all of COVID guidelines and regulations.
      CampDoc.com                                           However, if the need should arise, we will be prepared to provide
                                                            your girls with an amazing alternative camp program. We have set
    ‰ Medications form to be filled out by physician then
                                                            April 30, 2021, as our decision date to operate camp in person or
      parent uploads to CampDoc.com
                                                            switch to our alternative camp (virtual) program mode.
    ‰ Medical exam form - physician uploads
                                                            Our alternative camp program will operate 6 weeks, July 5th
    ‰ Complete COVID health screening form
                                                            through August 13th. We will continue with activity kits mailed
                                                            directly to your home as well as provide 3 live activity zoom
    Camp Payments
                                                            sessions a week. We will also be adding a more focused family
    ‰ Camp balances are due no later than two weeks prior   camp program. Families will have the option to come to any of
      to the start of camp                                  our 4 properties (Camp Piperwood, Camp Seven Hills, Camp
    ‰ Payment can be made online on CampDoc.com,            Timbercrest or Camp Windy Meadows) for a day rental or an
      by mail, or in person at any council office           overnight/weekend rental. While at camp, families can hike, cook
                                                            their own meals, do arts and crafts, swim, and boat, try their luck
    The Week Before Camp                                    with archery or test their skill level on the ropes challenge course.
    ‰ Review camp information packet on gswny.org           Additional information about alternative camp programming can
    ‰ Check drop off times for camp in Camp Information     be found on our website at gswny.org.
      Packet (and bus times, if applicable)                 We want to hear from you as to the programs options you would
    ‰ Review camp packing list in the Camp Information      feel comfortable in having your daughter participate in. Please fill
      Packet attached or online if using CampDoc.com        out our GSWNY summer camp pre-registration form and reserve
                                                            your spot for summer camp 2021 at bit.ly/gscamp2021 today!
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Day Camp 2021 summer Camp Catalog - Programs for girls in grades k-12 - Girl Scouts of Western New York
registration and info                                                           Campers that Require
    Due to the uncertainty of COVID-19 we are asking all of our GSWNY camp
    families who are interested in having their child participate in summer
                                                                                    Reasonable Accommodations
                                                                                    The Girl Scouts of Western New York wants to provide a positive summer
    camp 2021, to please pre-register to reserve a spot. On May 1, 2021, the
                                                                                    camp experience to every girl. If your child requires special accommodations
    summer camp 2021 camp registration portal will re-open and families
                                                                                    (transportation, diet, food restrictions, extra supervision, other, etc.) while at camp,
    can continue with completing their child’s camp registration and camper
                                                                                    please contact the Director of Camp Administration PRIOR to REGISTERING YOUR
    profile.
                                                                                    CHILD for camp at 1-888-837-6410 or summercamp@gswny.org to discuss the possible
    Please visit bit.ly/gscamp2021 to register your girl online. If you do not      accommodations that could safely and reasonably be made for your child.
    have a computer, contact Customer Care for online assistance, or submit
    a completed paper camp application form (both sides), and a $25 deposit
    to either our Rochester or Buffalo office (by mail, fax, or curbside pickup).
                                                                                    DISCOUNTS
                                                                                    EARLY BIRD DISCOUNT: Available for registered Girl Scouts of Western New York
    Families that pre-register their girl for camp between January 13               members only. To receive the Early Bird Discount of $25 for GSWNY day camp,
    and April 30, 2021, will also receive an exclusive GSWNY summer                 registration forms must be received online or at the Girl Scout office on or before
    camp 2021 patch, available through pre-registration only!                       Monday, May 31, 2021, at 4:30pm. Early Bird Discount applies to Camp Piperwood
      • From January 13 to April 30, 2021, you will have the opportunity to         only.
        pre-register and reserve a spot for your girl.                              MORE THE MERRIER DISCOUNT: This discount applies to resident and day camp
      • You will be required to pay a refundable $25 deposit (deposits              programs for registered Girl Scouts of Western New York members only. The first
        refundable from January 13 to April 30 only) and select an                  registered girl pays the full camp fee. Each additional session or additional sibling may
        option of day camp, overnight camp, troop camp adventure,                   deduct $10. All registration forms for multiple sessions and/or siblings must be received
        alternative camp or both.                                                   at the same time. The More the Merrier Discount applies to Camp Piperwood only.

      • You will have from Saturday, May 1, to Wednesday, May 5, to
        complete your summer camp registration for your child. May 6 camp
                                                                                    KEY BENEFITS OF GIRL SCOUT SUMMER CAMP
                                                                                    • Develop and cultivate girls’ self-identity, self-worth, self-esteem, and self-respect.
        registration opens to all who are interested.
                                                                                    • Build girls of courage, confidence, and character by providing opportunities for girls to
      • No walk-in registrations at camp will be accepted.
                                                                                      experience camp life on their own.
      • Financial aid applications can be completed with your camp
                                                                                    • Focus on the 3 keys to leadership: discover new skills within themselves, connect
        registration.
                                                                                      with others through team building and problem solving, and take action by making
      • Payment is due no later than two weeks prior to the start of camp.            things better at camp and in their communities.
      • Cookie Gift Cards cannot be used on the online registration system or       • Provide a safe environment that encourages leadership, imagination, and acceptance
        your deposit. They may be used toward your camp balance or put “on            as well as a community where girls feel less at risk.
        account” at our camp tuck shops. If using Cookie Gift Cards for camp
        balance, payment can be made at any of our Girl Scout Service Centers.      Seasonal Employment Opportunities
      • All deposits and camp balances can be paid by electronic check or           We currently have openings for summer camp counselors. If you are interested or
        credit/ debit card through the online registration system or at one of      know of someone who is interested in working at camp this summer, please visit
        our Girl Scout service centers.                                             gswny.org to view our current positions and fill out an application.

    Financial Assistance                                                            Camp Alumni
    Girl Scouts of Western New York is dedicated to ensuring that all girls         Are you an alumni of GSWNY? Have you attended a GSWNY summer camp, or are you
    are able to attend camp. Financial assistance can now be requested              a former GS troop leader, volunteer, or girl? If so, we want to reconnect with you. Visit
    with online camp applications! Please remember to provide/upload                bit.ly/gswnyalumninetwork
    all required income verification documents. Funding for financial               For more info on GSWNY Alumni please contact Heather Reed at
    assistance is limited and early applications are encouraged. See page 13        716-935-6068 or heather.reed@gswny.org
    for more details.
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Day Camp 2021 summer Camp Catalog - Programs for girls in grades k-12 - Girl Scouts of Western New York
Notable 2021 Dates:                                          WHEN IS MY 2021 PROGRAM OFFERED?
    ÌJune 1: Financial Aid Application Due             PIPERWOOD AND WINDY MEADOWS SUMMER DAY CAMPS
    ÌJune 21: Final Camp Payment Due For
     Session 1                                                                  Session 1        Session 2          Session 3    Session 4       Session 5          Session 6
                                               CAMP PIPERWOOD                    7/5-7/9         7/12-7/16          7/19-7/23    7/26-7/30        8/2-8/6           8/9-8/13
    (All final payments for each session due
    2 weeks before session start date.)                                                                GIRLS IN GRADES K-8
    ÌJune 28: Review Camp                          Use Your Senses Wisely           ★
     Information Packet for all                   I’m an Outdoor Explorer!                             ★
     important need-to-know info
                                                        Mechanical Mania                                                ★
    ÌJune 30: Virtual Camp Piperwood                                                                                                  ★
                                                                Storyteller
     Open House. See page 6 for details!
                                                  Gotta Sing, Gotta Dance                                                                              ★
                                                    It’s a Bug's Life for Me                                                                                            ★
                                                                                         SPECIALTY PROGRAMS GIRLS IN GRADES 4-5
                                                   Adventures in the Trees                          ★                        ★                                          ★
                                                                                                       GIRLS IN GRADES 6-8
                                                           A Little of Both                                                           ★
                                                           Spa Piperwood                               ★
                                               Piperwood Challenge Seeker           ★
                                                  Cadette Trail Adventures                                                                                              ★
                                                                                    SPECIALTY PROGRAMS FOR GIRLS IN GRADES 6-8
                                                    Cables and Carabiners                                    ★                                         ★
                                                                                        LEADERSHIP PROGRAMS GIRLS IN GRADES 7-10
                                                Program Aide (grades 7-8)           ★              ★           ★             ★                         ★                ★
                                                      Jr. CIT (grades 9-10)         ★                  ★                ★             ★                ★                ★
                                                         CIT (grades 11-12)                                             ★                                               ★

                                               CAMP WINDY MEADOWS                                          Session 1: 7/5-7/9   Session 2: 7/12-7/16       Session 3: 7/19-7/23
                                                                                                   GIRLS IN GRADES K-12
                                                         Girl Scouts Make the World a Better Place           ★
                                                                               Dinosaur Discoveries                                       ★
                                                                                        Galaxy Quest                                                                ★
                                                                                    LEADERSHIP PROGRAMS GIRLS IN GRADES 7-10
                                                                         Program Aide (grades 7-8)    ★                     ★                                       ★
                                                                                  CIT (grades 11-12)               ★                      ★                         ★

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Day Camp 2021 summer Camp Catalog - Programs for girls in grades k-12 - Girl Scouts of Western New York
Camp Piperwood in Fairport, NY, features vast hiking trails, a state-of-the-art

    Camp Piperwood                                                               splash pad, high and low ropes courses, an archery area, and open fields. Camp
                                                                                 Piperwood is a great setting for campers looking for a day camp experience.
    July 5 to August 13, 2021                                                    Virtual OPEN HOUSE AT PIPERWOOD
                                                                                 Wednesday, June 30, 2021 ▪ 5 to 7:30 p.m.
                                                                                 For the safety of our campers, families and staff we are not offering our traditional
                                                                                 camp open house for summer 2021. Instead we have opted to provide a virtual event
                                                                                 that will highlight all the best of camp. Look for additional information coming soon
                                                                                 to our GSWNY website and the camp information packet.

                            ALL CAMPERS WILL RECEIVE                             Bus Transportation
                                1 PATCH AND 1 T-SHIRT!                           Bus transportation is available at our day camp facilities for an additional fee of $50
                                                                                 per girl per week. The schedules are listed by time, place and bus stop. Please note
                                                                                 that any bus stop stated in this brochure may be cancelled due to an insufficient
                                                                                 number of boarding passengers. In this instance, the bus fee will be refunded. Bus
    BEFORE AND AFTER CARE                                                        refunds will not be given for any other reason or circumstance.
    Early Drop Off: Monday through Friday 8:00 a.m.
    Late Pick Up: Monday through Friday 5:30 p.m.                                Bus transportation is provided morning and afternoon, Monday through Friday.
                                                                                 Please indicate on the application if you will need bus service and carefully select
    $30 per week per camper for both morning and afternoon
                                                                                 the bus stop that will be best for your girl.
    OR $15 per week per camper for morning or evening only
                                                                                 We recommend that you arrive at the bus stop at least 10 to 20 minutes
    Put your mind at ease and take advantage of the before and after care
                                                                                 early. The times printed in this brochure are estimated and may be subject
    program at our day camp facilities. You may drop your child off at camp no
                                                                                 to delay (10-20 minutes) pending weather and traffic conditions. Parents,
    earlier than 8 a.m. and pick her up no later than 5:30 p.m. Peace of mind
                                                                                 if you are not at the bus stop when the bus arrives, your girl will remain on
    and convenience for only $30 PER WEEK PER CAMPER! Please indicate
                                                                                 the bus until it reaches the bus terminal. You will then have to pick her up
    morning care and after care on the camp registration form.
                                                                                 at the bus terminal.

    For the safety of our campers and staff, we will not be offering our         GSWNY Camp Piperwood Bus Schedule 2021
    Wednesday camp overnights this summer. We hope to bring this time-           Session 1: July 5-9           Session 2: July 12-16         Session 3: July 19-23
    honored tradition back in 2022.                                              Session 4: July 26-30         Session 5: August 2-6         Session 6: August 9-13
                                                                                           Wal-Mart, 1490 Hudson Ave. Rochester
                                                                                 BUS 1     Pick-Up - 8:15 a.m. Drop-Off- 4:30 p.m.
                                                                                           St. Charles Borromeo Church, 3003 Dewey Ave, Greece, NY 14616
                                                                                 BUS 2     (Parking lot along Maiden Lane)
                                                                                           Pick-Up. 8 a.m.    Drop-Off- 4:45.p.m.
                                                                                           Wegmans, 2301 Lyell Ave, Rochester
                                                                                           Pick-Up - 8:10 a.m. Drop-Off- 5 p.m.
                                                                                 BUS 3     Al Sigl Community of Agencies, 1000 Elmwood Ave., Rochester
                                                                                           Pick-Up - 8:30 a.m. Drop-Off- 4:30 p.m.
                                                                                           Tops Supermarket, 450 West Avenue, Rochester
                                                                                 BUS 4     Pick-Up - 8:15 a.m. Drop-Off- 4:45 p.m.
                                                                                           Rochester Public Library: Sully Branch, 530 Webster Ave., Rochester
                                                                                 BUS 5     Pick-Up - 8:20 a.m. Drop-Off- 4:30 p.m.

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Day Camp 2021 summer Camp Catalog - Programs for girls in grades k-12 - Girl Scouts of Western New York
CAMP PIPERWOOD PROGRAMS FOR GIRLS                                                                                  All programs on this page:
           AT LEAST 5 YEARS OLD OR ENTERING                                                                                Fee: $220 per girl/per session
             GRADES K-8 IN THE FALL OF 2021                                                                                  (fee includes T-shirt and patch)

    Use Your
    Senses Wisely
                                                   New!                                                                       Gotta Sing,
                                                                                                                              Gotta Dance
                                                   Mechanical Mania
    Session One: July 5-9, 2021                    Session Three: July 19-23, 2021                                            Session Five: August 2-6, 2021
    Registration closes June 21, 2021                                                                                         Registration closes July 19, 2021
                                                   Registration closes July 5, 2021
    Stop, look and listen. What do you see?                                                                                   Get into the beat of the music! Create
                                                   Join us for a week of tinkering with technology! Conduct hands-on
    What do you hear? Daisies and Brownies                                                                                    your own dance from one of your favorite
                                                   investigations and learn the secrets of electronics while designing,
    will use their senses through touch,                                                                                      songs or tell a story through creative dance
                                                   building and playing. This week also includes games and other
    while Juniors will learn to communicate                                                                                   expressions. Learn what dances were
                                                   activities that will explore various careers in science and
    through code, and Cadettes will learn the                                                                                 popular years ago and what dances are
                                                   engineering all while enjoying traditional camp activities.
    key to body language. All this and more                                                                                   popular today. Has anything changed?
    only at Camp Piperwood!                        Girls will earn requirements towards the following Girl Scout badges:      Share your creative spirit through music
                                                   Daisy - Mechanical Engineer: Game Board; Brownie - Mechanical              and dance.
    Girls will earn requirements towards
                                                   Engineering: Fling Flyer; Junior - Mechanical Engineer: Balloon Car;
    the following Girl Scout badges: Daisy                                                                                    Girls will earn requirements towards
                                                   Cadette - Journey - Think Like and Engineer
    - Clover’s Story - Use Resources Wisely;                                                                                  the following Girl Scout badges: Daisy -
    Brownie - Senses; Junior - Detective ;                                                                                    Gloria’s Story; Brownie - Dancer; Junior
    Cadette - Special Agent.                                                                                                  - Musician; Cadette - Public Speaker,
                                                                                                                              Science of Happiness, Screenwriter.

    New!                                                                                                                      New!
    I’m an Outdoor
    Explorer!                                                                                                                 It’s a Bug's Life for Me
                                                                                                                              Session Six: August 9-13, 2021
    Session Two: July 12-16, 2021                                                                                             Registration closes July 26, 2021
    Registration closes June 28, 2021
    Grab your hiking shoes, day pack, and
    water bottle and spend your week
                                                   New!                                                                       Why are bugs important? Did you know
                                                                                                                              that bugs are the only food source for
                                                                                                                              many amphibians, reptiles, birds, and
    exploring the wonders of the outdoors.         Storyteller                                                                mammals? Come to Camp Piperwood
    Hike, cook outdoors, learn a new camp          Session Four: July 26-30, 2021                                             with your friends and find out how bugs,
    skill, and practice first aid techniques all   Registration closes July 12, 2021                                          flowers, and trees all play a part in the
    while learning to leave a place better then    Storytelling is an age-old tradition that is enjoyed by all. Ignite        foods and products we use today. Make
    you found it.                                  your imagination and stimulate your curiosity as you learn the             samples and products to take home to
    Girls will earn requirements towards the       art of storytelling. Learn about favorite stories from the past and        family and friends. Games, camp songs,
    following Girl Scout badges: Daisy - Daisy     create new tales to share with family and friends. Come to Camp            laughter, and friendship also included.
    Trail Adventure; Brownie - Outdoor             Piperwood and tell us your story!                                          Girls will earn requirements towards the
    Adventure; Junior - Camper; Cadette -          Girls will earn requirements towards the following Girl Scout badges:      following Girl Scout badges: Daisy - Eco
    Primitive Camper.                              Daisy - Mari’s Story - Being Responsible for What I Say and Do;            Learner; Brownie - Bugs; Junior - Flowers;
                                                   Brownie - My Family Story; Junior - Scribe; Cadette - Screenwriter         Cadette - Trees.
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Day Camp 2021 summer Camp Catalog - Programs for girls in grades k-12 - Girl Scouts of Western New York
ADDITIONAL CAMP PIPERWOOD                                                                                PIPERWOOD CHALLENGE
          PROGRAMS FOR GIRLS                                                                                     COURSE PROGRAMS
    ENTERING GRADES 6-8 IN FALL OF 2021                                                                  The ropes course programs are done in a progression. Girls
                                                                                                         will start the week with team building and trust games,
                                                                                                         progress to the low course and finish out their week on the
    A Little of Both
    Session Four: July 26-30, 2021
                                                   New!                                                  high course. Girls will have time to participate on the high
                                                                                                         course elements at least one time. All low- and high-course
    Registration closes July 12, 2021              Piperwood                                             element usage is contingent on the weather.

    Fee: $ 265 per person                          Challenge Seeker
                                                   Session One: July 5-9, 2021                           Open to girls entering grades 6-8 in the Fall of 2021
    This program is designed for campers
                                                   Registration closes June 21, 2021
    who want to experience day camp and                                                                  Cables and Carabineers
    resident camp at the same time! Spend          Fee: $220 per person
    Monday and Friday at Piperwood and
                                                                                                         Session Three: July 19-23, 2021
                                                   Do you like a good challenge? This week is            Registration closes July 5, 2021
    on Tuesday, girls will be bused to Camp
                                                   dedicated to challenging yourself and taking
    Timbercrest to experience 3 days of
                                                   healthy risks. Try your hand at creating your
                                                                                                         Session Five: August 2-6, 2021
    resident camp. Spend time with your                                                                  Registration closes July 19, 2021
                                                   own obstacle course that you and your friends
    friends swimming, boating, hiking,                                                                   Fee: $235 per person
                                                   can compete in. Take a swing on one of our high
    learning new camp songs, practicing your
                                                   ropes course elements and put your taste buds         This program is designed for that individual who loves
    archery skills and more. Girls will return
                                                   to the test with the Piperwood food challenge.        a great challenge! Girls, this is your chance to test your
    to Piperwood Thursday afternoon in time
    for daily dismissal. Bus transportation        Girls will earn requirements towards the              balancing skills on our spectacular high course elements.
    provided to and from Camp Timbercrest.         following Girl Scout badge: Cadette - Good            Do you have what it takes to achieve our hire ropes course
                                                   Sportsmanship                                         elements? Our trained ropes challenge course facilitators
                                                                                                         are waiting for you to put your skills to the test. This program

    New!                                           New!
                                                                                                         includes elements of the low ropes course and all the
                                                                                                         splendors of Piperwood camp life.
    Spa Piperwood
    Session Two: July 12-16, 2021                  Cadette Trail                                         Open to girls entering grades 4-5 in the Fall of 2021
    Registration closes June 28, 2021              Adventures
    Fee: $220 per person                           Session Six: August 9-13, 2021                        Adventures in the Trees
                                                   Registration closes July 26, 2021                     Session Two: July 12-16, 2021
    Girls will spend time pampering                                                                      Registration closes June 28, 2021
    themselves with facials, relaxation            Fee: $220 per person
    techniques, and aromatherapy. Yoga,            Spend your week at camp learning the                  Session Four: July 26-30, 2021
    Pilates, healthy eating and fun, exciting                                                            Registration closes July 12, 2021
                                                   necessary skills of a Cadette Trail Adventurer.
    exercise tips are just a few of the healthy    Build your own shelter and tools using rope,          Session Six: August 9-13, 2021
    lifestyle habits that will be explored. Take   tarps, and materials you find in the natural          Registration closes July 26, 2021
    home natural skin products such as bath        environment around you. Plan your adventure,
    salts, facial masks, and lip balm that you     gather your gear and hike the trails of Piperwood
                                                                                                         Fee: $235 per person
    make yourselves.                               and beyond. Do you have what it takes to be a         This program is designed for thrill seekers everywhere!
    Girls will earn requirements towards the       Cadette Trail Adventurer?                             This is your chance to test your balancing skills on our
    Girl Scout badge: Cadette - Eating for                                                               spectacular high course elements. This program includes
                                                   Girls will earn requirements towards the
    Beauty                                                                                               elements of the low ropes course and all the splendors of
                                                   following Girl Scout badge: Cadette - Cadette Trail
                                                                                                         Piperwood camp life.
                                                   Adventure
8
Day Camp 2021 summer Camp Catalog - Programs for girls in grades k-12 - Girl Scouts of Western New York
CAMP PIPERWOOD LEADERSHIP PROGRAMS
                                                   Prepare yourself for future summer camp staff positions

    Open to girls entering                                   Open to girls entering
    grades 7-8 in the Fall of 2021                           grades 9-10 in the Fall of 2021

    Program Aide                                             Two Weeks
    Session One: July 5-9, 2021                              Junior CIT
    Registration closes June 21, 2021
                                                             (Counselor in Training)
    Session Two: July 12-16, 2021                            Session One & Two:
    Registration closes June 28, 2021
                                                             July 5-16, 2021
    Session Three: July 19-23, 2021                          Registration closes June 21, 2021
    Registration closes July 5, 2021
                                                             Session Three & Four:
    Session Four: July 26-30, 2021                           July 19-30, 2021
    Registration closes July 12, 2021                        Registration closes July 5, 2021
    Session Five: August 2-6, 2021                                                                                  For girls 15 - 17 years old
                                                             Session Five & Six:
                                                                                                                    New!
    Registration closes July 19, 2021
                                                             August 2-13, 2021
    Session Six: August 9-13, 2021                           Registration closes July 19, 2021
    Registration closes July 26, 2021                        Girls can register for one two-week                    Four Weeks
    Girls can register for two program session               program session option only.
    weeks only.                                              Fee: $220 per person
                                                                                                                    CIT (Counselor In Training)
    Fee: $220 per girl per session                                                                                  Sessions 3 through 6:
                                                             Begin training to become a camp counselor.
                                                             Junior Counselors in Training (JCITs) learn the
                                                                                                                    July 19 to August 13, 2021
    Here is an opportunity to get a jump start on being                                                             Registration closes July 5, 2021
    a future camp staff member. Spend time at camp           fundamentals of leadership, camp management,
    getting trained in program aide, earning leadership      childcare, and the safety and risk management          Fee: $440 per person
    hours, and developing valuable skills through            aspects of running a camp program. A participant       This four-week course will concentrate on
    hands-on experience working with younger                 must demonstrate appropriate maturity for her          the fundamentals of the Girl Scout Camping
    campers. This training/program will also allow you       age, have leadership potential, a positive attitude,   program, counseling techniques, leadership,
    to assist at program events and troop meetings/          and be able to work well with others. Junior CITs      self-esteem, and provide skills that are
    campouts. At the end of the camp week, girls will        can access all of the basic camp programs, (e.g.,      necessary when working with younger
    receive their program aide pin for successfully          exploring nature, arts & crafts, and relaxing around   campers. Participants will plan and assist with
    completing the program.                                  campfires, songs, games, etc.) This is a two-week      the supervision of activities, as well as assist
                                                             program. No application, interview, or references      with instruction supervised by senior staff. The
                                                             required.                                              CIT program is a recognized training program
                                                                                                                    throughout the country and is a recommended
                                                                                                                    prerequisite for summer camp employment.
                                                                                                                    CITs will receive their CIT pins upon successful
                                                                                                                    completion of this program.

9
Day Camp 2021 summer Camp Catalog - Programs for girls in grades k-12 - Girl Scouts of Western New York
Camp Windy Meadows                                                                                                       This is a volunteer-run
                                                                                                                              day camp program
     Volunteer-Run Day Camp 2021:                                                                                             led by experienced
     July 5 to 23, 2021 (9am - 4pm every weekday)                                                                             volunteers!
                                                                                                                              This program is for all registered
                                                                                                                              Girl Scouts of Western New York
                                                                                                                              girls who are at least 5 years old
                                                                                                                              or older, or entering Kindergarten
                                                                                                                              and up in the fall of 2021. All
                                                                                                                              grades K-12 are welcome to
                                                                                                                              attend. Girls who are not current
                                                                                                                              Girl Scouts can register for
                                                                                                                              membership while registering for
                                                                                                                              camp. Girls entering grades 8 and
                                                                                                                              up who would like to be trained
                                                                                                                              in or assigned to leadership
                                                                                                                              responsibilities also welcome!

     BEFORE AND AFTER CARE OPTIONS                                                                              FOR QUESTIONS REGARDING
     Early Drop Off: Monday through Friday 8:00 a.m.                                                              THE WINDY MEADOWS
     Late Pick Up: Monday through Friday 6:00 p.m.
     There is no additional charge for before and after care. Put your mind at ease and take advantage of
                                                                                                                VOLUNTEER-RUN DAY CAMP:
     the before and after care program at our day camp facilities. You may drop your child off at camp      Email Linda Zakrzewski:
     no earlier than 8 a.m. and pick her up no later than 6 p.m. Please indicate before and/or after care   Lindaz777@yahoo.com
     on the camp registration form.
                                                                                                            Or visit their Facebook group:
     FOOD AT CAMP                                                                                           facebook.com/groups/WindyMeadowsDayCamp/
       • The cost of camp includes lunch each day, plus dinner and breakfast for the sleepover.
       • Girls are welcome to bring their own afternoon snack.
       • THIS IS A NUT-FREE CAMP!
       • Girl Scouts are expected to have a water bottle with them at all times.
       • Fruit and healthy snacks will be available throughout the day.

     VOLUNTEERS
     Adults who would like to volunteer at Windy Meadows Day Camp should contact Linda
     Zakrzewski directly at Lindaz777@yahoo.com.
     Volunteers must be over 18 years old, and be screened and pass a background check, and register
     with Girl Scouts.

10
CAMP WINDY MEADOWS PROGRAMS FOR GIRLS AT LEAST 5 YEARS OLD
                 OR ENTERING GRADES K-12 IN THE FALL OF 2021

     Girl Scouts Make the                                    Dinosaur Discoveries                                  Galaxy Quest
     World A Better Place                                    Session Two: July 12 to 16, 2021
                                                             Registration closes June 28, 2021
                                                                                                                   Session Three: July 19 to 23, 2021
                                                                                                                   Registration closes June 28, 2021
     Session One: July 5 to 9, 2021
     Registration closes June 28, 2021                       Fee: $100 per girl                                    Fee: $100 per girl
                                                             Early Bird and sister discounts do not apply.         Early Bird and sister discounts do not apply.
     Fee: $100 per girl                                      See above for optional sleepover.                     See above for optional sleepover.
     Early Bird and sister discounts do not apply.
     See above for optional sleepover.                       What was earth like 100 million years ago?            Girl Scouts, take a trip across the galaxy at camp!
                                                             Discover the amazing creatures that were alive        We will explore earth, planets, the moon, and the
     Do you like to help others and your community? At
                                                             then and now. Campers will go on a dinosaur           sun, while traveling around camp and having a
     camp this week, girls will connect with important
                                                             dig, create salt dough fossils, and make fizzing      blast! Get in touch with your creative side, too! This
     helpers in the local community. Girls will also
                                                             dinosaur eggs. Girls will also learn how to take      week will feature special programming including
     learn about where they live and how they can
                                                             good care of the earth for the future as they learn   painting, photography, drawing, clay, and more
     make an impact in a big way. By meeting with
                                                             the principles of Leave No Trace.                     outdoor art.
     local first responders and healthcare experts, girls
     will earn the First Aid Badges at each level.           Girls will earn requirements toward the following     Girls will earn requirements toward the following
                                                             Girl Scout badges: Daisy - Eco Learner, Buddy         Girl Scout badges: Daisy - Space Science Explorer,
     Girls will earn requirements toward the following
                                                             Camper; Brownie - Eco Friend, Home Scientist;         Outdoor Art Maker; Brownie - Space Science
     Girl Scout badges: Daisy - Safety Pin, Rosie's Petal;
                                                             Junior - Eco Camper, Detective; Cadette - Eco         Adventurer, Outdoor Art Creator; Junior - Space
     Brownie - First Aid, Household Elf; Junior - First
                                                             Trekker, Archery                                      Science Investigator, Outdoor Art Explorer; Cadette
     Aid, Gardener; Cadette - First Aid, Archery
                                                                                                                   - Space Science Researcher, Outdoor Art Expert

11
CAMP WINDY MEADOWS
                       LEADERSHIP OPPORTUNITIES FOR GIRLS
                   PLEASE INCLUDE CAMP NAME ON YOUR REGISTRATION.
                      This is a nickname you will use at camp instead of your real name.

     Open to girls entering grades 8-12 in Fall 2021
     Session One - July 5 to 9, 2021
     Session Two - July 12 to 16, 2021
     Session Three - July 19 to 23, 2021
     Registration closes June 28, 2021 for all three sessions!
     Fee: $40 per girl per session
     Early Bird and sister discounts do not apply.
     Here is an opportunity to get a jump start on being a future camp staff member. Spend time at camp earning
     leadership hours, and developing valuable skills through hands-on experience working with younger campers.
     This program will also allow you to assist at program events and troop meetings/campouts.

12
Financial Assistance                                                    INCOME ELIGIBILITY INFORMATION
 Our Financial Assistance Fund is available to help defray camp          INCOME ELIGIBILITY FORM FOR THE SUMMER FOOD SERVICE PROGRAM LOCATED ON NEXT PAGE
                                                                         (For Use by Camps and Closed Enrolled Sites) Please complete and sign the form using the instructions below.
 costs for Girl Scouts registered with Girl Scouts of Western New
 York, Inc. The assistance is intended to supplement the applicant’s      Follow these instructions, if your household                       If your household includes a FOSTER CHILD, use one application for
 own contribution to the cost of camp. All information will remain        gets SNAP (Food Stamps) TANF or FDPIR:                             the whole household and follow these instructions:
 strictly confidential. Aid applications are on the back of the Day       Part 1: List participant's name and a SNAP (Food                   Part 1: Enter the child's name.
 and Resident Camp Registration forms. Note: Financial aid is             Stamp), TANF or FDPIR case number.                                 Part 2: Please contact Foodlink at (585) 328-3380
                                                                          Part 2: Skip this part.                                            Part 3: Complete this part if you are applying for other children in the
 available for only one (1) program choice per girl.                      Part 3: You must complete this part.                               household and you did not enter a SNAP (Food Stamp), TANF or FDPIR case
 With generous support from our local United Ways, private                Part 4: Sign the form. A Social Security Number                    number in Part 1.
 foundations and donors, we are able to offer families who qualify        is NOT required.                                                   Part 4: Sign the form. If Part 3 was completed, provide the last four digits
                                                                          Part 5: Answer this question if you choose to.                     of the signing adult's Social Security Number.
 up to 5 weeks of day camp or the combination of 1 week of resident
                                                                                                                                             Part 5: Answer this question if you choose to.
 camp with 3 weeks of day camp at a discounted rate. To see if you
 qualify or for more information on this opportunity please call          ALL OTHER HOUSEHOLDS, including WIC households, follow these instructions:
 1-888-837-6410 or email customercare@gswny.org.                          Part 1: List each participant's name.
 To be considered for financial assistance, you must meet the             Part 2: Skip this part.
                                                                          Part 3: Follow these instructions to report total household income from last month.
 following criteria:                                                           Column A-Name: List the first and last name of each person living in your household, related or not (such as grandparents,
 • Camper MUST be a registered Girl Scout member of the Girl Scouts            other relatives, or friends who live with you). You must include yourself and all children living with you. Attach another sheet
   of Western New York, Inc.                                                   of paper if you need to.
                                                                               Column B-Gross income last month and how often it was received. Next to each person’s name, list each type of
 • Applications should be submitted online or to a Girl Scout                  income received last month, and how often it was received.
   Service Center as early as possible and no later than June 1, 2021.         In Box 1, list the gross income each person earned from work. This is not the same as take-home pay. Gross income is the
   (Applications received after the deadline date may not be funded.)          amount earned before taxes and other deductions. The amount should be listed on your pay stub, or your boss can tell
                                                                               you. Next to the amount, write how often the person got it (weekly, every other week, twice a month, or monthly).
 • Campers must NOT be delinquent in payments to the council for               In box 2, list the amount each person got last month from welfare, child support, alimony.
   cookies, QSP merchandise, programs, or prior years’ camp fees.              In box 3, list Social Security, pensions, and retirement.
 Steps to Apply for Assistance                                                 In box 4, list ALL OTHER INCOME SOURCES including Worker’s Compensation, unemployment, strike benefits, Supplemental
                                                                               Security Income (SSI), Veteran’s benefits (VA benefits), disability benefits, regular contributions from people who do not live
 • Fill out one camp application for each girl.                                in your household. Report net income for self-owned business, farm, or rental income. Next to the amount, write how often
 • Complete the Financial Aid - Household Income Eligibility                   the person got it. If you are in the Military Housing Privatization Initiative do not include this housing allowance.
   Information.                                                                Column C-Check if no income: If the person does not have any income, check the box.
                                                                          Part 4: An adult household member must sign the form and include the last four digits of his or her Social Security Number, or
 • Identify a specific dollar amount the family can contribute.           mark the box if he or she doesn't have one.
 • Write an explanation of why you are requesting financial               Part 5: Answer this question if you choose to.
   assistance as detailed on the application.                             Privacy Act Statement: The Richard B. Russell National School Lunch Act requires the information on this application. You do not have to give the
 • Provide the income verification documents. Submit/upload a             information, but if you do not, we cannot approve your child for free or reduced price meals. You must include the social security number of the adult
                                                                          household member who signs the application. The social security number is not required when you apply on behalf of a foster child or you list a SNAP,
   copy of the family’s 2020 1040 tax form and/or 1099 (pay stubs         Temporary Assistance for Needy Families (TANF) Program or Food Distribution Program on Indian Reservations (FDPIR) case number for your child or
   not accepted) or another form of income verification (such as          other (FDPIR) identifier or when you indicate that the adult household member signing the application does not have a social security number. We will
                                                                          use your information to determine if your child is eligible for free or reduced price meals, and for administration and enforcement of the Program.
   Social Security statement, SNAP, or other county/state assistance      Non-discrimination Statement: In accordance with Federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations
   statements).                                                           and policies, the USDA, its Agencies, offices, and employees, and institutions participating in or administering USDA programs are prohibited from
                                                                          discriminating based on race, color, national origin, sex, disability, age, or reprisal or retaliation for prior civil rights activity in any program or activity
 If you are completing a paper application then please mail               conducted or funded by USDA. Persons with disabilities who require alternative means of communication for program information (e.g. Braille, large
 the completed 2021 Summer Day Camp to:                                   print, audiotape, American Sign Language, etc.), should contact the Agency (State or local) where they applied for benefits. Individuals who are deaf,
                                                                          hard of hearing or have speech disabilities may contact USDA through the Federal Relay Service at (800) 877-8339. Additionally, program information may
           Rochester Service Center                                       be made available in languages other than English. To file a program complaint of discrimination, complete the USDA Program Discrimination Complaint
           Girl Scouts of Western New York, Inc.                          Form, (AD-3027) found online at: http://www.ascr.usda.gov/complaint_filing_cust.html, and at any USDA office, or write a letter addressed to USDA and
                                                                          provide in the letter all of the information requested in the form. To request a copy of the complaint form, call (866) 632-9992. Submit your completed
           1000 Elmwood Ave, Door #9                                      form or letter to USDA by:
           Rochester, NY 14620                                                         (1) mail:     U.S. Department of Agriculture
           Attn: Summer Camp FA Awards                                    		                         Office of the Assistant Secretary for Civil Rights
                                                                          		                         1400 Independence Avenue, SW
 If financial aid information is completed in full and includes the       		                         Washington, D.C. 20250-9410;                               If you need help filling out the
 $25 deposit, parents/guardians should receive notice of their                         (2) fax:      (202) 690-7442; or
                                                                                       (3) email: program.intake@usda.gov.
                                                                                                                                                              form, please call 1-888-837-6410.
 request within a short period of submission.                                          This institution is an equal opportunity provider.
13
INCOME ELIGIBILITY FORM
 Part 1. Children enrolled in Camp or Closed Enrolled Sites.                                                                                                                Part 5. Participant’s ethnic and
                                                                                                                                                                            racial identities (optional)
     Names (First, Middle Initial, Last)                                               SNAP (Food Stamp), TANF or FDPIR case# (if any).                                     Mark one ethnic identity:
                                                                                                                                                                               Hispanic or Latino
                                                                                                                                                                               Not Hispanic or Latino

                                                                                                                                                                            Mark one or more racial identities:
                                                                                                                                                                               Asian
                                                                                                                                                                               American Indian or Alaska Native
                                                                                                                                                                               Black or African American
                                                                                                                                                                               Native Hawaiian or Other Pacific Islander
                                                                                                                                                                               White

                                                                                                                                                                            DON’T FILL OUT THIS PART.
                                                                                                                                                                            THIS IS FOR OFFICIAL USE ONLY.
 Part 2. Foster Child                                                                                                                                                             Annual Income Conversion:
 Foster children eligible for free and reduced-price meals regardless of household income. If a foster child lives with you, please                                              Weekly x 52, Every 2 Weeks x 26,
 contact Foodlink at (585) 328-3380. Complete Part 3 if you are applying for other children in your household and you did not                                                    Twice A Month x 24, Monthly x 12
 enter a SNAP (Food Stamp), TANF or FDPIR case number in Part 1.
                                                                                                                                                                            Total Income:_____________
 Part 3. Total Household Gross Income-You must tell us how much and how often                                                                                               Per:      Week,  Every 2 Weeks,
                                                                                                                                                               C.
                                                                                                                                                                                      Twice Month,  Month,  Year
     A. Name                          B. Gross income and how often it was received
     (List everyone in household,     Example: $100/monthly $100/twice a month $100/every other week $100/weekly                                               Check
                                                                                                                                                               if NO        Household size: ________________
     including children)
                                      1.Earnings from work         2. Welfare, child support,    3. Social Security,           4. All Other Income             income
                                      before deductions            alimony                       pensions, retirement,                                                      Categorical Eligibility: ___________
     1                                $                        $                                $                              $                                  
                                                                                                                                                                            Date Withdrawn:__________
     2                                $                        $                                $                              $                                  
     3                                $                        $                                $                              $                                           Eligibility:
     4                                $                        $                                $                              $                                           Free____ Reduced____ Denied_____
     5                                $                        $                                $                              $                                  
     6                                $                        $                                $                              $                                           Reason: ____________________________
     7                                $                        $                                $                              $                                           ___________________________________
     8                                $                        $                                $                              $                                  
                                                                                                                                                                            Determining Official’s Signature:
     9                                $                        $                                $                              $                                  
     10                               $                        $                                $                              $                                           ___________________________________
                                                                                                                                                                            Date:___________________
 Part 4. Signature and Social Security Number (Adult must sign)
 An adult household member must sign this form. If Part 3 is completed, the adult signing the form must also list the last four digits of his or her Social Security
 Number or mark the “I do not have a Social Security Number’’ box. (See Privacy Act Statement on the back of this page.)                                                    Confirming Official’s Signature:
                                                                                                                                                                            ___________________________________
 I certify that all information on this form is true and that all income is reported. I understand that this information is being given for the receipt of Federal funds.
 I understand that SFSP officials may verify the information. I understand that if I purposely give false information, the participant receiving meals may lose the         Date:___________________
 meal benefits, and I may be prosecuted.
 Sign here: X _________________________Print name: __________________Date:_________                                                                                         Follow-up Official’s Signature:
 Address:____________________________ Phone Number:____________________________
                                                                                                                                                                            ___________________________________
 Last four digits of Social Security Number: _______________                  I do not have a Social Security Number
                                                                                                                                                                            Date:___________________
14
2021 PIPERWOOD & WINDY MEADOWS DAY CAMP APPLICATION
                                                                                                                     Register for camp online! Visit us at www.gswny.org
                                                                                        Or mail this application and payment to:
 How did you hear about our Summer Day Camp Programs?                                   Rochester Service Center
                                                                                        1000 Elmwood Avenue, Door 9
                                                                                        Rochester, NY 14620
                                                                                        Fax: 585.292.1086

CAMPER INFORMATION                                                                             SCHOOL INFORMATION                                          CAMP INFORMATION
Camper’s Name                                                                                  Grade in school (9/2021):                                   PACKET (ALL CAMPERS)
Date of Birth                                  Current Age                                     Name of School:                                             Packets contain camp information that
Address		County                                                                                                                                            parents are required to review, directions
                                                                                               For Piperwood only:                                         to your camp, packing lists for your camper
City/State/Zip                                                                                                                                             and so much more. You will receive emails
                                                                                               Rochester City School District ID #
Home Phone: 		                                                                                 (Found in upper left corner of report card):                indicating receipt of registration, balance
Family E-mail                                                                                                                                              owed if applicable and a link to your Camp
                                                                                                                                                           Information Packet.
Buddy Name (only applicable if buddy is in the same age group and same program):               � I give GSWNY permission to contact
                                                                                               my child’s school to obtain their RCSID#.
                                                                                                                                                           T-SHIRT SIZE:
CAMPER MEMBERSHIP INFORMATION                                                                                                                               Youth M  Youth L  Adult S
Is the camper a registered Girl Scout? �Yes �No If no, please enclose a $25 membership fee on a separate check/Money Order.                                 Adult M  Adult L  Adult XL

PARENT/GUARDIAN INFORMATION                                                                                                                                FORM OF PAYMENT
Parent/Guardian #1                                                       Parent/Guardian #2                                                                Payment must include at least the
Relationship to Camper                                                   Relationship to Camper                                                            $25 deposit AND the Girl Scout
Email                                 Cell                               Email                                       Cell                                  Membership fee (if applicable)
                                                                                                                                                           Total amount of payment: $
     If different from camper’s:                                            If different from camper’s:
     Address                                                                Address                                                                        � My payment includes the $25 Girl Scout
                                                                                                                                                           membership fee
     Phone (Home)                                                           Phone (Home)

Camper lives with: � Both parents � Mother � Father � Other:                                                                                               � Cash, Check, or Money Order
                                                                                                                                                           -OR-
CAMPER PROGRAMS/SESSIONS CHOICES AT DAY CAMP
Please print neatly the Program Name; Bus Stop requested; Name and place an “X” in the boxes for the other items which you are requesting.                 � MC � Visa � Discover � AMEX
Girls should pick programs based on grade level they will be entering in the NEXT school year (2021).                                                      Credit Card Account #:
     Camp Choice:                                                                                         Before     Before Care After Care
                          Session Date(s)                                                    Bus Stop & After Care      ONLY       ONLY       Financial Aid
   Piperwood (P) or                                  Program Name       Bus Stop Requested
 Windy Meadows (WM)    -or- Session Number                                                     $50                                              Request     Exp. Date:
                                                                                                          $30           $15         $15

                                                                                                                                                           Print Name of Cardholder:

                                                                                                                                                           Signature of Cardholder:

15
PARENT/GUARDIAN AGREEMENT (ALL CAMPERS)
GSWNY Member and Camp Regulations: I hereby register my child for designated session(s) at one of the GSWNY summer camp(s) and I authorize my daughter to
become a member of Girl Scouts of Western New York. My daughter and I have read and understand the information in the camp brochure and agree to cooperate with
all camp regulations.
Camp Information Packet: I will read the Camp Information Packet upon registration and understand I am responsible for following the camp policies including but not
limited to payment procedures and deadlines, parent/camper behavior agreement, internet policies and camp hours of operation.
Participation Permissions: I give full permission for my daughter to attend and participate in all camp activities, including out-of-camp trips/hikes. I give consent for my
child to take part in field trips or excursions off camp property under proper supervision.
Photographs: I give consent that GSWNY may use photographs, slides, and video of my child, as may be needed for its records or promotional purposes including website
material to promote the interest of Girl Scouting. This includes the American Camp Association, the United Way grants, and Camp America.
Deadlines and Forfeiture of Registration: I further understand that my child’s spot is reserved only upon receipt by GSWNY of the fully completed registration form
health information, the required COVID-19 health screening form, and the $25 per child registration fee and that failure to pay balance due by the deadline, will forfeit my
child’s registration.
Inherent Risk Statement: I understand that GSWNY has taken the necessary steps to provide the appropriate training, the necessary equipment and skilled seasonal
staff for my child’s camp experience. I also acknowledge that there are inherent risks associated with camp activities such as ropes challenge course, horseback riding,
rock climbing, whitewater rafting, swimming, and boating/canoeing/kayaking and other components of camp and I am aware that by participating in any of these activities
that my child could be injured.
As the parent/guardian accountable for my child, I assume and accept the full responsibility for her participation at camp. I am also aware of and assume the risks
associated with camp and agree to release and hold harmless Girl Scouts of WNY, Inc., its employees (full, part-time and seasonal), agents and volunteers from any and
all claims or liabilities of any kind arising out of my child’s participation at any of the GSWNY camps.

PARENT/GUARDIAN SIGNATURE:						DATE:

FINANCIAL AID                             FAMILY CONTRIBUTION:
                                          How much can your family contribute (in addition to
                                                                                                              FINANCIAL AID STATEMENT OF NEED
                                                                                                              (attach a separate sheet of paper if necessary)
GSWNY has summer camp financial
aid available for our girls. Please       the deposit) towards camp? $                                        On the lines below, please explain why you are
fill out both pages 1 and 2 of this                                                                           requesting financial assistance. Please be specific
Registration Form completely, along                                                                           about your present financial obligations. Your
with the income verification form          HOUSEHOLD INCOME INFORMATION                                       application cannot be processed without this
(located in the camp catalog) and          Annual Household Combined Income: $                                information. All information included on this form is
submit as early as possible so that                                                                           held strictly confidential.
we can offer your girl the most                 # of adults supported by income:
financial assistance available to her.        # of children supported by income:
                                           Parent/Guardian 1 Name:
    PLEASE FILL
                                           �Employed �Unemployed �None/Retired
   THIS SECTION
                                           �One or more adults are working full-time
  OUT COMPLETELY                           Parent/Guardian 2 Name:
   IF ASKING FOR                           �Employed �Unemployed �None/Retired
   FINANCIAL AID.                          �One or more adults are working full-time
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