SUMMER VIBES YMCA CAMP Y-KODA - 2021 Summer Camp Brochure

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SUMMER VIBES YMCA CAMP Y-KODA - 2021 Summer Camp Brochure
YMCA CAMP Y-KODA
  2021 Summer Camp Brochure

SUMMER VIBES
SUMMER VIBES YMCA CAMP Y-KODA - 2021 Summer Camp Brochure
TABLE OF CONTENTS
                                                                                                      Benefits of Camp........................................................................3
                                                                                                      Camp Staff............................................................................ 4 - 5
                                                                                                      What to Expect...........................................................................6
                                                                                                      General Camp Information.........................................................7
                                                                                                      Extended Care & Transportation.............................................8
                                                                                                      Top 10 Reasons Camp is Good for Kids.................................9
    WELCOME & TABLE OF CONTENTS

                                                   WELCOME TO                                         Registration Information............................................... 10 - 11
                                                                                                      All Camps At a Glance.................................................... 12 - 13
                                                      YMCA                                            Open House & Kids Need Camp............................................ 14
                                                   CAMP Y-KODA                                        Registration Forms......................................................... 15 - 18
                                                                                                      Camp Y-Koda Information & Camp Descriptions...... 19 - 27
                                                                                                      CIT Camp & Volunteer Program............................................ 28
                                                                                                      Maywood Information & Camp Descriptions............. 29 - 31

                                                                                                      YMCA CAMP Y-KODA MISSION STATEMENT
                                                                                                      YMCA Camp Y-Koda promotes responsible stewardship of
                                                                                                      our environment and enhances participant quality of life by
                                                                                                      offering hands-on education opportunities.

                                                                                                      CAMP Y-KODA ANNUAL SUPPORT CAMPAIGN
                                                                                                      The Annual Support Campaign provides scholarships
                                  A MESSAGE FROM OUR DIRECTOR                                         for financially challenged and at-risk youth who wish to
                                  I’m sure one of the biggest questions you all have is, “What        experience summer camp. Your support makes a positive
                                  will summer camp at Y-Koda look like in 2021?” While I do           difference in the lives of children and families in our
                                  not possess a crystal ball, I can tell you our plan is to offer a   community. To make a donation, please contact Jeremiah
                                  full slate of camps without the restrictions that were in place     Dentz at jdentz@sheboygancountyymca.org or visit our
                                  during the difficult, yet successful 2020 season.                   website at sheboygancountyymca.org/camp-y-koda.

                                  We learned A LOT in the last year about how to navigate the         PARENT HANDBOOK & CAMP RESOURCES
                                  pandemic and how to operate our programs in a manner that           sheboygancountyymca.org/camp-y-koda
                                  provides a safe and rewarding experience to our campers.            Visit our website to find our 2021 Parent Handbook
                                  We are confident we will be able to expand upon what we’ve          and Camp Resources page. Our resource page includes
                                  learned in order to provide your campers the FULL experience.       everything you need to know to get your child ready for
                                                                                                      camp. You’ll find helpful tips on our policies, what to pack,
                                  That is not to say we are simply moving forward as if the           information on our sleepover and more! We’ve included
                                  pandemic is over, throwing all caution to the wind. You can         specific tips on Pee Wee Camp, Day Camp, Specialty Camps,
                                  expect enhanced sanitizing and cleaning. We may require             Resident Camps and Adventure Trips.
                                  masks while indoors depending on the mandates in place at
                                  the time. There may be temperature checks and other strange         When you visit our Camp Resources page, you’ll find a
                                  things that the pandemic brought us; like all the drinking          copy of the Parent Handbook, along with downloadable
                                  fountains being turned off. Those are the unknowns, and we          documents such as: the camp brochure, registration forms,
                                  can easily work with those as we all have for the past several      state licensing forms, waiver forms, detailed schedules,
                                  months.                                                             events and more.

                                  What we do know is that kids need camp this summer! They            SOCIAL MEDIA - CAMP PHOTOS
                                  need fresh air and the absence of screens. They need to run,        At camp, we love to take photos of
                                  and play, and swim, and sing! And in my humble opinion, they        your campers having a blast and of
                                  need it more than ever.                                             our camp groups all day long! Camp
Welcome Letter
                                                                                                      photos will be uploaded to our
                                  As the parent of four school aged children, I know that our
Table of Contents                                                                                     Facebook page and some may be
                                  decisions on what we sign our kids up for during these trying
                                                                                                      posted on our Instagram account.
                                  times are personal. We want our kids to be able to interact,
Mission                           but we want to keep our families and our community safe. I
Statement                                                                                             These photos will be uploaded during the week of or 1-2
                                  do believe that summer camp is one of the safer places you
                                                                                                      weeks after each camp week. Find our camp photos faster
                                  can send your child, but I wholeheartedly understand that is
Annual Support                    a decision only you can make.
                                                                                                      by searching for our 2021 official hashtags: #CampYKoda
                                                                                                      and #SummerCamp2021.
Parent Handbook                   If you have any questions on specific protocols or practices
                                  we plan to implement this summer, please visit our webpage
Social Media                      sheboygancountyymca.org/camp-y-koda or give me a call
                                  directly at 920-467-6882.

                                  Jeremiah Dentz

                                  Executive Director
                                   2
SUMMER VIBES YMCA CAMP Y-KODA - 2021 Summer Camp Brochure
BENEFITS OF CAMP
    CAMP Y-KODA AND MAYWOOD SUMMER CAMPS ARE:

              SAFE                            AFFORDABLE                               FUN!
•   Well trained, qualified           •   Field trips are included in     •   All Camp Games
    counselors who receive more           cost of camps.                  •   Archery (7 Yrs+)
    than 40 hours of pre-camp                                             •   Arts & Crafts
    training.                         •   Thursday night sleepover for    •   BB Gun (9 Yrs+)
                                          campers included.               •   Biking
•   1:6 staff to camper ratio for                                         •   Camper’s Choice Time
                                      •   All snacks throughout the
    pee wee campers ages 4 - 5.                                           •   Campfires
                                          week are provided.
                                                                          •   Canoeing
•   1:12 staff to camper ratio        •   Breakfast on Friday for         •   Climbing Wall (9 Yrs+)
    for campers ages 6 – 8.               campers who sleep over          •   Fishing
                                          Thursday night.                 •   Gaga Ball
•   All counselors are at least                                           •   Gardening                    See page 11 for
    18 years old.                     •   Lunch for all campers           •   Healthy Living Habits        more information!
                                          included on Friday.             •   High Ropes (9 Yrs+)
•   All staff are certified in CPR,                                       •   Kayaking
    AED and First Aid.                •   Very affordable bussing and     •   Lake Exploration
                                          extended care fees.             •   Nature Study
•   We are a State of Wisconsin                                           •   Paddle Boarding
    Licensed Day Camp that            •   Financial assistance is         •   River Tubing
    meets all child care licensing        available through application   •   Sleepovers
    guidelines.                           process.                        •   Slingshots (7 Yrs+)
                                                                          •   Slip ‘n Slide
                                      •   Additional scholarship
•   ALL water activities are                                              •   Songs & Skits
                                          opportunities for specific
    supervised by certified                                               •   Sports
                                          camp experiences.
    lifeguards.                                                           •   Team Building
                                      •   Become a Y member and save      •   Swimming
                                          even more!                      •   More, more and more!

                                                                                                       3
SUMMER VIBES YMCA CAMP Y-KODA - 2021 Summer Camp Brochure
JEREMIAH DENTZ • jdentz@sheboygancountyymca.org
                               EXECUTIVE DIRECTOR
                               Jeremiah started working for Camp Y-Koda in 2001 after earning his Bachelor's Degree
                               in Environmental Education from UW-Stevens Point. Jeremiah believes strongly in the
                               value of outdoor experiences as part of a healthy childhood and works to ensure Camp
                               Y-Koda provides those experiences to everyone. He enjoys his job because he knows
                               camp is impacting young lives in a positive way and providing life-long memories. He
                               loves seeing exhausted, dirty and smiling faces at the end of a full day of playing outside.
MEET THE LEADERSHIP TEAM

                               SARAH DEZWARTE • sdezwarte@sheboygancountyymca.org
                               DIRECTOR OF EDUCATION
                               Sarah has a degree in Biology and Elementary Education, a graduate certificate in
                               Leadership in Natural Resources from UW-Stevens Point, and a Master’s Degree in
                               Educational Policy and Community Engagement from UW-Milwaukee. She recently started
                               a Ph. D. program in Education, where she plans to focus her research on the growing gap
                               between children and nature. This is her 16th year working for Camp Y-Koda. She enjoys
                               her position at camp because she likes working with children and loves teaching about
                               the natural world.

                               KAITLYN RAUTMANN • krautmann@sheboygancountyymca.org
                               CAMP Y-KODA SUMMER CAMP DIRECTOR
                               Kaitlyn has been a member of the Camp Y-Koda community from the time she was a camper
                               and volunteer. She began as a counselor, Arts & Crafts Director, Outdoor Education
                               Instructor, Assistant Director and now is your Summer Camp Director. This is her 10th
                               year working for Camp Y-Koda. She is a certified trainer for Shaken Baby Syndrome
                               Prevention and a committee member for the YMCA Mid-America Camping Conference.
                               Kaitlyn graduated from UW-Milwaukee with a Bachelor of Science in Architecture and
                               has a Project Management Certificate from Lakeshore Technical College. She participated
                               in the Disney College Program as a Children’s Activities Hostess at Disney’s Port Orleans
                               Resort. Kaitlyn loves working with children and teaching our youth the wonders of being
                               outdoors in a safe and positive way. She enjoys going on nature hikes and marshmallow
                               roasting over the campfire. She is known as the frog whisperer at camp!

                               MACKINZI BEATY • mbeaty@sheboygancountyymca.org
                               MAYWOOD SUMMER CAMP DIRECTOR
                               Mackinzi is an Environmental Education Specialist and Maywood Summer Camp Director.
                               She has been working at camp since 2015. For the past several years, she has focused
                               on a career in environmental education. Before coming to camp, she worked for the
                               Wisconsin DNR as a Naturalist and Outdoor Educator. Mackinzi has a Bachelor of
                               Science degree in Biological Sciences from UW-Milwaukee. She enjoys working at camp
                               because she loves being able to share her passion for nature with students and campers.
                               She enjoys educating the public and hopes to create awareness and appreciation for our
                               environment. Mackinzi has many outdoor interests including gardening, kayaking, hiking
                               and camping. She also has many creative hobbies such as drawing and painting, crafting
                               and nature photography.

                               TERESE KOENE-CARROLL • tcarroll@sheboygancountyymca.org
                               BILLING AND REGISTRATION
                               Terese began working at Camp Y-Koda in 2007 as an Outdoor Educator. With her love
                               of camp, she became our Administrative Assistant and a Lifeguarding, CPR & First Aid
                               Trainer for the Outdoor Education and Summer Camp Team. When she was 9 years old,
                               she saved her 6 year old brother from drowning. She has been a lifeguard instructor for
                               over 20 years and a swim instructor for more than 30 years. The best part she loves
                               about working at camp is taking walks around our grounds and seeing our campers every
                               morning with the pure energy and excitement they have for camp. She enjoys working
                               with her family on a small hobby farm taking care of their ever-changing menagerie of
                               animals including 3 dogs, 6 goats, 4 bunnies and 16 chickens. During her down time,
                               Terese enjoys a good cookout with her friends and family. Her favorite activity at Camp
                               Y-Koda is anything to do with water either at the lake, river or swimming pool.
                           4
SUMMER VIBES YMCA CAMP Y-KODA - 2021 Summer Camp Brochure
CAMP STAFF
Every parent wants their child to have great role models and we’ve found them! They understand the magic of camp and
work hard to ensure that your child has an amazing experience keeping with the traditions and core values that Camp
Y-Koda has to offer. Counselors are carefully screened and selected based on experience working with children, maturity,
sound judgement and sensitivity. Safety is our top priority. Every member of our team goes through the requirements of
the Wisconsin Department of Children, which includes certification and trainings in CPR, First Aid, Lifeguarding, Child Abuse
Prevention, Shaken Baby Prevention and more.

                                                                                                                                MEET THE CAMP STAFF

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SUMMER VIBES YMCA CAMP Y-KODA - 2021 Summer Camp Brochure
A TYPICAL DAY OF CAMP                         WHAT TO BRING TO CAMP EACH DAY
                                                                              Please label your child’s name on everything they
                                                                              bring to camp. If any other supplies are needed,
                                                                              camp will inform you. Please send your camper in
                                                                              clothing that is ok to get dirty!

                                                                              aBack Pack                     aRain Poncho
                                                                              aBag Lunch                     aSunscreen
                          Each day of camp provides a variety of safe         aBug Spray                     aSwimsuit
                          and fun adventures!                                 aClosed Toe Shoes              aTowel
                                                                              aHat                           aWater Bottle
                          8:30AM - OPENING CEREMONY
                          Each morning we meet with our counselors, raise
                          the flag and get excited for the day ahead!
                                                                              WHAT TO BRING TO THE SLEEPOVER
     WHAT TO EXPECT

                          8:45AM - ICE BREAKERS                                            aChange of Clothes
                          Each day we have ice breakers and games to get                   aFlashlight
                          to know the other campers and make friends.                      aPajamas
                                                                                           aPants
                                                                                           aPillow
                            CAMP DAY: 9:00AM - 3:30PM                                      aSleeping Bag/Blanket
                            Campers begin their adventure with a wide                      aSweatshirt
                            variety of small and large group activities,                   aToiletries
                            nature activities, arts & crafts, water fun,
                            games, sports, special themed activities
                            and more while growing as individuals!            CAMP T-SHIRT
                            Mornings are so busy that we can’t help           A camp t-shirt is included
                            but build up an appetite. Mid-day we’ll kick      in the registration fee.
                            back and relax by eating lunch and making         Campers      receive   their
                            new friendships out at the campsite.              t-shirt at the beginning of
                                                                              their first camp week. They
                            Water fun begins after lunch with a jump in       receive only one t-shirt,
                            the swimming pool, swimming at the lake           regardless of how many
                            or enjoying a variety of water activities         weeks of camp they attend.
                            such as our slip n’ slide, tubing in the river
                            and much more! To end our day, campers
                             will enjoy a snack and one last activity.

                          3:45PM - CLOSING CEREMONY
                          We round out our day with a closing ceremony:
                          lowering the flag, a camp song and end of day
                          reminders.

                          4:00PM - DEPARTURE
                          Each afternoon we say goodbye to our counselors
                          and friends as we get picked up or head to the
                          bus to go home and share our exciting camp day!

                          NOTES
Typical
                          On Wednesday afternoon, campers participate
Day of Camp
                          in an all-camp game. Campers choose their own
                          activity on Friday morning. Specialty camps
What to Bring:
                          may take off-site trips or require more time for
- to Camp Daily
                          instruction so the activity period in the morning
- to the Sleepover
                          may be longer. The rest of the daily schedule is
                          adjusted accordingly.
Camp T-Shirt
                          Detailed schedules can be found on our website:
                          www.sheboygancountyymca.org/camp-y-koda.

                      6
SUMMER VIBES YMCA CAMP Y-KODA - 2021 Summer Camp Brochure
LUNCH & COOKOUT                                                 WEEKLY NEWSLETTER
Campers must bring a bag lunch with them to camp Monday         Each week, our camp staff will email a newsletter to all
- Thursday unless otherwise specified. Camp provides lunch      registered camp families for the overall summer camp
only on Fridays as all campers participate in an authentic      program. We will send out a variety of information in these
campfire cookout. Milk is provided every day with lunch as      newsletters such as, but not limited to: general camp
well as a nutritious afternoon snack. All meals are provided    reminders, cabin groups, which counselor has each camp,
for off-site adventure trips and resident camps.                special announcements, cancellations and more! Each
                                                                family is automatically signed up to receive these emails
ELECTRONICS AND CELL PHONE POLICY                               regardless of the number of weeks they attend camp.

                                                                                                                                   GENERAL CAMP INFORMATION
Cell phones and other electronic devices are NOT permit-
ted at Camp Y-Koda or Maywood. Our programs promote             NON-DISCRIMINATION STATEMENT
the opportunity for participants to learn and play in nature    In the operation of the summer camp program, no child,
and we strongly believe in the importance of disconnecting      as defined by program regulations, will be discriminated
during the camp experience. Please leave them at home. If       against because of race, sex, color, age, national origin
brought to camp, these devices will be taken away and           or handicap. Any person who believes that a child has
kept in the office until a parent comes to pick them up.        been discriminated against in any USDA related activity
They will not be returned to the child at the end of the day.   should write immediately to the Secretary of Agriculture,
                                                                Washington, D.C. 20250.

                                                                                                                              Lunch & Cookout

                                                                                                                              Electronics Policy

                                                                                                                              Weekly
                                                                                                                              Newsletter

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SUMMER VIBES YMCA CAMP Y-KODA - 2021 Summer Camp Brochure
EXTENDED CARE                                                  TRANSPORTATION
                                 Camp Y-Koda offers before and after camp care at the           There is a $15.00 per week fee for those who use the bus
                                 Sheboygan YMCA, Sheboygan Falls YMCA and Camp Y-Koda.          service as part of their summer camp experience. This fee
                                 Below are the times and locations that are available. YMCA     is non-refundable. Please indicate which stop your camper
                                 staff will not be available before 7:15am. A late pick-up      will use on page 15 of the registration form.
                                 fee of $5.00 per 15 minutes after 5:30pm will be charged.
                                                                                                Changes in transportation must be
                                 The fee for extended care is $25.00 per week. Pre-             made in writing. Phone calls are not
EXTENDED CARE & TRANSPORTATION

                                 registration is required; please mark the appropriate box on   accepted. You may send a note with
                                 your registration form. If you do not sign up for extended     your child or email to camp.
                                 care, you are expected to be at the designated bus or camp
                                 location to pick up your child.                                Buses run every week with several pick-up and drop-off
                                                                                                points throughout Sheboygan, Kohler and Sheboygan Falls.
                                 Extended care is not available at Maywood. Campers             A camp staff member is assigned to each bus as a monitor.
                                 who need extended care should sign up for bussing and          The 2021 schedule for the north and south bus routes is:
                                 extended care at the Sheboygan YMCA.
                                                                                                 NORTH BUS ROUTES TO CAMP Y-KODA
                                  SHEBOYGAN YMCA EXTENDED CARE
                                                                                                 Sheboygan YMCA, 812 Broughton Drive
                                  Location: Front Lobby by Entrance
                                                                                                 Route #1 North     Pick-up 7:40am     Drop-off 4:45pm
                                  AM Care: 7:15am - 7:40am PM Care: 4:45pm - 5:30pm
                                                                                                 North High School, North 10th Street Parking Lot
                                  SHEBOYGAN FALLS YMCA EXTENDED CARE
                                                                                                 Route #2 North     Pick-up 8:00am     Drop-off 4:30pm
                                  Location : Front Lobby or Gymnasium
                                  AM Care: 7:15am - 8:15am PM Care: 4:10pm - 5:30pm              Cleveland Park, Cleveland Ave & North 25th Street
                                                                                                 Route #3 North     Pick-up 8:05am     Drop-off 4:25pm
                                  CAMP Y-KODA EXTENDED CARE
                                  Location: Playground or Johnsonville Lodge (if it rains)       Maywood Environmental Park, 3615 Mueller Road

                                  AM Care: 7:15am - 8:30am PM Care: 4:00pm - 5:30pm              Route #4 North     Pick-up 8:10am     Drop-off 4:15pm

                                                                                                 SOUTH BUS ROUTES TO CAMP Y-KODA
                                                                                                 South High School, Washington Avenue Parking Lot
                                                                                                 Route #1 South     Pick-up 7:45am     Drop-off 4:40pm
                                                                                                 Kohler Elementary, School Street Entrance
                                                                                                 Route #2 South     Pick-up 8:05am     Drop-off 4:20pm
                                                                                                 Sheboygan Falls YMCA Parking Lot, 305 Buffalo Street
                                                                                                 Route #3 South     Pick-up 8:15am     Drop-off 4:10pm

                                                                                                 NORTH BUS ROUTES TO MAYWOOD
                                                                                                 Sheboygan YMCA, 812 Broughton Drive
                                                                                                 Route #1 North     Pick-up 7:40am     Drop-off 4:45pm
                                                                                                 North High School, North 10th Street Parking Lot
                                                                                                 Route #2 North     Pick-up 8:00am     Drop-off 4:30pm
                                                                                                 Cleveland Park, Cleveland Ave & North 25th Street
                                                                                                 Route #3 North     Pick-up 8:05am     Drop-off 4:25pm

                                  8
SUMMER VIBES YMCA CAMP Y-KODA - 2021 Summer Camp Brochure
TOP 10 REASONS WHY CAMP IS GREAT FOR KIDS!
TOP 10 REASONS WHY CAMP IS GREAT FOR KIDS!
10. Campers Spend the Day Being Physically Active
Children spend way too much time inside and most of that time sitting
down. Camp is walking, running, swimming, jumping, paddling, playing, hik-
ing, climbing and more!

9. Campers Gain Confidence by Experiencing Success
Camp helps build self-confidence and self-esteem by removing the
academic, athletic and social competition that shapes their lives at school.
With the diversity of activities and opportunities to succeed, camp is a real
boost for young people. There is accomplishment every day at camp.

8. Campers Gain Resiliency
The kind of encouragement and nurturing kids receive at camp makes it a
great environment to try new things, endure setbacks and try again. It’s
the perfect pressure-free environment to try new activities that may be a
bit fearful, a continuous part of life.

7. Campers Unplug
When kids take a break from television, cell phones, video games and the
internet, they rediscover their own creative powers and engage in the REAL
world, REAL people, REAL activities and REAL emotions. Camp is real!

6. Campers Develop Life-Long Skills
Camps provide the right instruction, equipment and facilities for kids to
enhance their athletic abilities, artistic talents and adventure skills. The
sheer variety of activities offered allows kids to discover and develop what
THEY like to do.

5. Campers Grow More Independent
Camp is the perfect place for kids to practice making decisions for themselves
without the constant guidance of a parent or teacher. Managing their daily
choices in a safe and caring environment, children welcome this freedom to
blossom in new directions. Camp helps kids develop who they are.

4. Campers Have Time for Unstructured Play
Free from the overly structured, overly scheduled routines of home, school
and athletics, life at camp gives children much needed time to just play!
Camp is a slice of carefree living where kids can relax, laugh and be silly all
day long. At camp we play!

3. Campers Learn Social Skills
Through the dynamic of camper groups, campers share jobs and
responsibilities, resolve disagreements, make group decisions, and learn
firsthand the importance of sincere communication. Camp builds teamwork.

2. Campers Reconnect with Nature
Camp is a wonderful antidote to Nature Deficit Disorder and the narrow
experience of modern indoor life. Outdoor experiences enrich a child’s
perception of the world and supports healthy childhood development.

1. Campers Make True Friends at Camp
Camp is a place where kids make their very best friends. Free from the
social expectations pressuring them at school, camp provides an easy and
silly no-pressure atmosphere for kids to make friends easily. All the fun at
camp draws everyone together; singing, laughing, talking, playing - doing
almost everything together. Camp creates friendships every day!

                                                                                  9
SUMMER VIBES YMCA CAMP Y-KODA - 2021 Summer Camp Brochure
WHAT IS NEEDED TO REGISTER                                       HOW TO REGISTER
                                Register at the Y, via email, mail or fax.
                                                                                                            1. IN PERSON REGISTRATION
                                •        At the time of registration, the completed 2021                    Completed registration forms along with the
                                         registration forms on pages 15 -18 are required for                down payment or full camp fees may be dropped
                                         each camper. This includes the Day Care Immunization               off at the Sheboygan YMCA, Sheboygan Falls
                                         Record for all children.                                           YMCA or Camp Y-Koda.

                                •        A one-time $15.00 registration fee and a $25.00 per                2. EMAIL REGISTRATION
                                         week camp deposit is due at the time of registration.              You can scan and email all completed
     REGISTRATION INFORMATION

                                                                                                            registration forms and payment information.
                                Children will be taken off rosters if:
                                •    All required paperwork is not on file at least 10                      3. MAIL REGISTRATION
                                     days prior to the start of your child’s first day of                   You can mail all completed registration forms
                                     camp. This is a State Licensing Mandate and we                         and payment.
                                     cannot allow a child to attend without completed
                                     paperwork.                                                             4. FAX REGISTRATION
                                •    There is an outstanding balance on any camp. The                       You can fax all completed registration forms
                                     payment schedule is listed on page 11.                                 and payment information.

                                                                                                 Registrations are processed in the order received. They
                                                                                                 are entered Monday - Friday. Confirmation of your child’s
                                                                                                 enrollment will be made via email when registration is
                                                                                                 complete.

                                                                                                 CONTACT INFORMATION

                                                                                                 YMCA CAMP Y-KODA
                                                                                                 W3340 Sunset Road
                                                                                                 Sheboygan Falls, WI 53085
                                                                                                 P 920-467-6882 • F 920-467-7240

                                                                                                 Terese Koene-Carroll, Billing and Registration
                                                                                                 Email: tcarroll@sheboygancountyymca.org

                                                                                                 SHEBOYGAN YMCA
                                                                                                 812 Broughton Drive
                                                                                                 Sheboygan, WI 53081
                                                                                                 P 920-451-8000 • F 920-451-8019

                                                                                                 Terri Keppler, Billing and Registration
                                                                                                 Email: tkeppler@sheboygancountyymca.org

                                                                                                 SHEBOYGAN FALLS YMCA
                                                                                                 305 Buffalo Street
                                                                                                 Sheboygan Falls, WI 53085
                                                                                                 P 920-467-2464 • F 920-467-4641

                                                                                                 Karen Meyer, Billing and Registration
                                                                                                 Email: kmeyer@sheboygancountyymca.org

Registration
- What is Needed
- How to Register

Contact
Information

                                    10
2021 PAYMENT SCHEDULE
                                                              Camp balances are due by the following dates:
                                                              Weeks 1 - 3........Final payment is due by........May 15, 2021
                                                              Weeks 4 - 7........Final payment is due by....... June 15, 2021
                                                              Weeks 8 - 11.....Final payment is due by........ July 15, 2021

                                                              The only other payment option is to complete a payment
                                                              policy form to authorize Camp Y-Koda to run your credit/
                                                              debit card for your child’s camp balance. Forms are available
                                                              on our website or see page 10 for contact information.

                                                                                                                                     REGISTRATION INFORMATION
                                                              FRIEND REQUEST
                                                              If your child plans to attend camp with a friend or group
                                                              of friends, you may request they be placed with the same
                                                              counselor by filling in the “Friend Request” on page 16.
                                                              Please note:
                                                              •    In order to be in the same group, children must be in
                                                                   the same age category and attend the same camp.
                                                              •    We will make every effort to grant your request.
                                                                   However, placement is not guaranteed as certain
                                                                   age groups are separated by State Licensing
                                                                   Regulations and we cannot make exceptions.

               3 MONEY
                       WAYS TO SAVE

1. 10% EARLY BIRD DISCOUNT
Register a camper for TWO OR MORE WEEKS of camp
by Thursday, April 1, 2021 and get 10% off the total
cost of your camp fees!

Special is per camper, not per household. The individual
camper must be signed up for two or more weeks of camp.
It is not valid for two siblings who are each signed up for
one week. Don’t delay! Take advantage of this wonderful
deal. The more weeks you sign up for, the more you save!

2. YMCA SUMMER MEMBERSHIP: 6/14/21 - 8/31/21
Purchase a summer youth membership for your child and                                                                           Ways to Save
they will receive the YMCA member rate for camps! Summer
membership rates are $30.00 for preschool through age                                                                           Payment
6 and $40.00 for ages 7 - 14. The summer membership                                                                             Schedule
application (available on our website) must be completed
before you register your child for camp.                                                                                        Friend Request

3. FINANCIAL SUPPORT
Scholarships are available for those who may need
assistance covering the cost of their camp experience.
Forms are available on our website or at the Sheboygan
YMCA and Sheboygan Falls YMCA.

                                                                                                                        11
1    WEEK 1: JUNE 14 -18, 2021                                            5   WEEK 5: JULY 12 - 16, 2021
                              Camp                              Age       Y Member   Participant       Camp
                              Day Camp                          6 - 13     $185.00     $205.00         Day Camp
                              Pee Wee Merry Unbirthday Camp     4-5        $215.00     $235.00         Pee Wee Splish Splash Camp

                         W    Blast From the Past Camp          9 - 12     $212.00     $232.00     W   Asteroids & Orbits Camp
                         E    Boots and Saddles Camp            7 - 10     $320.00     $340.00     E   Glamping Camp
                         E                                                                         E
                              Buggin’ Out Camp                  6-8        $201.00     $221.00         Mini Arts & Crafts Camp
                         K                                                                         K
                              Counselor in Training Camp        14 - 16    $242.00     $262.00         Ninja Warrior Camp
2021 CAMPS AT A GLANCE

                         1    Parkour Camp                      9 - 12     $215.00     $235.00     5   Road America Racing Camp
                              Timber Play Camp                  6-8        $201.00     $221.00         Maywood Capture the Flag Camp
                                                                                                       Maywood Mad Hatter Tree Party

                         2    WEEK 2: JUNE 21 - 25, 2021                                           6   WEEK 6: JULY 19 - 23, 2021
                              Camp                              Age       Y Member   Participant       Camp
                              Day Camp                          6 - 13     $185.00     $205.00         Day Camp
                              Pee Wee Little Chef Camp          4-5        $215.00     $235.00         Pee Wee Ooey Gooey Creations Camp

                         W    Boots and Saddles II Camp         11 - 14    $320.00     $340.00     W   Archery Basics Camp
                         E    High Ropes Camp                   9 - 14     $205.00     $225.00     E   Boots and Saddles Camp
                         E                                                                         E
                              Jurassic Island Adventure Camp    6-8        $201.00     $221.00         Mid-Summer Mania Camp
                         K                                                                         K
                              Kiwi Creations Camp               6-8        $257.00     $277.00         Mini Wet ‘n Wild Camp
                         2    Mermaids & Tritons Camp           5-7        $215.00     $235.00     6   Ropes, Rocks & Climb Adventure Camp
                              Safari Camp                       9 - 12     $201.00     $221.00         Maywood Quarry Quest Camp
                                                                                                       Maywood Wild Child Camp

                         3    WEEK 3: JUNE 28 - JULY 2, 2021                                       7   WEEK 7: JULY 26 - 30, 2021
                              Camp                              Age       Y Member   Participant       Camp
                              Day Camp                          6 - 13     $185.00     $205.00         Day Camp
                              Pee Wee Radical Reptiles Camp     4-5        $215.00     $235.00         Pee Wee Bugs, Bugs, Bugs! Camp

                         W    Amazing Animals Camp              6-8        $209.00     $229.00     W   Advanced Fishing Camp
                         E    Carpenter’s Apprentice Camp       9 - 12     $215.00     $235.00     E   Boots and Saddles Camp
                         E                                                                         E
                              Slimy Arty Party Camp             6-8        $209.00     $229.00         Color Wars Camp
                         K                                                                         K
                              Summer Olympic Games Camp         9 - 12     $205.00     $225.00         Mini Survivor Camp
                         3    Wildman’s Adventure Trip          12 - 16    $485.00     $505.00     7   Stranded Resident Camp
                                                                                                       Maywood Mini Quarry Quest Camp
                                                                                                       Maywood The Great Bake-Off Camp

                         4    WEEK 4: JULY 5 - 9, 2021                                             8   WEEK 8: AUGUST 2 - 6, 2021
                              Camp                              Age       Y Member   Participant       Camp
                              Day Camp                          6 - 13     $185.00     $205.00         Day Camp
                              Pee Wee Lil Athlete Camp          4-5        $215.00     $235.00         Pee Wee Beach Bash Camp

                         W    Choose Your Own Adventure Camp    12 - 16    $201.00     $221.00     W   Boots and Saddles II Camp
                         E    Junior Kayak Camp                 8 - 10     $209.00     $229.00     E   Bullseye Camp
                         E                                                                         E
                              Mini All Week Pool Party          6-8        $205.00     $225.00         Great Unbirthday Camp
                         K                                                                         K
                              Neverland Camp                    5-8        $201.00     $221.00         Mini Super Sports Camp
                         4    Zombie Apocalypse Resident Camp   9 - 13     $340.00     $360.00     8   Tenting It Camp
                                                                                                       Pictured Rocks Adventure Trip
                                                                                                       Maywood Quarry Quest Camp
                                                                                                       Maywood Woodland Workshop Camp
                         12
9   WEEK 9: AUGUST 9 - 13, 2021
Age       Y Member   Participant       Camp                             Age       Y Member   Participant
6 - 13     $185.00     $205.00         Day Camp                         6 - 13     $185.00     $205.00
4-5        $215.00     $235.00         Pee Wee Mini Artist Camp         4-5        $215.00     $235.00
6-8        $215.00     $235.00     W   BB Gun Camp                      9 - 12     $201.00     $221.00
9 - 12     $201.00     $221.00     E   Boots and Saddles Camp           7 - 10     $320.00     $340.00
                                   E
6-8        $215.00     $235.00         Hook, Line & Sinker Camp         6-8        $201.00     $221.00
                                   K
9 - 12     $215.00     $235.00         Mad Scientist Camp               6-8        $205.00     $225.00

                                                                                                           2021 CAMPS AT A GLANCE
12 - 16    $365.00     $385.00     9   Thrill Seekers Camp              12 - 16    $235.00     $255.00
10 - 14    $205.00     $225.00         Wet ‘n Wild Camp                 9 - 12     $236.00     $256.00
7-9        $205.00     $225.00

                                   10 WEEK 10: AUGUST 16 - 20, 2021
Age       Y Member   Participant       Camp                             Age       Y Member   Participant
6 - 13     $185.00     $205.00         Day Camp                         6 - 13     $185.00     $205.00
4-5        $215.00     $235.00         Pee Wee Under the Sea Camp       4-5        $215.00     $235.00
7-9        $201.00     $221.00     W   Bedazzled Camp                   6-8        $205.00     $225.00
                                   E
7 - 10     $320.00     $340.00     E   Kiwi Creations II Camp           8 - 10     $257.00     $277.00
9 - 12     $205.00     $225.00     K   Little Ninjas Camp               6-8        $205.00     $225.00
6-8        $215.00     $235.00         Twisted Sports Camp              9 - 12     $201.00     $221.00
                                   1
12 - 16    $305.00     $325.00     0   Apostle Islands Adventure Trip   12 - 16    $460.00     $480.00
10 - 14    $232.00     $252.00
7-9        $195.00     $215.00

                                   11 WEEK 11: AUGUST 23 - 27, 2021
Age       Y Member   Participant       Camp                             Age       Y Member   Participant
6 - 13     $185.00     $205.00         Day Camp                         6 - 13     $185.00     $205.00
4-5        $215.00     $235.00         Pee Wee Let’s Go Camping Camp    4-5        $215.00     $235.00
9 - 12     $201.00     $221.00     W   High Ropes Camp                  9 - 14     $205.00     $225.00
                                   E
7 - 10     $320.00     $340.00     E   Mini Wet ‘n Wild Camp            6-8        $215.00     $235.00
8 - 12     $201.00     $221.00     K   Season Finale Camp               9 - 12     $201.00     $221.00
6-8        $201.00     $221.00
                                   1
9 - 13     $340.00     $360.00     1
7-9        $232.00     $252.00
10 - 14    $215.00     $235.00

Age       Y Member   Participant
6 - 13     $185.00     $205.00
4-5        $215.00     $235.00
11 - 14    $320.00     $340.00
9 - 12     $201.00     $221.00
5-8        $201.00     $221.00
6-8        $201.00     $221.00
9 - 12     $256.00     $276.00
12 - 16    $430.00     $450.00
10 - 14    $232.00     $252.00
7-9        $195.00     $215.00
                                                                                                    13
SUMMER CAMP OPEN HOUSE NIGHTS
                                   Hosted by the Y-Koda Camper Council
                                   Come discover summer with YMCA Camp Y-Koda! At our                       KIDS
                                   summer camp open houses, you will have the opportunity
                                   to explore our camp offerings, tour the grounds and meet                 NEED
                                                                                                            CAMP
                                   with our camp directors to address any questions you
                                   have about the upcoming camp season or to help with any
                                   registration form inquires.
    OPEN HOUSES & KIDS NEED CAMP

                                                                                                        In a typical summer,
                                   Our grounds will be open at both                                     campers will experience:
                                   locations to walk the properties,
                                   purchase camp gear, view the cabins,               OPEN
                                   facilities and so much more!                       HOUSE
                                   CAMP Y-KODA OPEN HOUSES
                                                                                              2250
                                   May 18 - Tuesday.................4:00pm - 6:00pm
                                   May 20 - Thursday...............4:00pm - 6:00pm            minutes
                                   May 26 - Wednesday............4:00pm - 6:00pm              outdoors each week.
                                   MAYWOOD OPEN HOUSE
                                   June 23 - Wednesday...........4:00pm - 6:00pm
                                                                                              1900
                                   Can't attend any of these dates? No problem! Call camp
                                   at 920-467-6882 to schedule a tour with one of our         minutes
                                   directors either at Camp Y-Koda or Maywood.                playing each week.

                                                                                              225
                                                                                              minutes
                                                                                              swimming each week.

                                                                                              60
                                                                                              minutes
                                                                                              singing each week.

                                                                                              170
                                                                                              opportunities
                                                                                              to meet new friends!

                                                                                              0
Open Houses
                                                                                              minutes
Kids Need Camp                                                                                on cell phones/electronics!

                                                                                              and hundreds upon hundreds of minutes
                                                                                              exploring, swinging, splashing, digging,
                                                                                              creating, learning, trying, tagging,
                                                                                              climbing, laughing, building and more!

                                   14
CAMP Y-KODA AND MAYWOOD 2021 REGISTRATION FORM
                                                                                                                                                                                                                                                   Camper LAST Name_____________________________________________________FIRST Name________________________________________________ Birth Date___________________________ Age____________
Camper LAST Name___________________________________________________________________________________________________________ Camper FIRST Name___________________________________________________________________________________________________

                                                                                                                                                                                                                                                    R WEEK 1: 6/14-6/18, 2021                   R WEEK 4: 7/5-7/9, 2021                          R WEEK 7: 7/26-7/30, 2021                   R WEEK 10: 8/16-8/20, 2021
                                                                                                                                                                                                                                                         Extended Care                               Extended Care                                   Extended Care                                Extended Care
                                                                                                                                                                                                                                                         Day Camp                                    Day Camp                                        Day Camp                                     Day Camp
                                                                                                                                                                                                                                                         Pee Wee Camp                                Pee Wee Camp                                    Pee Wee Camp                                 Pee Wee Camp
                                                                                                                                                                                                                                                         Blast From the Past Camp                    Choose Your Own Adventure Camp                  Advanced Fishing Camp                        Bedazzled Camp
                                                                                                                                                                                                                                                         Boots and Saddles Camp                      Junior Kayak Camp                               Boots and Saddles Camp                       Kiwi Creations II Camp
                                                                                                                                                                                                                                                         Buggin’ Out Camp                            Mini All Week Pool Party                        Color Wars Camp                              Little Ninjas Camp
                                                                                                                                                                                                                                                         Counselor in Training Camp                  Neverland Camp                                  Mini Survivor Camp                           Twisted Sports Camp
                                                                                                                                                                                                                                                         Parkour Camp                                Zombie Apocalypse Resident Camp                 Stranded Resident Camp                       Apostle Islands Adventure Camp
                                                                                                                                                                                                                                                         Timber Play Camp                                                                            Maywood Mini Quarry Quest
                                                                                                                                                                                                                                                                                                                                                     Maywood The Great Bake-Off

                                                                                                                                                                                                                                                    R WEEK 2: 6/21-6/25, 2021                   R WEEK 5: 7/12-7/16, 2021                        R WEEK 8: 8/2-8/6, 2021                     R WEEK 11: 8/23-8/27, 2021
                                                                                                                                                                                                                                                         Extended Care                               Extended Care                                   Extended Care                                Extended Care
                                                                                                                                                                                                                                                         Day Camp                                    Day Camp                                        Day Camp                                     Day Camp
                                                                                                                                                                                                                                                         Pee Wee Camp                                Pee Wee Camp                                    Pee Wee Camp                                 Pee Wee Camp
                                                                                                                                                                                                                                                         Boots & Saddles II Camp                     Asteroids & Orbits Camp                         Boots and Saddles II Camp                    High Ropes Camp
                                                                                                                                                                                                                                                         High Ropes Camp                             Glamping Camp                                   Bullseye Camp                                Mini Wet ‘n Wild Camp
                                                                                                                                                                                                                                                         Jurassic Island Adventure Camp              Mini Arts & Crafts Camp                         Great Unbirthday Camp                        Season Finale Camp
                                                                                                                                                                                                                                                         Kiwi Creations Camp                         Ninja Warrior Camp                              Mini Super Sports Camp
                                                                                                                                                                                                                                                         Mermaids & Tritons Camp                     Road America Racing Camp                        Tenting It Camp
                                                                                                                                                                                                                                                         Safari Camp                                 Maywood Capture the Flag Camp                   Pictured Rocks Adventure Trip
                                                                                                                                                                                                                                                                                                     Maywood Mad Hatter Tree Party                   Maywood Quarry Quest Camp
                                                                                                                                                                                                                                                                                                                                                     Maywood Woodland Workshop

                                                                                                                                                                                                                                                    R WEEK 3: 6/28-7/2, 2021                    R WEEK 6: 7/19-7/23, 2021                        R WEEK 9: 8/9-8/13, 2021                    PLEASE NOTE:
                                                                                                                                                                                                                                                                                                                                                                                             The completed 2021 registration
                                                                                                                                                                                                                                                         Extended Care                               Extended Care                                   Extended Care
                                                                                                                                                                                                                                                                                                                                                                                             forms on pages 15 -18 are required
                                                                                                                                                                                                                                                         Day Camp                                    Day Camp                                        Day Camp                                for each camper AT THE TIME OF
                                                                                                                                                                                                                                                                                                                                                                                             REGISTRATION.
                                                                                                                                                                                                                                                         Pee Wee Camp                                Pee Wee Camp                                    Pee Wee Camp
                                                                                                                                                                                                                                                         Amazing Animals Camp                        Archery Basics Camp                             BB Gun Camp                             A Day Care Immunization Record is
                                                                                                                                                                                                                                                                                                                                                                                             required for all children. You may:
                                                                                                                                                                                                                                                         Carpenter’s Apprentice Camp                 Boots and Saddles Camp                          Boots and Saddles Camp
                                                                                                                                                                                                                                                                                                                                                                                             •    Contact your child’s doctor
                                                                                                                                                                                                                                                         Slimy Arty Party Camp                       Mid-Summer Mania Camp                           Hook, Line & Sinker Camp                     for a copy and attach it to the
                                                                                                                                                                                                                                                                                                                                                                                                  registration forms.
                                                                                                                                                                                                                                                         Summer Olympic Games Camp                   Mini Wet ‘n Wild Camp                           Mad Scientist Camp
                                                                                                                                                                                                                                                                                                                                                                                             •    Obtain a copy on-line at
                                                                                                                                                                                                                                                         Wildman’s Adventure Trip                    Rocks/Ropes/Climb Adventure Camp                Thrill Seekers Camp                          https://www.dhfswir.org and
                                                                                                                                                                                                                                                                                                                                                                                                  attach it to the registration
                                                                                                                                                                                                                                                                                                     Maywood Quarry Quest Camp                       Wet ‘n Wild Camp
                                                                                                                                                                                                                                                                                                                                                                                                  forms.
                                                                                                                                                                                                                                                                                                     Maywood Wild Child Camp                                                                 •    Fill out the form on page 18.

                                                                                                                                                                                                                                                    R CAMP Y-KODA TRANSPORTATION                                                                     R MAYWOOD TRANSPORTATION
                                                                                                                                                                                                                                                    R TO Camp Y-Koda                            R FROM Camp Y-Koda                                   R TO Maywood                            R FROM Maywood
                                                                                                                                                                                                                                                         None: Parent Drop-off                       None: Parent Pick-up                                 None: Parent Drop-off                   None: Parent Pick-up
                                                                                                                                                                                                                                                         Sheboygan YMCA                              Sheboygan YMCA                                       Sheboygan YMCA                          Sheboygan YMCA
                                                                                                                                                                                                                                                         North High School                           North High School                                    North High School                       North High School
                                                                                                                                                                                                                                                         Cleveland Park                              Cleveland Park                                       Cleveland Park                          Cleveland Park
                                                                                                                                                                                                                                                         Maywood                                     Maywood                                         R EXTENDED CARE                         R YMCA MEMBERSHIP
                                                                                                                                                                                                                                                         South High School                           South High School                               R Location                              R YMCA Member
                                                                                                                                                                                                                                                         Kohler Elementary School                    Kohler Elementary School                             Sheboygan YMCA                          Yes
                                                                                                                                                                                                                                                         Sheboygan Falls YMCA                        Sheboygan Falls YMCA                                 Sheboygan Falls YMCA                    No
                                                                                                                                                                                                                                                                                                                                                          Camp Y-Koda

                                                                                                                                                                                                                                                                                                                                                                                                         15
2021 CAMPER, CONTACT AND HEALTH INFORMATION

                                                                                               HEALTH HISTORY AND EMERGENCY CARE PLAN
 •     Please fill out registration information completely. Submit a
                                                                                               1. Please R check any special medical condition your child may have.
       separate form for each camper. Forms may be copied.
 •     Registration forms must be on file prior to your child attending                            No specific medical condition
       camp at Camp Y-Koda or Maywood.                                                             Asthma
 •     The Day Care Immunization Record is required for all children.                              Cerebral Palsy/motor disorder
                                                                                                   Diabetes
 R T-SHIRT SIZE
  Youth Small                     Youth Medium                  Youth Large                     Epilepsy/seizure disorder
  Adult Small                     Adult Medium                  Adult Large                     Gastrointestinal or feeding concerns
                                                                                                    including special diet and supplements
 FRIEND REQUEST - MUST ATTEND SAME CAMP!                                                           Any disorder including
 Friend’s Name_______________________________________________________________________               Cognitively Disabled, LD, ADD, ADHD or Autism
 Week___________________ Camp_________________________________________________________             Other condition requiring special care - specify:
 Week___________________ Camp_________________________________________________________              ______________________________________________________________________________________
                                                                                                    ______________________________________________________________________________________
 Friend’s Name_______________________________________________________________________
                                                                                                   Milk allergy
 Week___________________ Camp_________________________________________________________
                                                                                                    if child is allergic to milk, attach statement from medical
 Week___________________ Camp_________________________________________________________              professional including the acceptable alternative
                                                                                                   Food allergies - specify foods:
CAMPER INFORMATION Please print clearly!
                                                                                                    ______________________________________________________________________________________
Camper’s Name_______________________________________
                                                                                                    ______________________________________________________________________________________
Birth Date__________________________________________________________________  M  F
                                                                                                   Non-food allergies - specify:
Address____________________________________________________________________________________
City____________________________________________State_____________Zip_______________________        ______________________________________________________________________________________

Phone 1______________________________________Phone 2____________________________________            ______________________________________________________________________________________

PRIMARY CONTACT INFORMATION                                                                    2.   Triggers that may cause problems - specify.
Name_______________________________________________________________________________________         _____________________________________________
Relationship to Camper_________________________________________________________________             _____________________________________________
Phone 1______________________________________Phone 2____________________________________
Email Required___________________________________________________________________________      3.   Signs or symptoms to watch for - specify.
                                                                                                    _____________________________________________
SECONDARY CONTACT INFORMATION                                                                       _____________________________________________
Name_______________________________________________________________________________________
Relationship to Camper_________________________________________________________________        4.   Steps the child care provider should follow. If prescription or non-
                                                                                                    prescription medications are necessary, a copy of the Authorization
Phone 1______________________________________Phone 2____________________________________
                                                                                                    to Administer Medication form (available on camp’s website) should
Email Required___________________________________________________________________________           be attached to this form.
                                                                                                    _____________________________________________
ADDITIONAL EMERGENCY CONTACT
                                                                                                    _____________________________________________
Name_______________________________________________________________________________________
Relationship to Camper_________________________________________________________________        5.   Identify any staff to whom you have given specialized training/
Phone 1______________________________________Phone 2____________________________________            instructions to help treat symptoms.
Is this person authorized to pick up child?                        Yes            No              a.____________________________________________________________________________________
                                                                                                    b.___________________________________________________________________________________
PHYSICIAN/MEDICAL FACILITY INFORMATION                                                              c.____________________________________________
Physician Name__________________________________________________________________________
Phone 1______________________________________Phone 2____________________________________       6.   When to call parents regarding symptoms or failure to respond to
Address - Medical Facility______________________________________________________________            treatment:
City____________________________________________State_____________Zip_______________________        ______________________________________________________________________________________

PARENTAL AUTHORIZATION FOR CHILD OVER AGE 7                                                    7.   When to consider that the condition requires emergency medical
 Authorization for Child over Age 7                                     R Yes     R No              care or reassessment:

 I authorize my child to carry bee sting medication, an  Yes                                       ______________________________________________________________________________________
                                                                                   No
 inhaler, insulin syringe, other medication or device.
                                                                                               8.   Additional information that may be helpful to camp:
CAMP EXPERIENCE                                                                                     ______________________________________________________________________________________
Does child have prior camp experience?                             Yes            No              ______________________________________________________________________________________
If yes, please specify____________________________________________________________________

                             16
2021 AUTHORIZATIONS AND PAYMENT INFORMATION

SUNSCREEN/INSECT REPELLENT AUTHORIZATION
                                                                                                  TOTAL COST OF SUMMER CAMP
The sunscreen or repellent should be labeled with the child’s name.
                                                                                                  Total Camp Fees                                                  $
 SUNCREEN AUTHORIZATION                                                 R Yes R No                Less 10% Early Bird Discount until 4/1/21*                       $
 I authorize the center to apply sunscreen to my child.                  Yes  No                *Child must go to TWO or more weeks to receive early bird discount.
 I authorize the center to allow my child to self-apply  Yes  No                                Total Extended Care             @ $25.00 per Week                $
 sunscreen.
                                                                                                  Total Bus Service Fee           @ $15.00 per Week
 Sunscreen Brand                                Ingredient Strength
                                                                                                  One Time Registration Fee                                        $              15.00
                                                                                                  Total Amount Due
 INSECT REPELLENT AUTHORIZATION                                         R Yes R No
                                                                                                  AMOUNT DUE AT TIME OF REGISTRATION
 I authorize the center to apply insect repellent to my child.  Yes  No
                                                                                                  $25.00 Deposit per Week of Camp                                  $
 I authorize the center to allow my child to self-apply  Yes  No
 insect repellent.                                                                                One Time Registration Fee                                        $              15.00
 Insect Repellent Brand                         Ingredient Strength                               Down Payment Due                                                 $
                                                                                                  Balance Due (Total less down payment)                            $

BUS AND FIELD TRIP PERMISSION                                                                 •      Please see page 10 for detailed registration information.
Bussing: I hereby authorize Camp Y-Koda to transport my child by bus to                       •      If you email or fax the completed forms, payment information may
and from Camp Y-Koda or Maywood at the bus stop that I have specified                                be listed below -OR- you can call and provide a credit card number.
on page 15. I understand that either myself or one of the persons                             •      REGISTRATIONS WILL NOT BE PROCESSED WITHOUT PAYMENT.
indicated below as an authorized pick-up person must be present to pick
up my child. I have read and understand the above statements and I grant                      CANCELLATION POLICY/NON-REFUNDABLE FEES
my permission as indicated by my signature.                                                   •  The $15.00 registration fee and all $25.00 camp deposits are non-
                                                                                                 refundable under any circumstances.
Field Trips: I hereby authorize Camp Y-Koda to transport my child back                        •  Any payment made in addition to required down payment is refund-
and forth from Camp Y-Koda or Maywood for field trips.                                           able only if we are notified of cancellation in writing by May 1, 2021.
                                                                                              •  There are no refunds on cancellations received after May 1, 2021.
Parent Signature________________________________________________________________________      •  The $15.00 per week bussing fee is non-refundable.

AUTHORIZED PICK-UP PERSON                                                                     PARTICIPATION AND PAYMENT AGREEMENT
In the event that I am not available to call or pick up my child, the bus                     I approve this application and certify that the applicant is capable of such
driver and/or camp staff are permitted to leave my child with:                                an experience. I grant permission for the applicant to participate in all
                                                                                              planned camp activities, including out-of-camp trips by van, bus or hiking.
Name_______________________________________________________________________________________   In case of accident or illness, the YMCA is authorized to secure emergency
                                                                                              medical treatment. Prudent attempts will be made to contact the parents
Phone 1______________________________________Phone 2____________________________________
                                                                                              immediately. The YMCA is not responsible for lost, stolen or damaged
Relationship to Child____________________________________________________________________     personal articles. I also authorize the YMCA to have and use photographs
                                                                                              and videos of the person named on this application as may be needed
Name_______________________________________________________________________________________   for its public relations programs. I agree to waive any claims against the
Phone 1______________________________________Phone 2____________________________________      YMCA and its members and volunteers for injuries or damages that may
                                                                                              result from the conduct of other persons including participants in YMCA
Relationship to Child____________________________________________________________________     programs.

Driver’s license or photo ID is required to show proof of identity. If                        I agree to pay the balance of camp fees prior to the payment schedule on
the above named person is not present, the child will be taken to the                         page 11. We cannot hold reserved space past that date without full payment.
Sheboygan YMCA.                                                                               All change and cancellation requests must be made in writing. I understand
                                                                                              no refunds are given if a child leaves early because of homesickness or for
SPECIAL ACTIVITIES PERMISSION AT CAMP Y-KODA                                                  disruptive behavior as determined by the Executive Director.
I hereby authorize my child to participate in the following activities:
Archery ....................age 7 and older   Yes          No
                                                                                              Parent Signature_______________________________________________________________________
BB Gun .....................age 9 and older   Yes          No
Climbing Wall ..........age 9 and older       Yes          No                               Date_______________________________________________________________________________________
Sling Shots................age 7 and older    Yes          No
                                                                                              PAYMENT INFORMATION
CAMPER SWIMMING SKILLS                                                                         Cash
Please R check all that apply.                                                                 Check #_________________________ (payable to Sheboygan County YMCA)
 My child enjoys the water.                                                                   Credit Card (VISA, Mastercard or Discover)
 My child can float.                                                                                Card #_______________________________________________________________________________
 My child will jump from the side.
                                                                                                     Expiration Date____________________________ Security Code______________________
 My child is comfortable in chest-deep water.
 My child can swim 10 - 20 yards.
 My child can swim 25 yards.                                                                 Receipt #______________________________________________ Date______________________________
                                                                                              Amount $_____________________________________________ Staff______________________________
                                                                                                                                                          17
DEPARTMENT OF HEALTH SERVICES                                                                                                           STATE OF WISCONSIN
Division of Public Health                                                                                                                   Wis. Stat. § 252.04
F-44192 (Rev. 12/2017)                                   CHILD CARE IMMUNIZATION RECORD
COMPLETE AND RETURN TO CHILD CARE CENTER. State law requires all children in child care centers to present evidence of immunization against
certain diseases within 30 school days (6 calendar weeks) of admission to the child care center. These requirements can be waived only if a properly
signed health, religious, or personal conviction waiver is filed with the child care center. See “Waivers” below. If you have any questions about immunizations,
or how to complete this form, please contact your child’s child care provider or your local health department.

               PERSONAL DATA                                                  PLEASE PRINT
STEP 1     Child’s Name(Last, First, Middle Initial)                                         Date of Birth (Month/Day/Year)      Area Code/Telephone Number

           Name of Parent/Guardian/Legal Custodian (Last, First, Middle Initial)             Address (Street, Apartment number, City, State, Zip)

           IMMUNIZATION HISTORY
STEP 2     List the MONTH, DAY AND YEAR the child received each of the following immunizations. DO NOT USE A (√         √) OR (X) except to indicate whether
           the child has had chickenpox. If you do not have an immunization record for this child, contact your doctor or local public health department to
           obtain the records.
                                                           First Dose        Second Dose             Third Dose          Fourth Dose             Fifth Dose
           TYPE OF VACCINE
                                                        Month/Day/Year      Month/Day/Year        Month/Day/Year       Month/Day/Year         Month/Day/Year
           Diphtheria-Tetanus-Pertussis
           (Specify DTP, DTaP, or DT)
           Polio
           Hib (Haemophilus Influenzae Type B)
           Pneumococcal Conjugate Vaccine (PCV)
           Hepatitis B
           Measles-Mumps-Rubella (MMR)
           Varicella (chickenpox) vaccine
           Vaccine is required only if the child has
           not had chickenpox disease.
           Has the child had Varicella (chickenpox) disease? Check the appropriate box and provide the year if known.
              Yes year _____________________ (Vaccine is not required)
                 No or Unsure (Vaccine is required)

           REQUIREMENTS
STEP 3     The following are the minimum required immunizations for the child’s age/grade at entry. All children within the range must meet these
           requirements at child care entrance. Children who reach a new age/grade level while attending this child care must have their records updated
           with dates of additional required doses.
                    AGE LEVELS                                                          NUMBER OF DOSES
            5 months through 15 months         2 DTP/DTaP/DT            2 Polio      2 Hib       2 PCV          2 Hep B
           16 months through 23 months         3 DTP/DTaP/DT            2 Polio      3 Hib1      3 PCV2         2 Hep B         1 MMR3
                                                                                           1              2
            2 years through 4 years            4 DTP/DTaP/DT            3 Polio      3 Hib       3 PCV          3 Hep B         1 MMR3     1 Varicella
           At Kindergarten entrance            4 DTP/DTaP/DT 4          4 Polio                                 3 Hep B         2 MMR3     2 Varicella
           1
            If the child began the Hib series at 12-14 months of age, only 2 doses are required. If the child received one dose of Hib at 15 months of age or
            after, no additional doses are required. Minimum of one dose must be received after 12 months of age (Note: a dose 4 days or less before the
            first birthday is also acceptable).
           2
            If the child began the PCV series at 12-23 months of age, only 2 doses are required. If the child received the first dose of PCV at 24 months of
            age or after, no additional doses are required.
           3
            MMR vaccine must have been received on or after the first birthday (Note: a dose 4 days or less before the 1st birthday is also acceptable).
           4
            Children entering kindergarten must have received one dose after the 4th birthday (either the 3rd, 4th or 5th) to be compliant (Note: a dose 4 days
            or less before the 4th birthday is also acceptable).
           COMPLIANCE DATA AND WAIVERS
STEP 4     IF THE CHILD MEETS ALL REQUIREMENTS (sign at STEP 5 and return this form to the child care center), OR
           IF THE CHILD DOES NOT MEET ALL REQUIREMENTS (check the appropriate box below, sign and return this form to child care center).

                  Although the child has not received all required doses of vaccine for his or her age group, at least the first dose of each vaccine has been
                  received. I, understand that it is my responsibility to obtain the remaining required doses of vaccines for this child WITHIN ONE YEAR and
                  to notify the child care center in writing as each dose is received.
           NOTE: Failure to stay on schedule or report immunizations to the child care center may result in court action against the parents and a
           fine of up to $25.00 per day of violation.

                For health reasons this child should not receive the following immunizations __________(List in STEP 2 any immunizations already
           received)
                                                                    ______________________________________________________________________
                                                                     Physician’s Signature Required
                  For religious reasons this child should not be immunized. (List in STEP 2 any immunizations already received)

                  For personal conviction reasons this child should not be immunized. (List in STEP 2 any immunizations already received):
           SIGNATURE
STEP 5
               To the best of my knowledge, this form is complete and accurate.
               _________________________________________________________________________                        ___________________________________
               SIGNATURE - Parent, Guardian or Legal Custodian                                                   Date Signed

                         18
YMCA CAMP Y-KODA
 Camp Y-Koda is an 80 acre camp located just west of Sheboygan Falls bordered by the
 Sheboygan River to the north and east. The camp was founded in 1969 by the Sheboygan
 County YMCA and has been offering summer camp experiences ever since. Camp Y-Koda
 features a beautiful stretch of the Sheboygan River for canoeing, kayaking, tubing and
 nature studies. The property has a low and high ropes course complete with a zip line and
 40-foot climbing wall.

 YMCA Camp Y-Koda also features a swimming pool, four acre lake, bb gun and archery
 range, basketball and volleyball courts, playground, soccer field, arts and crafts center

                                                                                                                                   CAMP Y-KODA INFORMATION
 and camp store, and a huge slip and slide. There are two lodges at camp, Lohmann Lodge
 and Johnsonville Lodge. They serve as headquarter areas during inclement weather, our
 cafeteria and lodging for resident camps and other indoor programming. Camp has four
 campsites which include cabins, a picnic and campfire area. In addition, Camp has a new
 pavilion area named the Denison Pavilion, which houses our Pee Wee campers and is a
 site for snack and camp activities.

LOCATION                                                       THURSDAY FAMILY NIGHT AND CAMP SLEEPOVER
YMCA Camp Y-Koda                                               On Thursdays, campers leave at 4:00pm and then return
W3340 Sunset Road, Sheboygan Falls, WI 53085                   later with their family for the Thursday Family Program and
                                                               camp sleepover. Throughout our camp week, each group
HOURS OF OPERATION                                             will practice a camp song and entertaining skit to perform
Summer Camp Hours.............8:30am - 4:00pm                  and sing at the family program. This event allows families
Summer Office Hours............7:15am - 5:30pm                 to meet the counselors, tour the grounds and see the fun
                                                               activities the camper has been doing all week. The program
The office is staffed all night during Thursday
                                                               begins at 7:30pm for weeks 1-7 and at 7:00pm for weeks
night sleepovers and all resident camps.
                                                               8-11. Families are encouraged to arrive 30 minutes prior to
                                                               drop items off and shop at the camp store.
CONTACT INFORMATION
Jeremiah Dentz
                                                               When the program is finished, all campers who would like to
Executive Director
                                                               sleepover will meet at their campsite with their counselor
jdentz@sheboygancountyymca.org
                                                               and partake in a night activity, campfire songs and more!
                                                               Our night activities range from swimming in the camp pool,
Kaitlyn Rautmann
                                                               carnivals, night hikes, star gazing, a campfire sing-a-long
Summer Camp Director
                                                               and so much more!
krautmann@sheboygancountyymca.org
                                                               If the Family Program and sleepover is cancelled due to
Terese Koene-Carroll
                                                               inclement weather, it will be announced on Camp Y-Koda’s
Billing and Registration
                                                               website www.sheboygancountyymca.org/camp-y-koda and
tcarroll@sheboygancountyymca.org
                                                               Facebook page.
Phone............920-467-6882
                                                               CAMP STORE
Fax................920-467-7240
                                                               The camp store is your official source for a wide variety of
                                                               novelty items and camp “swag” such as t-shirts, sweatpants,
                                                               long sleeve sweatshirts, hats and more! Campers may also
                                                               purchase nutritious snacks and refreshments at select times
                                                               during the week and on Thursday evening during the family
                                                               program. The store is not open on Monday. Snack items are
                                                               $0.25 to $1.50. Merchandise items range from $1.50 to
                                                               $50.00. We recommend purchasing all merchandise items
                                                               on Thursday night.                                             Location

                                                               CAMP POOL                                                      Hours
                                                               All groups using our pool are supervised by camp staff who     of Operation
                                                               are lifeguard certified by the American Red Cross. Each
                                                               camper is required to take a swim test to determine their      Contact
                                                               swimming ability. If your child passes the swim test, they     Information
                                                               will wear a green wristband. If they do not pass, they are
                                                               required to stay in the roped-off shallow end. The deepest     Family Night/
                                                               part of our pool is 4 ½ feet and the shallowest area is 2      Sleepover
                                                               ½ feet. Lifejackets are available to use upon request. More
                                                               pool information can be found in the Parent Handbook.          Camp Store

                                                                                                                              Camp Pool

                                                                                                                       19
PEE WEE CAMPS                             WEEKS 1 - 11
                                 Ages 4 - 5
                                 This program is designed especially for young children
                                 to enjoy a great camp experience. The Pee Wee program
                                 is run by its own director who develops age appropriate
                                 curriculum and activities. We pay special attention to
                                 our youngest campers to make sure that their first camp
                                 experience is a positive one. Pee Wees will attend the
                                 Family Program, but won’t sleep over. All Pee Wee Camps
    CAMP Y-KODA PEE WEE CAMPS

                                 have a theme each week.

                                PEE WEE “MERRY UNBIRTHDAY PARTY” CAMP WEEK 1
                                A merry, merry unbirthday to you! Get ready to celebrate
                                your birthday camp style with games, piñatas, face painting,
                                delicious treats and more. Happy Unbirthday!

                                PEE WEE “LITTLE CHEF” CAMP                         WEEK 2
                                Together campers will learn some easy-to-make and easier-
                                to-eat recipes! We’ll craft our very own cookbook and cook
                                delicious treats for our Thursday bake sale, which will be
                                sold at our Thursday Night Family Program.

                                PEE WEE “RADICAL REPTILES” CAMP                     WEEK 3
                                If your camper loves snakes, turtles and lizards, this is the
                                camp for them! We’ll learn about Wisconsin reptiles that
                                live near us, and what makes these animals freaky, fun and
                                fascinating. During the week, we’ll get the chance to touch
                                our camp snakes! Mid-week we’ll join the Amazing Animals        PEE WEE “SPLISH SPLASH” CAMP                       WEEK 5
                                Camp at a zoo.                                                  Splish, splash you’ll have a blast in all things water!
                                                                                                Throughout the week, we’ll splash into the pool with games,
                                PEE WEE “LIL ATHLETE” CAMP                           WEEK 4     go down the camp slip n’slide and head to the beach for
                                It’s time for an action-packed week of teamwork and FUN!        more. On Friday, we’ll have our very own pool party!
                                T-ball, soccer, basketball, kickball, relay races, swimming,
                                you name it... we’ll play it!                                   PEE WEE “OOEY GOOEY CREATIONS” CAMP                WEEK 6
                                                                                                Get ready for some ooey gooey fun! Find your inner Einstein
                                                                                                while making goo, slime and more. We’re sure to get our
                                                                                                hands ooey and gooey this week!

                                                                                                PEE WEE “BUGS, BUGS, BUGS!” CAMP                      WEEK 7
                                                                                                Creepy, crawly, scary bugs is what this week is all about! If
                                                                                                your child loves to look at bugs, then this is the right camp
                                                                                                for them. We will look for bugs, learn about bugs and play
                                                                                                bug games. Who wouldn’t have fun bugging into some fun?

                                                                                                PEE WEE “BEACH BASH” CAMP                       WEEK 8
                                                                                                Let’s take our group to the beach at camp! Campers will
                                                                                                make awesome sand art, do a little limbo and play beach
                                                                                                games. The fun in the sun never stops!

                                                                                                PEE WEE “MINI ARTIST” CAMP                          WEEK 9
Pee Wee Camps                                                                                   Paint, sparkles, markers, glue and so much more! This week
for Ages 4 - 5                                                                                  is full of creativity, smiles and inspiring artists that will
                                                                                                have a blast at doing what they do best. We’ll make many
                                                                                                projects throughout the week to bring home, and we’ll show
                                                                                                these off at the Thursday night Parent Program!

                                                                                                PEE WEE “UNDER THE SEA” CAMP                      WEEK 10
                                                                                                Get ready to take a splash under the sea by discovering sea
                                                                                                creatures, swimming and spending time at the camp lake.
                                                                                                We’ll learn more about animals that live in the sea such as
                                                                                                sharks, octopuses, fish, sea plants and so much more!

                                                                                                PEE WEE “LET’S GO CAMPING” CAMP                   WEEK 11
                                                                                                Let’s create the best camping experience while simply being
                                                                                                at camp! We’ll sing campfire songs, create crafts, make
                                                                                                s’mores, go hiking and more. At the end of the week, we’ll
                                                                                                pitch our tents and have our very own mini camp out!
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