Hanover Township Community Center

3660 Jacksonville Road Bethlehem, PA18017

Email Address…

Phone: (610) 317-8701 fax: (610) 317-8704

HanoverTownshipHealth Form

(please complete before event/camp commences)

Part A: General Information

Child’s Name: ______Birth-date: ______

Address: ______
City: ______State: ______Zip: ______

Home Phone: ______Work Phone:______

Parent(s)/Guardian(s) name:______

If for any reason I cannot be reached, please contact the following physician or hospital for emergency care for my child:

______

Primary Care Physician Phone NumberInsurance Provider/Policy Number

Eligible Guardians to pick up the child:

Name: Phone Number:

Name: Phone Number:

Name: Phone Number:

Part B: Medical History

Does your child have any hearing, learning, visual, or other physical or mental conditions?

or disabilities we should be aware of that may impact their ability to participate in any activities?

___ Yes ____ No If yes, please list any health problems or special needs and recommended treatment ______

Does you child have any allergies?

___ Yes ____ No If yes, please list ______

Please list any medications that your child will be taking while at camp. (Your child must be able to self-administer all medication) ______

To the best of my knowledge I hereby certify that I have provided all the health information relating to my child that could impact their stay at camp. In case of an emergency, Hanover Township Community Center has my permission to seek medical attention for my child.

______

Parent or Guardian’s Signature Date

‘The Heart of the Community’

Hanover Township Camps Behavior Guidelines

General Rules

  • Listen to the staff and follow their directions
  • During camp time, camper should remain in their camps unless given permission to leave.
  • Campers should not be alone at any time while in camp.
  • No cell phone or electronics are allowed.
  • Please do not climb trees.
  • Please respect nature; do not pick leave, grass, and do not harm plants or animals
  • Please do not throw sticks or stones.
  • Keep camp clean. This includes picking up litter, no writing graffiti, and replacing any camp equipment after you use it.
  • No fighting. If you have a problem, walk away from the situation and tell a counselor.
  • Appropriate footwear must be worn at all times.
  • Hallways are quiet places where there is no running/eating/horsing around.

Code of Conduct

We are committed to providing a safe and welcoming environment for all of our members and guests. To ensure safety and comfort for all, we ask individuals to act appropriately while they are in our facility or participating in a program. This applies to staff, campers AND their parents. We expect persons using the Community Center to behave in a mature and responsible way and to respect the rights and dignity of others. Our code of conduct does not permit language or action that can hurt or frighten another person or that falls below a generally accepted standard of conduct. Specifically this includes:

  • Angry or vulgar language including swearing, name calling, and shouting;
  • Physical contact with another person in an angry or threatening way;
  • Any demonstration of sexual activity or sexual contact with another person;
  • Harassment or intimidation (bullying) with words, gestures, body language or other menacing behavior;
  • Behavior which intends to or results in the theft or destruction of property;
  • Carrying or concealing any weapons or devices that may be used as weapons.

Expectations of Campers

Campers are entitled to a pleasant and safe environment while participating in our Camp program. We know that everyone is not always going to get along or agree on things, especially when competition is involved. However, we expect that these disagreements will be handled in a non-violent and nonthreatening manner. We want everyone at camp to feel that they are in a safe environment where they are valued. All campers should use their number one resource when an unexpected altercation happens, that is to self-report to the counselor in charge right away.

HTCC reserves the right to withdraw a participant from our program if he or she is unable or unwilling to adjust to our schedule and program.

The following disciplinary policy will be followed for general misbehavior:

  • 1st offense: Camper will be redirected and given a verbal warning
  • 2nd offense: Camper will be asked to take a personal time-out
  • 3rd offense: Camper will lose some or all of the privilege of participating in a special activity (Loss of privilege of any high risk activity such as swimming, they may be assigned to a silent lunch table, etc.)
  • 4th offense: Camper will talk with Camp Leadership and parent will be called to discuss a positive plan for change.
  • 5th offense: Parent will be called to pick-up child early or risk the child being suspended for additional days of camp or removed from camp completely.
  • 6th offense: Camper will be suspended based on severity of the offense from a day to a week of summer camp.
  • 7th offense: Camper’s enrollment will be terminated for the remainder of the summer.

Zero Tolerance Policy

Our Camp has a zero-tolerance policy for serious behavior infractions since our goal is to provide a healthy, safe and fun environment for every camper. The behaviors below are grounds for immediate removal from camp for the remainder of the current day and additional days as deemed necessary by camp staff. Each incident will be considered on a case-by-case basis to determine if the child is capable of functioning in a group setting while at camp. HTCC management will meet with the camper’s parent(s) to determine a course of action and the length of the suspension.