ASSISTANCE DOGS OF THE WEST
Summer Camp 2015 Schedule
Camp Name Date/Time Location Ages Fee
Dog Days of Summer CampSanta Fe / Monday, June 1 – Thursday, June 4
9:00 am – 3 pm / La Mariposa Montessori, Santa Fe / 8 – 18 / $175
Dog Days of Summer Camp /
Mixed abilities
Albuquerque / Monday, June 8 –
Thursday, June 11
9:00 am – 3 pm / Dogwood Therapy Services, Albuquerque / 8 – 18 / $175
Dog Days of Summer Camp
Santa Fe / Monday, June 15 –
Thursday, June 18
9:00 am – 3 pm / La Mariposa Montessori, Santa Fe / 8 – 18 / $175
Dog Days of Summer Camp /
Mixed abilities
Albuquerque / Monday, June 22 –
Thursday, June 25
9:00 am – 3 pm / Dogwood Therapy Services, Albuquerque / 8 – 18 / $175
Dog Days of Summer Camp /
Mixed abilities
Albuquerque / Monday, July 6 –
Thursday, July 9
9:00 am – 3 pm / Dogwood Therapy Services, Albuquerque / 8 – 18 / $175
Dog Days of Summer Camp
Santa Fe / Monday, July 13 –
Thursday, July 16
9:00 am – 3 pm / La Mariposa Montessori, Santa Fe / 8 – 18 / $175
Dog Days of Summer Camp /
Mixed abilities
Albuquerque / Monday, July 20 –
Thursday, July 23
9:00 am – 3 pm / Dogwood Therapy Services, Albuquerque / 8 – 18 / $175
Dog Days of Summer Camp
Santa Fe / Monday, July 27 –
Thursday, July 30
9:00 am – 3 pm / La Mariposa Montessori, Santa Fe / 8 – 18 / $175
Program Descriptions:
Albuquerque Dog Days of Summer Camp – Ages 8-18
Join us for a fun-filled camp that also serves a great community cause! Come learn to handle and train service dogs for people with disabilities with Assistance Dogs of the West, and dogs that participate in animal assisted interventions from Dogwood. This is an integrated summer program for the Albuquerque location. Come learn from and work with our specialty trainers with disabilities! Hands on activities include skills for responsible pet ownership, summertime pet cautions, basic and intermediate grooming techniques, basic and intermediate dog training skills, and public access work with dogs (we walk to close community shops to practice skills with dogs in new environments). Additional activities include cooking for humans and hounds (recipes made for man and beast to share), recycled art and crafts, agility, “Minute to Widget”- our dog version of the game show with a similar name, DOGA (yoga with our furry friends), reading to dogs, and much more! Bring your own snacks, lunch, sunscreen and water bottle. Camp takes place at Dogwood Therapy Services, 1111 Alameda Blvd NW, Albuquerque, NM 87109.
Santa Fe Dog Days of Summer Camp – Ages 8-18
Join us for a fun-filled camp that also serves a great community cause! Come learn to handle and train service dogs for people with disabilities with Assistance Dogs of the West. Hands on activities include skills for responsible pet ownership, summertime pet cautions, basic and intermediate grooming techniques, basic and intermediate dog training skills, and public access work with dogs, disability awareness education and community interaction, arts and crafts projects, and much more! Bring your own snacks, lunch, sunscreen and water bottle. Camp takes place at La Mariposa Montessori, 18 Puesta Del Sol, Santa Fe, NM 87508.
FAQs:
Where do the camps take place?
Albuquerque camps: Dogwood Therapy Services, 1111 Alameda Blvd NW, Albuquerque, NM 87109
Contact: Melissa Winkle at Dogwood Therapy Services, (505) 228-4650
Santa Fe camps: La Mariposa Montessori, 18 Puesta Del Sol, Santa Fe, NM 87508
Contact: Liz Napieralski at Assistance Dogs of the West, (505) 986-9748,
Can I bring my dog?
We love your pets, but our liability does not cover dogs even when dropping off or picking up. Only program dogs are allowed in the building. PLEASE DO NOT LEAVE YOUR DOG IN THE CAR, this takes the lives of hundreds of dogs each year.
Can I stay with my child during class?
We are happy to offer a one-time 20-minute sneak preview for parents or caregivers at the beginning of the 1st day. We have limited occupant load, and an average staff-student ratio of 1:4. We will be going for walks into the community and expect that participants are able to follow directions and rules of safety. Albuquerque participants: Please let us know if the participant requires any reasonable accommodations; we do have an occupational therapist on staff.
What should my child wear?
Comfortable clothing that they don’t mind getting dog hair on, and sensible shoes.
Do I need to supply snacks or lunch for my child?
Please provide 2 snacks, lunch and a refillable water bottle. We prefer that snacks and lunches are not traded secondary to dietary restrictions.
Do you offer childcare before and after camp?
ALBQUERQUE: Early drop off (starting at 8:30 a.m.) is available for an additional $5 per day. Extended day/late pick up available until 4 p.m. for an additional $15 per hour/per day (ex: pick up 3:15-4:00 p.m. is $15). LATE PICK UP AVAILABLE UNTIL 4 P.M. ONLY. ADW must have advanced notice upon registration. Payment is CASH ONLY at the time of drop-off/pick-up.
SANTA FE: Late pick up is available until 5 p.m. for an additional $20 per hour/per day. After camp, students will be transported from La Mariposa Montessori to the Assistance Dogs of the West office at 730 St. Michael’s Drive. ADW must have advanced notice upon registration.
PLEASE KEEP PAGES 1-3 FOR YOUR RECORDS
ASSISTANCE DOGS OF THE WEST DOG DAYS OF SUMMER CAMP 2015 REGISTRATION FORM
Participant Name: ______(Please print clearly)
(BLUE SECTION FOR ALBUQUERQUE CAMP PARTIPANTS ONLY)
Please remember that Assistance Dogs of the West summer camp in Albuquerque is an integrated/mixed abilities program.
Your child is: ¨ A child with special needs ¨ A buddy to a child with special needs
Does the participant require accommodations? ¨ Yes* ¨ No
*Assistance Dogs of the West does not have the resources to provide 1-on-1 support; however, we are able to make reasonable accommodations for Albuquerque participants. Please contact Occupational Therapist, Melissa Winkle of Dogwood Therapy Services (505-228-4650), to determine if we can meet your needs.
Participant Date of birth: ______Allergies: ______
Address:______
City, State, Zip: ______
Email address: ______
Parent 1 name:______
Parent 1 cell: ______wk#:______other: ______
Parent 2 name:______
Parent cell:______wk#:______other: ______
Please check the session(s) you would like your child to attend and indicate if you will need early drop-off (ABQ only) or late pick-up.
¨ Monday, June 1 – Thursday, June 4 / 9 a.m. – 3 p.m. / Santa Fe
□ Late pick-up
¨ Monday, June 8 – Thursday, June 11 / 9 a.m. – 3 p.m. / Albuquerque
□ Early drop-off □ Late pick-up
¨ Monday, June 15 – Thursday, June 18 / 9 a.m. – 3 p.m. / Santa Fe
□ Late pick-up
¨ Monday, June 22 – Thursday, June 25 / 9 a.m. – 3 p.m. / Albuquerque
□ Early drop-off □ Late pick-up
¨ Monday, July 6 – Thursday, July 9 / 9 a.m. – 3 p.m. / Albuquerque
□ Early drop-off □ Late pick-up
¨ Monday, July 13 – Thursday, July 16 / 9 a.m. – 3 p.m. / Santa Fe
□ Late pick-up
¨ Monday, July 20 – Thursday, July 23 / 9 a.m. – 3 p.m. / Albuquerque
□ Early drop-off □ Late pick-up
¨ Monday, July 27 – Thursday, July 30 / 9 a.m. – 3 p.m. / Santa Fe
□ Late pick-up
PAYMENT INFORMATION
Please complete payment information on the following page. Payment is required to reserve a space and attend class.
______weeks of camp @ $175 per camp + ______early drop-off/late pick-up fees (SANTA FE ONLY. ALBUQUERQUE FAMILIES, PLEASE BRING CASH TO DOGWOOD)= ______
Payment Method:
_____Check Enclosed
· Please make all checks payable to: Assistance Dogs of the West and mail to:
P.O. Box 31027
Santa Fe, NM 87594
_____Credit/Debit Card
· Circle Card Type: Visa / MasterCard / Amex
Card Number: ______
Expiration date: ___ /___
Name on card: ______
I authorize Assistance Dogs of the West to charge my credit/debit card for ADW 2015 Summer Camp.
(Cardholder signature) ______
REFUND POLICY: Refunds will be remitted for cancellations made no less than 7 days in advance of the program start-date, minus a 20% administration fee. Any cancellation made less than 7 days prior to the first day of class results in forfeiture of the registration fee.
I understand that if my student misses a class, there are no refunds and the student may not attend another camp as a make-up session.
I have read and agree to the above terms:
Signature: ______Date: ______
EMERGENCY INFORMATION
Student name:______Date of birth: ______
Child lives with:______
Address:______
Primary Contact Number: ______Home phone:______
Parent 1 name:______cell: ______wk#:______
Parent 2 name:______cell:______wk#:______
My child has the following health problems/disabilities (for example, allergies, bad knees, diabetes, asthma, seizures, heart problems, etc.)______
______
My child has the following allergies:______
______
My child requires the following action for allergic reactions or medical emergencies:______
______
My child may take non-prescription pain medication if the need arises ____Yes _____No
** ADW staff is not able to administer medications, except under the written emergency plan from physician.
EMERGENCY CONTACTS: (Must be 2 individuals other than parents or step-parents)
Name:______Daytime Phone: ______
Name:______Daytime Phone: ______
I, ______, authorize Assistance Dogs of the West to seek medical attention for my child, ______, in case of an emergency.
Physician: ______Phone: ______Address: ______
Dentist: ______Phone: ______Address: ______
Health Insurance Co.:______Policy #:______
In the case of a medical emergency, I authorize the staff of Assistance Dogs of the West to contact 911, and have my child transported to the nearest hospital.
Signature: ______Date: ______
Assistance Dogs of the West
Media Authorization and Release
For (Student Name):______
Subject to the terms and conditions set forth in this Agreement, I, ______
do hereby authorize Assistance Dogs of the West, Dogwood, its successors and assigns, and those acting under its permission and on its authority to copyright, use, and publish for:
art
sales materials
advertising
promotion, packaging, or trade
any other lawful purpose whatsoever
articles written or comments made by me
photographs, pictures, portraits,
images of me and or my dog(s) or other animal(s)
in conjunction with my/our own fictitious name
reproductions thereof in color or otherwise, made through any medium
Film
Video
Website
Social Media
Any and all comments made by me are provided to Assistance Dogs of the West without receipt of any promise of consideration.
The undersigned warrants that he/she has full power and authority to grant all of the rights conveyed there under and hereby waives any right that he/she may to inspect or approve the finished product or the advertising or other copy that may be used in connection therewith or the use to which it may be applied. The undersigned further agrees that this authorization and release binding upon his/her heirs, executors, administrators, successors and assigns.
The undersigned warrants that he/she is of full agreement and has every right to contract in his/her own name in the above regard, and further that he/she has read the above authorization and release, prior to its execution, and that he/she is fully familiar with the contents thereof.
I, undersigned, hereby consent to the foregoing conditions and warrant that I have the authority to grant such consent.
Parent/Guardian Signature ______Date ______
Release from Liability
I indemnify and hold Assistance Dogs of the West and Dogwood Therapy Services harmless from and against all claims, losses, liabilities, and damage to persons or property, governmental charges or fines and attorney’s fees arising out of the acts or omissions of Client Placement Training, Owner/Self Training Workshops, ADW Student Trainer Classes and meetings, Seminars, Meetings, After School and Summer Dog Training Programs, or any gathering sponsored by or conducted at Assistance Dogs of the West offices, including but not limited to interactions with instructor/trainers, attendees, or animals, demonstrations involving an assistance dog, or transportation of assistance dogs to or from training sites or within the training site.
Student name (please print)______
Parent/Guardian Signature______
Date______
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