Somers Summer Fun Program

Starts Tuesday, July 11th

Dear Parents,

It is our pleasure to welcome you and your child to our Summer Fun Program for 2017. This packet includes basic information about the schedule, what children should bring to Summer Fun and other important information such as medical and emergency contact forms.

Based on the success of last year’s program, SEPTA is repeating the program this year, and we are very excited for your children. Our program is designed to give students who are enrolled in Extended School Year (ESY) an opportunity to experience a camp-like program. It is our primary goal to provide your child with a safe and fun summer. However, summer programs can be a lot more...a chance to learn from new experiences, to grow, to make new friends and to develop important social skills that will last a lifetime.

We would like to thank Katy Faivre and Melissa Carino, the program directors, for their continued efforts in putting the components of this program together, and the Somers Central School District for permitting us to use the Primrose and High School grounds.

If you have any questions about the camp, please email , and someone will get back to you as soon as possible.

Sincerely,

The Somers SEPTA Executive Board

Somers SEPTA: Summer Fun Program Application

Child’s Name______M/F______DOB______

Mailing Address______City______Zip______

Parent Name______Phone______Email______

Child’s Grade______Teacher______

Please mark the week(s) your child will attend:

Week 1____ Week 2_____ Week3______Week 4______

General Release: The undersigned hereby releases the Somers Special Education PTA (SEPTA), employees and volunteers thereof, of any responsibility should an accident or injury occur to the aforenamed participant in the aforementioned program sponsored by SEPTA.

Parent/Guardian Signature______Date______

Somers SEPTA: Welcome Information

Child’s name:______Date of Birth:______

Summer Fun Medical Form

School last attended: ______Grade in Sept.______

1. Does your child have any allergies (food, environmental, medication)?

____Yes _____ No

If yes, please explain:______

______

2. Is Your child taking any medications? ____Yes _____ No

If yes, please explain:______

______

** IF ANY MEDICATION (INCLUDING OVER THE COUNTER, EPIPEN, OR ANY OTHER MEDICATION) NEEDS TO BE GIVEN DURING THIS PROGRAM, AN ADDITIONAL FORM MUST BE COMPLETED AND SIGNED BY BOTH YOUR DOCTOR AND YOU, AND THE MEDICATION MUST BE PROVIDED TO THE NURSE. PLEASE CONTACT THE SUMMER FUN PROGRAM DIRECTOR IF YOU NEED THE FORM**

3. Does your child have any significant medical history or special physical needs? ____Yes _____ No

If yes, please explain:______

______

4. Does your child wear glasses or have any vision problems? ____ Yes ____ No

If yes, please explain:______

______

5. Does your child have any hearing problems? ____Yes _____ No

If yes, please explain:______

______

6. Does your child have a special diet or any dietary concerns? ____Yes _____ No

If yes, please explain:______

______

7. In the event of a sting or bite, do you give the nurse permission to apply calamine lotion to your child? ____Yes _____ No

8. Is there anything else that the nurse needs to know about your child while at the summer program (for example: fears, sensory issues etc.) ?

______

In case of an emergency and I cannot be reached, I give permission for the nurse to call the physician listed below:

Doctor’s Name: ______

Address: ______

______

Phone Number: ______

Parent/Guardian Signature: ______Date: ______

Home Phone: ______Work/Cell Phone: ______

Emergency contact if you can not be reached:

Name: ______Relation:______

Phone Number: ______

Name: ______Relation:______

Phone Number: ______

Please designate who will be picking your child up at dismissal. Please list ALL people who are responsible for picking up your child including yourself, siblings and or caregivers. Your child will not be dismissed to anyone that is not designated on this list.

The following people are designated to pick my child up from the Summer Fun Program:

______

Parent/Guardian Signature______

Date______