CAMPER INFORMATION (FOR GIRLS GOING IN TO GRADES 1-6)

General:

  • Girls must be registered with GSUSA to attend camp. If not currently registered, the registration fee is $12.00 and is active through September 30, 2014. To register, please fill out the GSUSA form and send it in with your day camp registration paperwork.
  • Camp is open to girls entering grades 1-6 in the fall of 2014
  • Girls are placed in groups of 8-12 with girls in the same grade
  • Girls enjoy three fun-filled days of activities and receive a participation patch and t-shirt. A tentative schedule is available for review at
  • Lunch and transportation are included in the fee.
  • An optional overnight on Thursday is offered for girls in grades 5 and 6.

Transportation:

  • Check-in daily at 7:30AM at Steve Michaud (formerly North) Park, Lakeville (170th Street & Ipava Ave)
  • Buses leave promptly at 7:50AM
  • Buses return to North Park by 5:00PM
  • Buses return to North Park around10:00AM Friday morning following the overnight.
  • For security purposes, everyone is required to ride the bus to and from day camp

Fees and Dates:

  • The cost of day camp is $125.00 per girl.
  • The cost for the overnight is $15.00 (optional for grades 5 and 6 only).
  • Girls not registered with GSUSA will incur a $12.00 registration fee.
  • Unexpired cookie credits may be used to pay for camp.
  • Full payment is due no later than June 16, 2014.
  • Payment taken after June 16, but before June 30 will incur a $20.00 late fee.
  • Registration/payment will not be accepted after June 30, 2014. NO EXCEPTIONS!

PROGRAM AIDE TRAINEE INFORMATION (PAT – FOR GIRLS GOING IN TO GRADES 7-12)

General Information:

  • Program Aide Trainees must be registered with GSUSA to attend camp. The registration fee is $12.00 and is active through September 30, 2014. To register, please fill out the GSUSA Girl Form and send it in with your day camp registration paperwork.
  • PAT positions are offered to girls entering grades 7-12 in the fall of 2014.
  • PATs must attend the Thursday overnight as it is considered part of the training program.
  • Girls enjoy three days of training and activities that fulfill requirements for Program Aide, Jr. Caddie, Caddie, and LIA required for Program Aide pin and receive a t-shirt. Once this training is complete girls are eligible to work at camp as a Program Aide the following summer.
  • Lunch and transportation are included in the fee.

Transportation:

  • Check-in daily at 7:15AM at Steve Michaud (formerly North) Park, Lakeville (170th Street & Ipava Ave)
  • Buses leave promptly at 7:50AM
  • Buses return to North Park by 5:00PM and about10:00AM Friday morning following the overnight.
  • For security purposes, everyone is required to ride the bus to and from day camp

Fees and Dates:

  • The cost of Program Aide Training is $65.00.
  • Girls not registered with GSUSA will incur a $12.00 registration fee.
  • Unexpired cookie credits may be used to pay for camp.
  • Full payment is due no later than June 16, 2014.

KEY INFORMATION

  • All campers, Program Aide Trainees and Program Aides must be registered with GSUSA to attend camp. The registration fee is $12.00 and provides a membership through September 30, 2014. To register, please fill out the GSUSA Girl Form and send it in with your day camp registration paperwork.
  • The following items must be submitted before the June 16thdeadline:
  • Day Camp Registration Form
  • Health History Form
  • GSUSA Registration Form (if not currently registered)
  • Wallet size photo of camper
  • Please make checks payable to: Lakeville Day Camp
  • Mail registrations to: April Sorensen, 16572 Horizon Ave, Lakeville, MN 55044.
  • Please visit more day camp information.

Registering as:Camper (girls entering grades 1-6 in Fall 2014)

Program Aide Trainee (girls entering grades 7-12 in Fall 2014)

Personal Information:

Camper Last Name:______Camper First Name:______Middle Initial: ______

Parent First Name/s______Parent Last Name/s______

Address:______City:______State: _____ Zip: ______

Phone(H): ______Phone(C): ______Phone (W): ______Preferred Contact(circle one): H C W

Email: ______Birthdate: ______School: ______

Troop #/Juliette: ______Grade in Fall 2014: ______(grade girl will be in NEXT school year)

Current Member of Girl Scouts USA?

Yes, Girl Scouts of MN and WI River Valleys
Yes, Other Council: ______/ No, my registration form is included (all girls must be registered with GSUSA; add $12 fee below)

Emergency Contact/Guardian Information:

Emergency Contact Name(second contact, other than parents listed above): ______

Daytime Phone: ______Alt. Phone: ______

Relationship to Participant: ______

If under 18, participant is in the custodial care of: Both parents Mother only Father only Other

Camp Information:

I will be attending the overnight (grades 5 & 6 only; add $15 below): Yes No

If preferred to be in a group other than your troop, please list here______

At Steve Michaud (formerly North) Park, the following individuals (other than parents listed above) are authorized to pick upparticipant:______

T-Shirt Size:Child Size: S (5-6) M (8) L (10)

Adult Size: S M L XL XXL

Program Aide Trainees Only:

I understand that as part of my required PA Training I will work the overnight on Thursday: Yes No

Payment Information:

I am applying for River Valleys Grants for Girls financial assistance (include your application): Yes No

Day Camp Fee: Camper $125.00/PAT $65.00 / $
Overnight Fee (optional grades 56 only): $15.00 / $ / Please make checks payable to: Lakeville Day Camp
GSUSA Registration Fee (if not registered): $12.00 / $
Cookie Credits Submitting / $ / Check enclosed: $______
Check #:______
Balance Due by June 16th / $

I give permission for my participant to attend day camp and participate in all activities, including overnights, shooting activities and tomahawk throwingwhich is part of the program, unless otherwise indicated. I agree to cooperate with all regulations and policies. I give permission for my participant to be photographed or recorded, and for River Valleys to use this material for publicity purposes. I will not send my participant if she becomes exposed to any contagious disease (including head lice), or if I do not consider her to be in good physical condition. I give permission for my participant to receive necessary medical treatment at area hospitals/medical centers or from the Day Camp Health Supervisor or designee. I give permission for my participant, if not currently a member, to join Girl Scouts of the USA and have enclosed $12 membership dues. I will read and abide by any other communications from the Day Camp. I understand that Lakeville Girl Scouts, GSUSA, Camp Phillippo and the bus company are not responsible for any lost, stolen or damaged property that I bring to camp.

Parent/Guardian Signature:______Date:______

PLEASE ATTACH A WALLET SIZE PHOTO OF CAMPER