YMCA OF GREATER CLEVELAND

ROCKY RIVER SUMMER CAMP 2017 FIELD TRIP PERMISSION SLIP

DATES: June 12th, 2017 – August 18th, 2017 CHILD CARE LOCATION – St. Thomas Lutheran Church

BELOW IS INFORMATION AND A PERMISSION SLIP FOR THE SCHEDULED FIELD TRIPS AND SWIMMING ACTIVITIES FOR SUMMER CAMP AT ROCKY RIVER. BE SURE TO SIGN, DATE AND INITIAL THE FORM (UNDER PARENT INITIALS). THIS PERMISSION SLIP MUST BE TURNED IN BEFORE YOUR CHILD MAY ATTEND CAMP FOR THAT GIVEN WEEK. ALL PERMISSION SLIPS ARE DUE ON OR BEFORE MONDAY MORNING AT THE START OF CAMP. IF A FIELD TRIP IS CHANGED, YOU WILL RECEIVE A CORRECTED FIELD TRIP PERMISSION SLIP FOR THAT PARTICULAR DAY/ACTIVITY.

FIELD TRIP PERMISSION:

DAY/DATE / FIELD TRIP DESTINATION
(Include Address) / DEPARTURE TIME / APPROX. RETURN TIME / TYPE OF TRANS.
(CHECK ONE) / PARENT INITIALS
6/13/2017 / Madison Park
13201 Madison Ave.
Lakewood, Ohio / 9:50 AM / 3:00 PM / YMCA Bus
6/15/2017 / Fairview Lanes
Fairview Shopping Center, 21847 Lorain Rd, Cleveland, OH 44126
South Mastick Picnic Area, Rocky River Reservation, Fairview Park, OH 44126 / 9:45 AM
12:30 PM / 3:00 PM / YMCA Bus
6/22/2017 / Painted Penguins
South Park Mall, 800 South park Center, Cleveland, OH 44136
Bonnie Park, Mill Stream Run Reservation, Bonnie Park Dr, Strongsville, OH 44136 / 9:25 AM
11:30 AM / 4:00 PM / YMCA Bus
6/27/2017 / Hinkley Reservations
Hinckley, OH 44233 / 9:30 AM / 3:45 PM / YMCA Bus
6/29/2017 / Akron RubberDucks,
Canal Park, 300 S Main St,
Akron, OH 44308 / 10:30 AM / 4:05 PM / YMCA Bus
6/30/2017 / Ravenna Community Playground
The Portage Hike and Bike Trail, Ravenna, OH 44266 / 9:30 AM / 3:30 PM / YMCA Bus
7/06/02017 / Seneca Caverns
15248 East Township Road 178
Bellevue, Ohio 44811 / 9:10 AM / 3:45 PM / YMCA Bus
7/07/2017 / Preston H.O.P.E
26001 S Woodland Rd,
Beachwood, OH 44122 / 9:30 AM / 3:00 PM / YMCA Bus
7/11/2017 / Clague Park,
Westlake, OH 44145 / 9:50 AM / 3:45 PM / YMCA Bus
7/13/2017 / Great Lakes Science Center
601 Erieside Avenue
Cleveland, Ohio 44114
Elmwood Playground
Rocky River, OH 44116 / 9:30 AM
1:35 PM / 3:45 PM / YMCA Bus
7/18/2017 / Roman Park
Westlake, OH 44145 / 9:45 AM / 3:45 PM / YMCA Bus
7/20/2017 / Cleveland Metropark Zoo
3900 Wildlife Way, Cleveland, OH 44109 / 9:30 AM / 3:00 PM / YMCA Bus
7/21/2017 / North Olmstead Community Park
28114 Lorain Rd,
North Olmsted, OH 44070 / 9:45 AM / 3:00 PM / YMCA Bus
7/25/ 2017 / Lakewood Park
Belle Avenue
Lakewood, OH 44107 / 9:45AM / 3:45 PM / YMCA Bus
7/27/2017 / Wagon Trails
907 Youngstown Kingsville Road SE
Vienna, Ohio 44473 / 9:30 AM / 2:30 PM / YMCA Bus
8/01/2017 / Bohlken Park,
3885 W 210th St,
Fairview Park, OH 44126 / 9:55 AM / 3:45 PM / YMCA Bus
8/03/2017 / Pump it up
7007 Engle Road
Suite C
Middleburg Heights, OH 44130-3512
Brecksville Reservations
9000 Chippewa Creek Drive, Brecksville, OH 44141 / 9:30 AM
12:00 PM / 4:00 PM / YMCA Bus
8/04/2017 / Morton Park,
22065 Morton Ave, Fairview Park, OH 44126 / 9:50 AM / 3:45 PM / YMCA Bus
8/10/2017 / United Skates of America
30325 Palisades Pkwy,
Wickliffe, OH 44092 / 11:20 AM / 3:30 PM / YMCA Bus
Transportation services will be provided by (YMCA Staff check one):
YMCA owned/operated bus X Leased bus with YMCA driver  Contracted bus services through school district
In any of the above field trips, will children have access to water that is 18 inches or more feet in depth? No Yes
If yes, list field trip destination(s):
Are water activities planned in water that is eighteen inches or more feet in depth? No Yes
If yes, complete swimming permission section

SWIMMING PERMISSION (CHECK APPROPRIATE ANSWER):

1. MY CHILD IS A _____ SWIMMER _____ NON-SWIMMER

2. MY CHILD HAS PERMISSION TO PARTICIPATE IN WATER ACTIVITIES ____ YES ____ NO

DAY/DATE / LOCATION OF SWIMMING SITE / START TIME / END TIME / TYPE OF TRANS. / PARENT INITIALS
Tuesday’s
6/13/2017
6/20/2017
6/27/2017
7/11/2017
7/18/2017
7/25/2017
8/01/2017
8/08/2017
8/15/2017 / West Shore YMCA
1575 Columbia Rd,
Westlake, OH 44145 / 1:00 PM / 3:45 PM / YMCA Bus
Transportation services will be provided by (YMCA Staff check one):
YMCA owned/operated bus ×  Leased bus with YMCA driver  Contracted bus services through school district

THE CENTER WILL NOT BE PROVIDING ADDITIONAL ADULTS OR STAFF MEMBERS ABOVE THE RATIO REQUIREMENTS FOR THESE SWIMMING ACTIVITIES.

SPECIAL INSTRUCTIONS FOR FIELD TRIPS: ______
______

In the consideration of the opportunity for my child to be a participant in the YMCA of Greater Cleveland’s child care field trip, I, the parent or guardian, hereby assume all risks and release and hold harmless the Association and all its members, volunteers and employees from any claim that might arise as the result of my child’s participation in the field trip including transportation related to the field trip. I have read the above and willingly consent to allow my child’s participation under the above stated condition.

______

CHILD’S NAMEDATE OF BIRTH

______

PARENT/GUARDIAN SIGNATUREDATE

REV 06/17