2016 Camper Registration
Summer Camp 2016
Camp Blodgett
Where fun, learning and the great outdoors collide!
Online Registration Also Available at www.campblodgett.org
CAMP BLODGETT
1545 Buchanan Ave. SW Grand Rapids, MI 49507
Where to
Submit Forms
And Payments?
Camp Blodgett provides
summer activities that
every family can afford
with transportation from
Grand Rapids to the camp
provided.
Simply complete the
enclosed
4-PAGE
REGISTRATION FORM
(ALL pages with the
yellow band at the top)
to get your kids signed up.
IMPORTANT! Please mail
or deliver completed
registration form and
payment in the form of
cash, check or money
order (no credit or debit
cards accepted) to the
address below.
Mail to:
Camp Blodgett
ATTN: Program Director
1545 Buchanan Ave. SW
Grand Rapids, MI 49507
Where to
Submit Forms
And Payments?
Camp Blodgett provides
summer activities that
every family can afford
with transportation from
Grand Rapids to the camp
provided.
Simply complete the
enclosed
4-PAGE
REGISTRATION FORM
(ALL pages with the
yellow band at the top)
to get your kids signed up.
IMPORTANT! Please mail
or deliver completed
registration form and
payment in the form of
cash, check or money
order (no credit or debit
cards accepted) to the
address below.
Mail to:
Camp Blodgett
ATTN: Program Director
1545 Buchanan Ave. SW
Grand Rapids, MI 49507
Where to
Submit Forms
And Payments?
Camp Blodgett provides
summer activities that
every family can afford
with transportation from
Grand Rapids to the camp
provided.
Simply complete the
enclosed
4-PAGE
REGISTRATION FORM
(ALL pages with the
yellow band at the top)
to get your kids signed up.
IMPORTANT! Please mail
or deliver completed
registration form and
payment in the form of
cash, check or money
order (no credit or debit
cards accepted) to the
address below.
Mail to:
Camp Blodgett
ATTN: Program Director
1545 Buchanan Ave. SW
Grand Rapids, MI 49507
Where to
Submit Forms
And Payments?
Camp Blodgett provides
summer activities that
every family can afford
with transportation from
Grand Rapids to the camp
provided.
Simply complete the
enclosed
4-PAGE
REGISTRATION FORM
(ALL pages with the
yellow band at the top)
to get your kids signed up.
IMPORTANT! Please mail
or deliver completed
registration form and
payment in the form of
cash, check or money
order (no credit or debit
cards accepted) to the
address below.
Mail to:
Camp Blodgett
ATTN: Program Director
1545 Buchanan Ave. SW
Grand Rapids, MI 49507
Where to
Submit Forms
And Payments?
Camp Blodgett provides
summer activities that
every family can afford
with transportation from
Grand Rapids to the camp
provided.
Simply complete the
enclosed
4-PAGE
REGISTRATION FORM
(ALL pages with the
yellow band at the top)
to get your kids signed up.
IMPORTANT! Please mail
or deliver completed
registration form and
payment in the form of
cash, check or money
order (no credit or debit
cards accepted) to the
address below.
Mail to:
Camp Blodgett
ATTN: Program Director
1545 Buchanan Ave. SW
Grand Rapids, MI 49507
Where to
Submit Forms
And Payments?
Camp Blodgett provides
summer activities that
every family can afford
with transportation from
Grand Rapids to the camp
provided.
Simply complete the
enclosed
4-PAGE
REGISTRATION FORM
(ALL pages with the
yellow band at the top)
to get your kids signed up.
IMPORTANT! Please mail
or deliver completed
registration form and
payment in the form of
cash, check or money
order (no credit or debit
cards accepted) to the
address below.
Mail to:
Camp Blodgett
ATTN: Program Director
1545 Buchanan Ave. SW
Grand Rapids, MI 49507
Where to
Submit Forms
And Payments?
Camp Blodgett provides
summer activities that
every family can afford
with transportation from
Grand Rapids to the camp
provided.
Simply complete the
enclosed
4-PAGE
REGISTRATION FORM
(ALL pages with the
yellow band at the top)
to get your kids signed up.
IMPORTANT! Please mail
or deliver completed
registration form and
payment in the form of
cash, check or money
order (no credit or debit
cards accepted) to the
address below.
Mail to:
Camp Blodgett
ATTN: Program Director
1545 Buchanan Ave. SW
Grand Rapids, MI 49507
Camp Blodgett
Overview:Since 1921 Camp Blodgett has been recognizing the importance of keeping children active both physically and mentally to ensure continued healthy development during summer vacation. The camp experience includes physical activities like swimming, hiking and biking but we also make sure campers are exposed to learning opportunities with new activities such as archery, canoeing and nature studies to keep their minds active and growing too!
Camp Blodgett also encourages our campers to attend other camps and programs so they stay active all summer and return to the classroom in the fall ready to learn.
Safety:
The safety of our campers is our highest priority. Camp Blodgett undergoes rigorous inspections each summer by the State of Michigan and intensive, high quality staff training to ensure that our programs, staff and facilities meet the highest standards for safety.
Programs/Activities:
During all sessions, no matter the theme, campers have many unique hands-on opportunities to learn, grow, and enjoy activities they may not be able to experience at home including:
* Swimming * Fishing * Canoeing * Hiking
* Bicycling * Team-building ropes courses * Arts & crafts * Talent show
* Campfires * Sports activities
* Archery * Exploring nature along the Lake Michigan shore and along the wooded trails
Camper Qualifications:
Camp Blodgett serves campers who live or attend a school in Kent or Ottawa Counties and are between the ages of 8 and 13.
Staff:
Camp Blodgett’s staff is made up of caring energetic young adults who are at
least 18 years of age, pass thorough background checks and receive intensive training before beginning work at camp. Most are college students or recent graduates who enjoy working with and teaching children. Each staff member has specific skills that allow him/her to engage campers in unique learning and recreational activities. We hire individuals who are enthusiastic, creative, honest, dependable, and who are dedicated to being positive role models for campers and other staff. Our staff ratio is approximately 1 staff member to 3 campers.
Cost:
Camp Blodgett offers summer camp to families using a sliding fee based on family size and income. This may reduce the cost of your camp session to as low as $40.
Camper Check-in:
Campers may check in at the camp in West Olive or at the Grand Rapids office. Please indicate on the registration form where you will check in. Free
transportation is provided from the Grand Rapids office to camp. Check-in times and a list of recommended items to bring to camp will be provided on your
camper’s confirmation form.
Send or drop off registration information to:
Grand Rapids office Andrea Robinson, Program Director
1545 Buchanan Ave. SW [email protected]
Grand Rapids, MI 49507 www.campblodgett.org
p: (616) 940-9874 f: (616) 245-7394
Camp Schedule
Session 1
(ages 8-13) June 13
–
17
HAPPY 95
THBIRTHDAY CAMP BLODGETT!
–
In the spirit of giving and appreciating the
gifts of each of our campers and staff, we
will spend the week celebrating all that we
love about Camp Blodgett. Party games,
piñatas and birthday cake will be included
in the fun this week.
Session 2
(ages 11-13) June 20
–
24
CAMP B’S GOT TALENT
WEEK
–
Want to show
off a talent this week or do you just like
being in the audience? Perform your solo
act, team up with fellow campers, or cheer
cabin mates on from the audience. This
week is all about talent!
Session 3
(ages 8-11) June 27
–
July 1
DISNEY ADVENTURE WEEK
–
This week is all
about Disney so bring your favorite Disney
gear and get ready to enjoy all your favorite
Camp Blodgett activities with a fun Disney
twist. Hakuna Matata!
Session 4
(ages 11-13) July 11 - 15
WEIRD SCIENCE
–
Calling all lovers of nature,
science, math, experiments, building and
designing. This STEM oriented week will keep
you guessing (and thinking) about the
amazing things discovered in nature and in
our world. Get ready for the explosion of fun
we will have!
Session 5
(ages 8-11) July 18
–
22
SUPER HEROES WEEK
–
Test your agility or
elasticity, your super hearing powers or
amazing strength during this magnificent
session. Sensational games and events
make this an astounding week! Campers
assemble!
Session 6
(ages 8-13) July 25
–
29
SUMMER OLYMPICS
–
With the 2016 Summer
Olympics just around the corner, we are
going to have an amazing
‘
Camp B
’
Olympics of our own. Earn medals by
competing in feats of strength and speed
and showing off your awesome attitude.
Show your team spirit in cabin competitions.
We’ll m
eet you at the opening ceremonies!
How Do I
Submit Forms
And Payments?
Simply complete the
enclosed
5-PAGE
REGISTRATION FORM
to get your kids signed
up for camp
IMPORTANT!
Please mail or deliver
completed registration
form and payment in
the form of cash, check
or money order (no
credit or debit cards
accepted) to the
address below.
Mail to:
Camp Blodgett
ATTN: Program Director
1545 Buchanan Ave. SW
Grand Rapids, MI
49507
Or you may drop off
applications and
registration fees to the
above address on
weekdays.
ARE YOU REGISTERING MORE THAN ONE CHILD - or-
DO YOU HAVE ACCESS TO A COMPUTER WITH INTERNET ACCESS?
We highly encourage you to fill out our new online registration that can be found
on our website at www.campblodgett.org
First, decide which session you’d like your camper to attend. Children may only attend ONE session so please indicate 1st, 2nd, and 3rd choices.
Each registration must include:
1. Completed camp registration form (5 pages). You must complete each section with a blue heading - pages 1-3 for each camper. Pages 4 and 5 only need to be completed once per family. Stop by the 1545 Buchanan Avenue SW office or give us a call at 616-940-9874 if you need help completing the application.
2. Proof of age. If your child has never attended Camp Blodgett, submit a copy of a birth certificate or immunization chart as proof of age.
3. A deposit of at least $10 per camper is required to hold a place at camp. The deposit will be part of your total payment. If the final fee after discounts is $10, the fee must be paid in full at time of registration. Your child will not be registered until a deposit is received. The entire fee must be paid in full before the camp session begins.
4. A copy of the MOST RECENT report card showing ALL grades to-date is needed if you are requesting a Good Student Discount. Camper’s report card must be submitted with registration form.
Discounts
Additional discount details on page 2
Early Registration Discount - Register for any session by May 15 to get this discount.
Good Student Discounts - Camper’s most recent report card that shows grades or attendance for the
entire year to-date must be submitted with completed registration form in order to be considered for a discount.
*You may combine the above discounts although a minimum registration fee of $10 is required regardless of available discounts.
*Registration fees paid by third party agencies (such as DA Blodgett, Wedgwood, Bethany, Arbor Circle, etc.) are not eligible for the above discounts. Please use the sliding fee scale to determine the registration fee.
Referrals
Referrals are the best way for us to tell people about camp. Head over to
http://goo.gl/forms/zv8aZpSVfP to complete the referral process. You may also call our office with referrals. If the person you refer attends any camp session, you will be entered to win a $100 Meijer Gift
Card. Drawing to be held at the end of the summer. Refer as many times as you’d like - each qualifying
referral is an entry!
How to Make a Payment
You may mail or deliver your payment and registration to Camp Blodgett. Cash payments should be made in person at the Camp Blodgett office. You may mail checks or money orders. Camp Blodgett does not accept debit or credit card payments.
Refunds and Cancellations
If there is a need to cancel your child’s registration, your deposit will be refunded according to the
following guidelines:
- If the cancellation occurs one or more weeks before the first day of camp, 90 percent of the fee will be refunded.
- If the cancellation occurs less than one week before the first day of camp, no refund will be provided.
What Happens After Registration?
Camp Blodgett will confirm your camper’s registration by mail and provide directions and instructions for check-in. You will also be given a check-list of things to pack or not to pack.
CAMP BLODGETT
CAMPER REGISTRATION FORM
–
2016
Office Use Only
Date Rec’d:
Fee: Deposit: Final Pmt: Session: SFSP: Conf: Database:
CAMPER INFORMATION
Last Name: First Name: Middle Initial:
New to Camp Blodgett? Yes No
If new to camp, how did you hear about us? Birth Date: / /
Gender: M F Current School: School Attending Next Year (if different): Age at Start of Camp: Grade Next Year:
Current Street Address: Apt. Number (if applicable) Home Phone Number:
( )
City: State: ZIP Code: Adult T-shirt Size:
PARENT/ GUARDIAN INFORMATION
Mother/ Guardian Last Name: First Name: Phone:
( )
Relationship to Child: Employer: Work Phone:
( )
Father/ Guardian Last Name: First Name: Phone:
( )
Relationship to Child: Employer: Work Phone:
( ) Email Address (please print clearly):
If you are unable to pick up your child from camp, please give the names of two adults (age 18 yrs or older) who have permission to do so. *Photo ID is required at check-out*
Name: Address: Phone:
( )
Name: Address: Phone:
( )
CAMP SESSION SELECTION
Please select your session preferences with a “1” for your first choice, a “2” for your second choice and a “3” for your third choice.
Campers are assigned to sessions on a first come, first served basis. Please take note of the age limitations of some sessions. Is the child coming to camp with a friend? Yes No
Name of friend your child would like to share a cabin with:
Session 1: June 13-17 “Happy 95thBirthday, Camp Blodgett” Week Ages: 8-13
Session 2: June 20-24 Camp B’s Got Talent Week Ages: 11-13 Session 3: June 27-July 1 Disney Adventure Week Ages: 8-11 Session 4: July 11-15 Weird Science Ages: 11-13 Session 5: July 18-22 Super Heroes Week Ages: 8-11 Session 6: July 25-29 Summer Olympics Week Ages: 8-13
Camp Check-In Location: Grand Rapids Office (bus transportation to camp) Camp Blodgett (you will bring your child to camp)
Where to
Submit Forms
And Payments?
Camp Blodgett provides
summer activities that
every family can afford
with transportation from
Grand Rapids to the camp
provided.
Simply complete the
enclosed
4-PAGE
REGISTRATION FORM
(ALL pages with the
yellow band at the top)
to get your kids signed up.
IMPORTANT! Please mail
or deliver completed
registration form and
payment in the form of
cash, check or money
order (no credit or debit
cards accepted) to the
address below.
Mail to:
Camp Blodgett
ATTN: Program Director
1545 Buchanan Ave. SW
Grand Rapids, MI 49507
Camper Registration
–
Page 1
Camp Blodgett Sliding Fee Scale Total Household
Yearly Income Number of Family Members in Household
1 2 3 4 5 6 7 8 $0 - $21,775 $40 $40 $40 $40 $40 $40 $40 $40 $21,776 - $29,471 NA $40 $40 $40 $40 $40 $40 $40 $29,472 - $37,167 NA $55 $40 $40 $40 $40 $40 $40 $37,168 - $44,863 NA $80 $55 $40 $40 $40 $40 $40 $44,864 - $52,559 NA $105 $80 $55 $40 $40 $40 $40 $52,560 - $60,255 NA $130 $105 $80 $55 $40 $40 $40 $60,256 - $67,951 NA $180 $130 $105 $80 $55 $40 $40 $67,952 - $75,647 NA $255 $180 $130 $105 $80 $55 $40
For incomes above $75,647 please contact Camp Blodgett to determine fee.
Cost:
Camp Blodgett offers summer camp to families using a sliding fee based on family income as you see above. Your camp fee may be as low as $40.
Special Discounts and Incentives*:
Early Registration Discount – Register and pay deposit for any session by May 15 and take $10 off the registration fee.
Good Student Discount - One of the following discounts may be used:
· If you have all A’s on your report card we’ll take $20 off your camp fee.
· If you have A’s and B’s on your report card we’ll take $15 off your camp fee.
· If you have A’s, B’s, and C’s on your report card we’ll take $10 off your camp fee.
· If you have perfect attendance on your report card we’ll take $15 off your camp fee.
A copy of the student’s most recent report card showing all grades to-date and sent to the camp office is required to verify the discount. All marking periods will be considered to determine the discount. Honor roll or achievement certificates are not acceptable.
Referral Drawing—See the information about referrals on instruction page. Each referred child who attends camp will earn you an entry in our end-of-summer drawing for a $100 Meijer Gift Card.
*You may combine the above discounts although a minimum registration fee of $10 is required regardless of available discounts. * Registration fees paid by third party agencies (such as Wedgewood, Bethany, Arbor Circle, etc.) are not eligible for any discounts.
Fee Calculation
Estimated Fee $________
(from sliding scale above)
Early Registration Discount - $________
-$10if before May 15
Good Student Discount - $________
(See above for details –Report Card showing ALL grades up to this point MUST be included for this discount)
Total Estimated Fee $________
A minimum fee of $10 is required regardless of available discounts
Deposit Amt. Enclosed - $________
Balance Due $________
CAMP BLODGETT SLIDING FEE SCALE & PAYMENT INFORMATION
To find your estimated fee, please use the sliding fee scale below. Find your total household income in the left column and follow that row right to the column that designates the number of people in your household. That is your fee for camp – circle it if you wish. Enter that
amount in the Estimated Camp Fee line below the scale. Campers may attend only one session at Camp Blodgett.
Camper Registration
–
Page 2
Emergency Contact: Phone: Child’s Doctor or Clinic: Phone:
Name of Health Insurance: Policyholder’s Name: Policy # Group # No Coverage Check Here: Is the camper currently diagnosed with or receiving treatment for any of the following:
Hayfever/ Asthma/ Respiratory conditions Diabetes Eczema/ Skin Rashes Heart Conditions Enuresis/ Bedwetting Colds/ Sore Throat/ Earaches Sleepwalking Aspergers/ Autism Convulsions/ Seizures Shortness of Breath ADHD ODD OCD Other ______________________________________________
List any previous operations, injuries or physical limitations that may
restrict camper activity: Does the camper have any infectious diseases? If Yes, please explain:
List any known allergies or dietary restrictions (please include the type of reaction and treatment):
Are your child’s immunizations up to date?
Yes No
List latest immunization update or attach a copy of immunization records: Tetanus booster: Measles/ Mumps/Rubella (MMR): Polio: Hepatitis B:
Please list your child’s medications. Bring all necessary medications to camp check-in. All medications MUST be in original containers. Add additional medications on a separate sheet.
Name of Medication Frequency Dosage
PERMISSION AND AUTHORIZATION
I certify that the above information is true to the best of my knowledge and agree to the following:
In case of emergency, I authorize the administration of Camp Blodgett to secure proper treatment for my child, including hospitalization, anesthesia or surgery and/ or routine, non-surgical medical care if so needed in the opinion of an available or attending physician at the time. I understand that administrators of Camp Blodgett will make every effort to contact me in case of an emergency.
I consent to allow Camp Blodgett to provide my child with transportation to and from camp and on field trips while at camp.
I understand the nature of the camp activities offered by Camp Blodgett as explained in this camp registration packet and give permission for my child to participate in them.
I understand my child must behave appropriately at camp and that behaviors which pose a danger to self or others, failure to cooperate with staff/ other campers and extreme or repeated disruptive behavior may result in being sent home and forfeiting any fees paid. I understand this policy is also stated in the confirmation I will receive upon registration.
I acknowledge that Camp Blodgett is not responsible for any lost, stolen or damaged personal property that my child brings to camp. I give permission for the use of photographs, videos/ DVDs or recordings including my son or daughter to be used in camp publicity and/or publications.
I give permission for my child to complete a pre/ post program survey, and understand that the general data provided in this registration (child’s
age and gender, for example – no identifying information will be used) and in the surveys may be used in reporting data to Camp Blodgett funders and program partners.
_____________________________________________ ____________________________________________ ____________________ Parent/ Guardian Signature Printed Name Date
EMERGENCY & HEALTH INFORMATION
Camper Last Name: First: Middle Initial:
Camper Registration
–
Page 3
Camper Registration
–
Page 4
Camper Registration
–
Page 5
