Description

The Green Bay Kroc Center offers a wide range of camp activities to serve your camper's interests and summer care needs. Our all day, outdoor day camp is licensed by the State of Wisconsin, developed and delivered in a faith-based environment, and are structured to provide children the opportunity to grow and develop in a safe and positive atmosphere.

"A new commandment I give to you, that you love one another: just as I have loved you, you also are to love one another." John 13:34

Camper Name

Date of Birth

Gender

Male
Female
Non-binary

Allergies

What school does your child attend?

Swimming Ability:

CAN swim, no flotation device required
CAN'T swim, flotation device required
Swim ability unknown

I give permission for my child's image or likeness to be used through photography, videography, advertisement, social media, and other promotionals

Media Release -YES
Media Release - NO

I give permission for my child to participate in transported/walking field trips and other activities during operating hours

Yes, my child can participate
No, my child can not participate

Summer Camp Transportation

I give permission for my child to be transported to and from the Kroc Center through Lamers Bus Lines for field trips (all return times are approx.)
I DO NOT give permission for my child to be transported to and from the Kroc Center through Lamers Bus Lines for field trips

Please choose all weeks and add-ons that will apply. Due upon registration is a $20 non-refundable deposit per camper per week to hold your campers spot. Regular billing, which includes extended care and specialty camp add-ons, will be processed each Monday during the camp season (June 9 - August 15). Please refer to the table below regarding the pricing structure. :

	Member	Public
Early Bird 2024 Families January 6-19	$195	$225
Early Bird 2024 Families w/ Specialty Camp January 6-19	$230	$260
Early Bird Members January 20-26	$195	$225
Early Bird Members w/ Specialty Camp January 20-26	$230	$260
Early Bird January 27-February 2	$195	$225
Early Bird w/ Specialty Camp January 27-February 2	$230	$260
Non-Early Bird After February 3, 2025	$210	$240
Non-Early Bird w/ Specialty Camp After February 3, 2025	$245	$275

Week 1: June 9-13, Directions Not Included Add-Ons

Specialty Camp: Pickleball, ages 5-12
Additional $35 per child
Early Care
Additional $30 per week per child
Late Care
Additional $30 per week per child

Week 2: June 16-20, In the Dirt Add-Ons

Specialty Camp: Clay Creations 1 ages 5-8
Additional $35 per child
Specialty Camp: Clay Creations 2 ages 9-12
Additional $35 per child
Early Care
Additional $30 per week per child
Late Care
Additional $30 per week per child

Week 3: June 23-27, Game On Add-Ons

Specialty Camp: Boomwackers
Additional $35 per child
Early Care
Additional $30 per week per child
Late Care
Additional $30 per week per child

Week 4: June 30-July 3. Rockin' in the USA Add-Ons

Specialty Camp: Log Rolling, ages 5-12
Additional $35 per child
Early Care
Additional $30 per week per child
Late Care
Additional $30 per week per child

Week 5: July 7-11 Color Kaleidoscope Add-Ons

Specialty Camp: Clay Creations 1, ages 5-8
Additional $35 per child
Specialty Camp: Clay Creations 2, ages 9-12
Additional $35 per child
Early Care
Additional $30 per week per child
Late Care
Additional $30 per week per child

Week 6: July 14-18 Spirit Week Add-Ons

Specialty Camp: Dance, ages 5-12
Additional $35 per child
Early Care
Additional $30 per week per child
Late Care
Additional $30 per week per child

Week 7: July 21-25 Ship Wrecked Add-Ons

Specialty Camp: Splashtacular, ages 5-12 [Sold Out]
Additional $35 per child (SOLD OUT)
Early Care
Additional $30 per week per child
Late Care
Additional $30 per week per child

Week 8: July 28-Aug 1, Live It Out Loud! Add-Ons

Early Care
Additional $30 per week per child
Late Care
Additional $30 per week per child

Week 9: Aug 4- 8, Jurassic Kroc Add-Ons

Specialty Camp: Disc Golf, ages 5-12
Additional $35 per child
Early Care
Additional $30 per week per child
Late Care
Additional $30 per week per child

Week 10: Aug 11-15, Circus Circus Add-Ons

Specialty Camp: Lil' Ninjas, ages 5-12 [Sold Out]
Additional $35 per child (Sold Out)
Early Care
Additional $30 per week per child
Late Care
Additional $30 per week per child

Please answer the following questions or write N/A if it does not apply.

Child's Name

Triggers that may cause problems - specify

Signs or symptoms to watch for - specify

Action steps (in the event of a medical emergency the Kroc Center staff should follow

Identify any staff to whom you have given specialized training/instructions to help treat symptoms

When to call parents regarding symptoms or failure to respond to treatment

When to consider that the condition requires medical care or reassessment

Any additional information that may be helpful to staff (medical or behavioral)

Physical/medical facility

Emergency Medical Treatment

I hereby give medical consent for emergency medical care or treatment to be used only if I cannot be reached immediately.
I hereby DO NOT give consent for emergency medical care or treatment to be used only if I cannot be reached immediately

Medication

My child will not require any medication while attending camp
I hereby give The Salvation Army Ray & Joan Kroc Community Center camp staff my permission to carry and give my child the medication that he/she needs

Immunization Record

I understand that I need to give an up to date Immunization Record to the Kroc Community Center before the first day of after school or camp

Sunscreen (SC) Authorization

Yes, staff and my child can apply SC
Yes, only my child can apply SC
No, staff or my child cannot apply SC

Insect Repellent (IR) Authorization

Yes, staff and my child can apply IR
Yes, only my child can apply IR
No, staff and my child cannot apply IR

The caregiver listed under caregiver information will be listed as the primary emergency contact.

Name

Address

Phone Number

Date of Birth

Gender

Male
Female

Caregiver relationship to camper:

Additional Contact 1

Additional Contact 1 Phone Number

Additional Contact 1 Email

Please check all that applies for this additional contact:

Lives in the same household as registered child(ren)
Emergency contact
Authorized to pick-up child(ren)

Would you like to add another contact?

Camp Deposit

Total

$0.00

Waiver

A copy of the complete Procedures and Policies Handbook will be sent to the email listed in registration by the Youth Development Supervisor. We require all families to read through the handbook to fully understand the expectations of camp. Below are a few key camp acknowledgments regarding our procedures and policies. By marking "I have read and agree to the terms above," you are acknowledging the few key camp points and responsibility of reading the handbook as a whole.

Terms

Summer Camp Procedures and Policies Acknowledgments

Kroc summer day camp is an outdoor camp.

The camp’s operational hours are 8:00am – 5:30pm five days a week unless otherwise specified.

Morning check-in takes place at the Pavilion outside the south end of the Kroc Center and in inclement weather, inside in the Kroc Center lobby. In both regards, campers must be checked in by an authorized adult.

Check-out takes place in the Kroc Center building at the camp office with the Youth Development Supervisor or Kroc Administration. Camper can only be checked out to an authorized adult or another adult designated in writing. Adults may be asked to present photo identification.

Camps registered and the deposit is paid for prior to between January 27th and February 2nd will be billed at the rate of $195 MEMBERS and $225 NON MEMBERS per week per child

Camps registered and the deposit is paid for after February 3rd will be billed at the rate of $210 MEMBERS and $240 NON MEMBERS per week per child

Additional charges apply for extended care or specialty camps on top of the weekly rates specified above.

A non-refundable deposit of $20 dollars per week per child is due at the time of registration to secure the camper's spot.

All charges and any elected charges must be paid in full by noon the MONDAY before the start of each week of camp.

Until payment in full is received, my camper(s) will not be allowed to attend camp.

I must maintain an active family membership through the end of summer to receive the member pricing.

If my membership status changes, I must communicate that with the Youth Development Supervisor. Rates will not be retro paid.

Scholarships and financial assistance are available to those who qualify. Please reach out to the Youth Development Supervisor.

Up-to-date immunization records for my camper(s) must be submitted to the camp office prior to their first day of camp.

If I marked NO to “permission for my camper’s image or likeness to be used through photography, videography, advertisement, social media, and other promotions” will be required to wear a paper wristband each day at camp to ensure their safety as our Marketing team does regular drop ins to capture camp memories.

I have shared with my camper the following camper expectations: Positive attitude, participation, safety, honesty, accountability, respect, collaboration, toys, stuffies, game cards, electronics, gum/candy etc. to be left at home.

The Salvation Army may immediately remove any camper whose behavior creates a significant risk of harm to the health and safety of other children or staff, without following the guidance steps outline in the Procedures and Policies handbook.

Swimming is a big part of Kroc summer camp but is subject to change due to the availability of lifeguards and aquatics attendants to ensure required ratios and safety standards are met.

Camp will not allow a camper to be in attendance if the camper is displaying the following symptoms: severe cold, sore throat, drainage from the eye, fever, rash, vomiting, diarrhea, and other signs of illness. Should a camper begin to display symptoms of illness while participating in camp, they will be isolated in an area separate from other campers and the Youth Development Supervisor, Youth Development Coordinator or Kroc Administration will notify the caregiver or another authorized adult to pick up your camper as soon as possible.

A head injury of any type, no matter the perceived amount of impact, will be considered a significant injury and the camp office will call and notify the caregiver of the incident, and the circumstances involved.

Snacks will be served both in the morning and afternoon. The morning snack will be served at 9:00am, the afternoon snack at 3:00pm. Lunch is provided by the USDA Summer Food Program through the Green Bay Area Public Schools. Caregivers can send their own lunch with campers to tailor to their child's desires and/or if there are special dietary or allergenic needs.

The Kroc Center day camp has posted outside their office door the most current DCF (Department of Children and Families) 251 policies handbook and the Kroc Center Day Camp Procedures and Policies handbook.

I have read and agree to the terms above.

Requirements to be fully enrolled:

Online registration questionnaire completed
Registration deposit paid
Autopay set up through ProCare
Procedures and policies handbook signed
Current immunization record submitted

*The Youth Development Supervisor, will send a confirmation email to families stating that their camper(s) are fully enrolled.

Kroc Summer Day Camp

Description

Camper Registration

Emergency Medical Care Plan

Caregiver Information

Camp Deposit

Waiver