Quapaw Twilight Camp
Reach For The Stars!
Join us for a fun, constellation themed week of songs, games, nature activities, and so much more!
INSERTED INTO
THIS TEXT BOX
When:
Monday, June 8, 2015 through Friday, June 12, 2015
Where:
Monday, Tuesday, Wednesday: McHenry Township Park, Johnsburg, IL
6:00 PM – 8:30 PM
Thursday: Chapman Hills, East Troy, WI
3:00 PM – 8:30 PM / 10 AM for overnighters
Friday: Knox Pool, Green Street, McHenry, IL – Family Swim
7:15 PM – 9:15 PM
Family Swim Night: Parents must be in attendance for rest of family members to attend. You may
bring your own snacks and drinks, but no glass bottles.
Campers are responsible for their own transportation each evening.
Cost:
$40.00 registered Girl Scouts. “Cookie Dough”/“S’More Dough” may be used.
$55.00 new Girl Scouts (includes $15 Girl Scouts of the USA registration fee, valid
through September 2015)
Cost includes patch, T-shirt, snacks, Thursday dinner and Family Swim Night.
Overnight:
Open to all girls entering 3rd grade and up
Date: Thursday, June 11 – Friday, June 12, 2015
Location: Chapman Hills, East Troy, WI
Equipment List to follow.
$5.00 additional includes two meals and snacks.
Make check payable to GSNI Quapaw Twilight Camp – NO REFUNDS
Mail registration form and payment to: Margie Dacheff
8317 William Ln.
Spring Grove, IL 60081
Questions: Margie Dacheff (815) 675-6939
Girl Scouts of Northern Illinois
Registration Closes: May 4, 2015
Registration Information: Enrollment is limited and will be on a first-come, first-served basis.
Registration begins March 18, 2015 and closes May 4, 2015.
.
All registrations must be postmarked on or before the closing date.
1. Complete both sides of the registration form, filling in ALL of the blanks.
2. Mail form and payment to: Margie Dacheff
8317 William Ln.
Spring Grove, IL 60081
3. Payment in full is due at the time of registration, unless applying for financial assistance. “Cookie
Dough” or “S’More Dough” may be used for girl registrations.
Financial Assistance: Financial assistance is available for a portion of the girls’ fees.
1. To apply for financial assistance call 847-741-5521 as soon as possible. A simple form will be
mailed to you and must be completed and returned to the Girl Scout Center no later than May 15.
2. Anyone applying for financial assistance must still fill out and return the registration form, along with
“Cookie Dough” or “S’More Dough” and the amount you will be able to pay, to the name above by
the close of registration.
3. Financial assistance will be forwarded to the day camp directly. Parents will receive a letter
indicating the amount of assistance awarded. Any balance not covered by financial assistance must
be paid in full before the start of camp. If further financial assistance is needed, it is the parent’s
responsibility to call 847-741-5521 to request additional assistance.
Refund Procedure:
NO REFUNDS —NO confirmation of registration will be sent.
Parents/Guardians:
Twilight camp is a volunteer-based program—there is no paid staff at camp. Safety guidelines require a
1:6 ratio of adults to children for the operation of our twilight camps. Volunteers are the soul of our
program—complete the attached application to join in the fun!
Training is required for all twilight camp volunteers. The dates for training are: To Be Announced
Questions?
Name:
Margie Dacheff
Phone: 815-675-6939
Email:
[email protected]
Twilight camp offers girls of all ages the opportunity to discover the fun, friendship and power of girls together.
Girls will be able to enjoy the out-of-doors, while learning basic camping and outdoor skills.
Would you like to make a difference in a young girl’s life? Twilight camp offers you that opportunity. Service unit
twilight camp is powered by volunteers—some are Girl Scout leaders who have been serving troops throughout
the year, while others are involved in Girl Scouting in other ways. Parents’ help is needed to ensure success of
the camp. Come and share your knowledge and skills . . . try new things . . . spend time with your daughter. The
Quapaw Twilight Camp Committee has already done the planning for you—you can come and HAVE FUN.
Training will be provided for you. Please indicate your desire to join us on the back of the registration form.
Girl Scouts of Northern Illinois
Office Use – Fees
Cash ________________________________________
Check________________________________________
“Cookie Dough”/“S’More Dough” ___________________
GSUSA Reg. __________________________________
FA __________________________________________
Overnight _____________________________________
Total
Registration Closes: May 4, 2015
REGISTRATION FORM
Please complete both sides and mail to:
Margie Dacheff
8317 William Ln.
Spring Grove, IL 60081
Please Print
Camper’s Full Name
Age
Address
Home Phone (
City
)
Zip Code
Parent’s/Guardian’s Name
Daytime Phone (
)
Parent/Guardian E-Mail
Grade entering in the fall
Troop #
School
Leaders’ name(s)
New Girl Scout? [
] check if yes
She is (Check all that apply):
American Indian or Alaskan Native
Asian
White
Black or African American Other
Hawaiian or Pacific Islander
I choose not to share
She is Hispanic or Latina:
Yes
No
I choose not to share
Media Permission: When participating in Girl Scout activities I (or the person that I am registering) give consent to be interviewed,
photographed, videotaped, or electronically imaged for the purposes of promotional materials, news releases, or other published formats for
either the local Girl Scout Councils or Girl Scouts of the USA. The images will be the sole property of the local Girl Scout Council or Girl
Scouts of the USA,. I hereby release and hold harmless the local Girl Scout Council and Girl Scouts of the USA from any claim arising from
the use of these images.
_____ I wish to opt out of the media permission at this time.
Camper Fees
Camper’s Name
Camper’s T-Shirt size: Youth: [ ] M [ ] L
Volunteer Fees
Camp Fee
$40
(Please Circle)
Adult:
Overnight
Fee
$5.00
Total A
T-Shirt Cost
$8.00
$9.00 for
XXL
Total B
Adult: [ ] S [ ] M [ ] L [ ] XL
Days
Attending
Name
New Scout
GSUSA Fee
$15
Fees
$5.00 for
Overnight*
M, T, W,
Th, F
Adult’s T-Shirt size: Adult: [ ] S [ ] M [ ] L [ ] XL [ ] XXL [ ] XXXL
*Please note: Parents do not sleep in the same tent/room as campers
*Free for overnight trained adults
Discounts – Deduct listed dollar amount for each that applies to your registration
Addl girl in family - $10
Overnight trained adult
attending Thurs. overnight
- $15 (plus no $5 fee)
Make check payable to “GSNI Quapaw Service Unit Twilight
Camp” – no refunds.
Attended camp last year $5
Total Fees Enclosed
Total A + Total B, less
discounts
Camper’s Medical Information:
This camper, ______________________________________________________is in good physical condition
and can take part in usual outdoor activities. Special health considerations (allergies, diabetes, dietary
restrictions, etc.), include instructions for medication sent to camp with camper: _______________________
_______________________________________________________________________________________
Print name of parent/guardian ______________________________________________________________
I can be reached during camp at (_____) _____________________cell ( __________ ) _______________
Date of last tetanus shot ___________________________________________________________________
Please list two (2) emergency contacts in case you cannot be reached.
Emergency contact #1 name ______________________ relationship __________phone (
Emergency contact #2 name ______________________ relationship __________phone (
Child’s physician ___________________________________________________phone (
Name of family insurance carrier ______________________________________phone (
____ )
____ )
____ )
____ )
_________
_________
_________
_________
The bearer of this letter has my permission as a parent or legal guardian to act on my behalf in any emergency
dealing with the health and welfare of my daughter and to obtain emergency treatment for her by a licensed
physician.
[
]This girl is not currently registered with Girl Scouts of the USA, and I am willing to have her become a Girl Scout.
____________________________________________
________________________________
(signature of parent/guardian)
(date)
Twilight Camp Volunteer Help Information:
I would love to help! Dads, grandparents, aunts and uncles at least age18 are welcome. An Application for
Volunteer Position and CBC Authorization Form (Criminal Background Check) must be completed by all
volunteers. Forms can be found at www.girlscoutsni.org.
Name
address
I prefer to work with (check all that apply):
[ ] GS Daisy [ ] GS Brownie [ ] GS Junior [
[ ] with my camper [ ] not with my camper
*requires specialized training
phone (
] GS Cadette [
I can volunteer:
[ ] for all five days
[ ] for only the following days. Circle all that apply: Monday
] overnight [
Tuesday
)________________
] first aid/CPR*
Wednesday
Thursday
Friday
Volunteer Medical Information:
Name
Doctor’s Name and Phone #
Special Health Considerations