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HomeMy WebLinkAbout2017 May 17 - Updated Policies, Procedures, Misc. Information i � Required Documents i See the MA Regulations for Minimum Standards for Recreational Camps for Children, State Sanitary Code, Chapter IV-105 CMR 430.000 and the guidance documents issued '. by the Department of Public Health, Division of Community Sanitation for additional assistance with developing the following documents. Check Docurnents Submitted *Staff information forms(see attached).................................................................. ✓ *Procedures for the background review of staff and volunteers(105 CMR 430.090)............. ,/ *Copy of promotional literature(105 CMR 430.190(C))............................................. / *Procedures for reporting suspected child abuse or neglect(105 CMR 430.093).................. � ', *Health care policy(105 CMR 430.159(B)),including immunization records................... � *Discipline policy(105 CMR 430.191).................................................................. � �' *Fire evacuation plan—approved by local fire department(105 CMR 430.210(A)).............. � *Disaster plan(105 CMR 430.210(B)).................................................................. ✓ ', *Lost camper plan(105 CMR 430.210(C))............................................................. � *Lost swimmer plan(105 CMR 430.210(C))........................................................... ,� *Traffic control plan(105 CMR 430.210(D)).......................................................... � *Day Camps—contingency plan(105 CMR 430.211)................................................. ,� *Primitive, Trip or Travel Camps — Written itinerary, including sources of emergency care and contingency plans(105 CMR 430.212).............................................................. ' *Current certificate of occupancy from local building inspector(105 CMR 430.451)............ �a ,�, rb *Written statement of compliance from the local fire department(105 CMR 430.215)........... ��, 3,i� ' *Aquatic plan,including Christian Law, PFD fitting tests,water testing and swim tests...... Attach the names, ages, applicable current certifications (if any), such as First Aid, and the anticipated role at the camp of all supervisory staff(see below). Use as many pages as necessary to complete this. Please: If you are applying for an original camp license for a camp based in Yarmouth, you must file a plan showing the following with the board of health at least 90 days before your desired opening date (5ee MGL Ch. 140 § 32A): ➢ Buildings, structures, facilities and fixtures ➢ Proposed source of water supply ➢ Works for disposal or sewage and waste water Supervisorv staff ineans those persons with the responsibility, authority and training to provide direct supervision to camper groups. This may include counselors, junior counselors, general activity leaders or other staff who provide supervision to campers without assistance. � 04/30/IS . 2017 FLAX POND STAFF LIST 2017 Position C/S CK CPR/FA ALLIN LINDSEY SC X X BEGLEY TIMOTHY SC X X BENKIS JOHN Initiatives X X COBILL MARIA Director X X ' COBILL DANIEL Asst. Director X X ' COLLUCCI NICOLE SC X X MACDONALD MACKENZIE SC X X COUGHLAN ORLA SC X X COYLE MEGHAN SC X X MEDEIROS ALLYSSA STEM X X WAKEFIELD TREVOR SC X IN PROCESS FEINSTEIN SAMANTHA SC X X FELLOWS CORY SC X X FITZGERALD MEAGHAN SC X X ', FLAMMOND CHARMAGNE health and safety supervisor X X ', GILCHREST NtCOLE SC X X GILCHREST KRISTEN SC X X GILCHREST SAMANTHA SC X X GRANT ALEXANDER SC X X HASELTON LILY SC X X BEARD BRIANNA SC X IN PROCESS HOGAN JOANIE sub/prog sup X X JOURNET LAUREN SC X X SC X KARRAS ULY Arts and Crafts X X LONGOBOARDI ANDREW 1C X X WOLLACOT ALLIE SC X IN PROCESS CRARY KATELIN Asst. Director X X O'BRIEN KONOR SC X X O'SULLIVAN PEGGY SC X X REID TREVOR SC X X SC X RYAN 10HN SC X X SANDERS ABIGAIL Flaxtivities Sup X X SULLIVAN MARY JC X X SYLVESTRE CUROUDE SC X X WAGNER EMMA SC X X DILLON JULIA AIDE X IN PROCESS TRAVERS JESS 1C X IN PROCESS ALLIN MATTHEW JC X IN PROCESS BADACH JOSH JC X IN PROCESS PASSOS MARIANNA JC X IN PROCESS DAVIS ETHAN JC X IN PROCESS FITZGERALD JAMIE JC X IN PROCESS GOLDSTEIN JAYDEN JC X IN PROCESS DELLACOSTA COLLIN JC X IN PROCE55 JONES PHILLIP Sports Sup X IN PROCESS Waterfront X DONOHOE JACK Archery SC X X r Required Documents See the MA Regulations for Minimum Standards for Recreational Cainps for Children, State Sanitary Code, Chapter IV-105 CMR 430.000 and the guidance documents issued by the Department of Public Health, Division of Community Sanitation for additional assistance with developing the following documents. Check Documents Submitted *Staff information forms(see attached).................................................................. x *Procedures for the background review of staff and volunteers(105 CMR 430.090)............. X *Copy of promotional literature(105 CMR 430.190(C))............................................. X *Procedures for repo��ting suspected child abuse or iieglect(105 CMR 430.093).................. X *Health care policy(105 CMR 430.159(B)), including immunization records................... X *Discipline policy(105 CMR 430191)...........................................:...................... X *Fire evacuation plan—approved by local fire deparhnent(105 CMR 430.210(A)).............. X *Disaster plan(105 CMR 430.210(B)).................................................................. X *Lost camper plan(105 CMR 430.210(C))............................................................. X *Lost swimmer lan 105 CMR 430.210 C ............................. X P � ( ............................. *Traffic control plan(105 CMR 430.210(D)).......................................................... X ' *Day Camps—contingency plan(]OS CMR 430.211)................................................. X *Primitive, Trip or Travel Camps — Written itinerary, including sources of emergency care and contingency plans(105 CMR 430.212).............................................................. x *Current certificate of occupancy from local building inspector(105 CMR 430.451)............ X *Written statement of compliance from the local fire department(105 CMR 430.215)........... X *Aquatic plan, including Christian Law,PFD fitting tests,water testing and swim tests...... X Attaeh the names, ages, applicable current certifications (if any}, such as I'irst Aid, and the anticipated role at the camp of all supervisory staff(see below). Use as many pages as necessary to complete this. Please: If you are applying for an original camp license for a camp based in Yarmouth, you must tite a plan showing the following with the board of health at least 90 days before your desired opening date (See MGL Ch. 140 § 32A): ➢ Buildings, structures, facilities and fixtures ➢ Proposed source of water supply ➢ Works for disposal or sewage and waste water Supervisory staff ineans those persons with the responsibility, authority and training to provide direct supervision to ca�nper groups. This may include counselors, junior ! counselors, general activity leaders or other staff who provide supervision to campers � without assistance. � 04/30/I S CircleWeeksAttending: FLAX POND SUMMER ADVENTURE PROGRAM � #1—June 26—June 30 31 DUPONT AVENUE S.YARMOUTH, MA 02664 � #2—July 3—July 7 In season Camp Phone:508-760-4815 or flaxpond@varmouth.ma.us � #3—July 10—July 14 Attendance Phone line: 508-760-4819 � #4—luly 17—July 21 [ #5—luly 24—July 28 Child's Information: Resident or Non-resident � #6—July 31—August 4 [ #7—August 7—August 11 Name: � #8—August 14—August 18 [ Address: #9—August 21—August 25 [ KC—August 29—Sept 1 Date of Birth: Age: Grade Entering in Fall: � TIME: Parent(guardian email): [ � � Parent(Guardian)Information: � Name: Relationship: � Address: Home(work) phone: Cell phone: Emergency Contact information (other than above): 1st Name: Relation: Cell: 2"a Name: Relation: Cell: Approved Names of people who can pick up your child(vehicle picking child up must have placard on windshield) Primary Relation: 1• Relation: 2• Relation: 3• Relation: * Pick up Tags must be picked up at Flax Camp Office prior to your child's first day of camp ** If someone different is picking child up you must provide written note:Attention Nurse MEDICAL INFORMATION REQUIRED: Copy of most updated child's shot record on file: Y or N—(if no please have it faxed to 508-790-9152) Does your child need an Epi Pen or Inhaler: Y or N —(if yes please bring to camp nurse on the first day) Does your child have any allergies: Y or N -(if yes,please list) Any past history of a concussion: Y or N -(if yes,please give us date) Type of over the counter medications that can be administered at Camp in case your child is sick: Circle: Tylenol Advil Benadryl Neosporin InsectWipes Antacid/Tums Does your child have any medical,special needs,or behavioral concerns we need to be aware of and assist with, Please Explain: Prescribed Medications: Please fill out a medication form provided by Recreation office or at camp office on the first day.I give my permission for Flax Pond to administer my child's prescribed medications to him/her while at camp Signature Name of Medication: I authorize transport and treatment of my child,in the event of an extreme emergency where medical attention is needed and a guardian cannot be reached.Required Signature ���ks � R�c�rc��tic�,3 Yarmouth � .,t�,�c��is ttirsst,;,,K�•.,.�, 1 Flax Pond Adventure Pro�ram Consent and Si�n Off Forms Consent& Release Form: I, (parendgrandparent) of. (list all children) hereby consent to my child's participation in voluntary athletic or recreation programs of the Town of Yarmouth.I also agree to forever release the Town of Yartnouth,Board of Selecrinen,and all their employees,agents,board members,volunteers and any and all individuals and organizations assisting or participating in voluntary athletic or recreation programs of the Town("the Releases")from any and all claims,rights of action and causes of action that may have arisen in the past, or may arise in the future,directly or indirectly,from personal injuries to my child or property damage resulting ftom my child's participation in the Town voluntaty athletic or recreation programs. I also promise,to indemnify,defend,and hold harmless the Releases against any and all legal claims and proceedings of any description that may have been asserted in the past,or may be asserted in the future,directly or indirectly,arising from personal injuries to my child or property damage resulting from my child's paRicipafion in the Town of Yarmouth voluntary athletic or recreation programs. I further affirm that I have read this Consent and Release Form and that I understand the contents of this Form. I understand that my child's participation in these programs is voluntary and that my child and I are free to choose not to participate in said programs. By signing this Form,I affirm that I have decided to allow my child to participate in the Town recreation programs with full knowledge that the Releasee will not be liable to anyone for personal injuries and property damage my child or I may suffer in voluntary Town recreation programs. Refund Policv• 1. No refund for removal from the program due to disciplinary problems. 2. Full refunds will be given for medical reasons with a Doctor's note submitted when notified immediately. 3. Refund requests for any other reason will be reviewed by the Recreation and may have a cancellation fee of up to 50% applied. Consent Release Signature Date: Behavioral/DisciplineBullvin�Si�n off: I,the parendguardian,have received,read,and understand the attached disciplinary guidelines and bullying policy. I agree to follow the procedures set forth by the Yarmouth Recreation Division in regards to my child's behavior. Required BehavioraUDiscipline Signature Date: Media Release: (Optional) There will be times when pictures will be taken by staff for our newsletter,website and marketing purposes.Please indicate if you would allow your child(s)likeness and name be used in any capacity Yarmouth Parks and Recreation by signing below: Media Release Signature Date: 1 � � } Q� I J ^ W I'- � J � W � > c`' ,� �¢ '�u � a ,� a 'u� � a, � r � �- � � � av � � � Z O IL � } = J � O y� W S (n LL J 00 O C' W N LL � ln O 1' � = ln LL J LL C7 � Z W W � z O � 3 � vf g '"� x O � 3 � S � N z 0 � � > 2 Q�i fC O �y OC � � O J � � � Z J W C.7 � Z W W � � N U LL � � U LL � � O V LL � Z O V LL . � N '�, VI J W J . 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Th� �SI�l���ir�� t��ith tl7ree l�lasts �n � �rhis�le. TIg� dri�l iz��=c��v�s �quick and�ffici�nt searcla of u=a�erfroz�t and ���ac�rit�rea� zz�cl�dix��ur���i-rae�th t�e dacl�. All ��ni�r�r�uns�lars �hc�u�d r�i�aiza uTith their�r���s c�zz tl�e be�cl�i��a li�ae a�id �eep t��n� silent u�itil ��e sire�l alarzns �nd tl�ez���y sl�auld fall€�«� L,c�st Cl�ild Pr�cedu�-�. Tla� T��z� �ader will call nn tl�e r�dio to ii�fii�rm th��I� Coor�isaatar c�f th� para��d�r��. J����zo�� �csuz�s�lc�r� sl�c�uld i�nmediat�ty searcl�the char��in�rc�ams,}�c�rt�-jo�an�, I-��alth az�d�af�ty C?�`fice anct ba�hrc�e�zz��. The��T�ter�i-�nt�upervxs�����i�1 ��ay c�n Iand to ca�ardinat���ater s�aa-G1a �d ta �uard�fater s�arcl��rs. Tl�e Flax Pazad Caoi•dit�atc�r t�i�l pull tlxe I��st �hil� �ir�i�. I4'IISSII'�;G P�I��QI�S��ARCH: l. Cxet as n�u�l1 i�lforrzla�ic�n as �tassi�le. (�c�ane�aow long,��l��r�. 1�st s����, z�a�ne; �ea��i����r��at, etc.� Contact the�'lax �r►ordinatar im�uedi�tel�=. '. �Iake land searc�, utilize st�ff to sear�h ���ery ar�a possibl�. 3. If ncat lc�c�ted durin�I�.nd searc.la,the Flax Por�d C°oozdinatt�r�vi11 can�act�he Assis�ant Recreatic�u I�ir�ct�r, R.ecreatic��3 T.�ir�c�ar, as�c�rescu�p�rsca�rt�L Cl��rr wat�r c��`a�1 s�viz�aer�. �a�her staff azaci do a wa1�Zn��ear�13 �f"tl�e s�irnmir�g area c�nsistin��f t�i�talle�t a��ailable�n-duty�uard��sitioned at the �art�est part �f�Iie Iin�. Auatll�r�uard wzll be �t�he b�gi�za�in� ���.�te beach Ii��e. Qt�ea- guards will be spread aut�uith-i� the li1�e. �'�at�r�r€�zat G'oardizzatar mus�be i�� ck���� �f s�arcla�r�c�dure. C�z�e or n�ore available�aards`��ill utili�e tl��z��scaze board ir�deeper�=�t�rs i�ne��ssa�y. A11 s�arch par�es sl��uld 1�ave int�ric�cl�in; arnas ar�� ��es, a �weep se�rcl°� �rom �n���d af t�e �u�rimmin�area tc� t�e other. Remain ca�m ar�d 'az� ��a�tr�l c�f`t�ie si�u��iaz�a� all time�. Search a11 iand areas befor��r�tnm�r�cin���Tater searcl�, D� sa imm�diately if�c�u tl�init the situatiaz� rec�uir�s it. Befc�re daing an��l�ing,just sttap and tl�ink, .t-�,ccidents in �3�atin� Are�s �3cta�in�Ar�� (l� Th� s�ff��aerr�her(s) �Fh�wit��ess the acciden:t ar�aau�ce"�ccidez�t" and rnaint�i�� sigla�of t�l� w�t�r a�rea. If t�uo staff z�aem�+ers ar��uitness one sk�auld n�n ove�°to �he lifeguard i�the chair. (��Tl°�e life�raard in the�svat�r o�� �h�bt�ard svi�I swi�to�here the capsize� l�oat is flc�ating. The �ife�aa�d c�n the beach vaill bl�vv t�e��rhistle and r��nove all swim�ners frnn�the V��:�erfrc�nt ar�a in"�vaim ch��k" �`ashi�n. Th�Ii�`eguard an tl�e dack�vill �ct a� a iaaci�up f�r the rescu�Iifeguarci. i Page 18 (3) The staff inember who did not witness the accident will immediately notify the Flax Pond Coordinator and the Health and Safety Supervisor. The Flax Coordinator will notify the appropriate authorities. � (4) The Flax Coordinator will assign a staff inember to run to the front gate to direct emergency vehicles if necessary. Aquatic Safety Policy Lifeguards { • Lifeguards will be at least 16 years old and will be certified in American Red Cross Life guarding or equivalent. ! • All lifeguards will wear guard suits while on duty. They must concentrate their entire attention � on the area assigned to them. They must not engage in any conversation or activity that will distract them. • Lifeguards should be prompt, alert, firtn, fair, and courteous. , • Serious Rule infractions, injuries or rescues should be reported to the appropriate Waterfront Supervisor who will in turn report them to the Flax Pond Coordinator. Classification of Swimmers • All non-swimmers or at risk swimmers shall have a lifejacket available for their use at all times. (Christian's Law). Supply of Lifejackets held on property. • All children wishing to utilize Flax Pond aquatic areas shall be classified as Level 1, 2, or 3 swimmers by the Waterfront Supervisor or their appointee as follows: Documentation of what level and non-swimmers are kept in a binder at waterfront All camp participants are swim tested on their 15`day of attendance: No life jackets are used during the swim test. If a child is deemed a non-swimmer the child must wear lifejacket during swimming activities. http://www.inass.gov/eohhs/gov/departments/dph/programs/environmental-health/com m- sanitation/christians-law.html • Level l: Unable to put head under water, or can submerge minimally and blow bubbles, can ; float on front and back with support, exploring arm movements. All Pioneers (grades 1 and 2), regardless of ability will be kept in Level 1. • Leve12: Can fully submerge head under water,bobs, rotary breathing, can do front stroke and back stroke but are not extremely strong swimmers. • Leve13: Mastery of front and back stroke, swim underwater, tread water for 1-2 minutes, and uses appropriate breathing methods and shows strong methods of swimming. • Participants are never allowed to swim in an area beyond their ability level; this includes all special needs children. Anyone designated non-swimmer will have a PFD fitted to them and that will be marked with their name far the remainder of the season Facilities •On property, children and staff will swim only in marked swimming areas. •Boating may take place in marked or areas deemed appropriate by the Flax Pond Coordinator and Waterfront Supervisor. Boating may not occur in marked swimming areas!Boaters must adhere to policies and procedures in the Boating Regulations Policy. Appropriate Equipment for the Waterfront Area Page 19 • Lifesaving equipment shall be placed so it is immediately available in case of an emergency. The staff should not be using the safety equipment for a seat. • Minimum equipment must include a whistle or other audible signaling device for each staff person on duty; a rescue tube, a backboard with head restraint and a minimum of three straps; a First Aid Kit; and a rescue surfboard. Appropriate Equipment for Other Waterfront Areas Including Off-Camp Aquatic Sites • Lifesaving equipment shall be placed so it is immediately available in case of an emergency. • Minimum equipment must include a whistle or other audible signaling; a throwing assist device; and a First Aid Kit. • In all boating areas, the staff inember on the pier must have immediate and unrestricted access to a water craft with which to provide emergency assistance. One kayak should be available for the staff to use in the event of an emergency. Lost Swimmer Dri11-Practice • The LSD is learned and practiced by all staff during staff training. The Waterfront Supervisor will explain the procedures to the children on the first Monday of every week. She will also review over the rules of the Waterfront Area and how the children should conduct themselves during"swim checks." , Fire Safety Policy Introduction Flax Pond is located on 100 acres of woodlands which include Yarmouth Conservation land. It is important that extreme care be taken in the use of fire,both on property and on overnight trips. Fire Safety Strategies ' • The property is inspected by a Qualified Fire Inspector every year as per Massachusetts statute. • Portable fire extinguishers are kept in every building and checked for appropriate pressure, ' tagged, and dated every year. ' • Smoke detectors are mounted in every building. Batteries are replaced at the beginning of the program season. • During the staff training week, staff inembers are apprised of the location and proper use of the fire extinguishing equipment that is available on site, including fire extinguishers and water hoses. • A fire drill will be practiced within 48 hours of the start of each session and it will be noted in the Flax Pond Coordinator's log. Fire Prevention Strategies • Flax Pond is a non-smoking facility. • Flammable materials and fuels are kept locked in non-camper-occupied buildings and are only accessible by staff. • Only designated campfire pits and grills may be used for fires. Fire Prevention Rules • Always clear an adequate area around any campfire and be sure that the fire is watched at all times. Never leave a fire unattended. A water source should be readily available to extinguish or control the fire. Always be certain that campfires are completely extinguished. Page 20 • Children are not allowed to have or carry matches or lighters. Counselors should keep matches ; out of sight when not being used. j •Never throw away lit materials without being certain that they are completely out. ! Fire Emergency Procedure Staff Duties and Responsibilities • Upon suspicion or discovery of a fire, the staff inember in charge should clear campers quickly and safely out of the immediate area. If available, one staff inember should accompany the campers to a safe location. ' • A staff inember is immediately dispatched to locate the closest fire extinguishing device and bring it back if appropriate. • A staff inember should either be dispatched to notify the Flax Pond Coordinatars and ' Health and Safety Supervisor of the severity of the situation, or if accessible use a radio to contact the Flax Pond Coordinators. • Staff inembers should use available and appropriate equipment to fight the fire but should not place themselves in danger in this effort. • Available nearby staff will take steps to help prevent the spread of the fire and be especially careful of flammable fluids, gasoline, and so on. When in doubt of your ability to contain a fire,leave! • The Flax Pond Coordinator or the most seni�r staff inember on duty will make the decision ', whether to invoke the all camp evacuation procedure or"Lost Camper Drill" or not. '; Weather Emergency Procedures Notification The Flax Pond Coordinators will periodically monitor local weather conditions via television, I radio, or Internet. i Tornado or Severe Winds ', In the event of a weather emergency(tornado, hurricane, or severe damaging wind) campers and '' staff will go immediately to their respective nation areas, or if little warning, to the nearest ' shelter. The following steps shall be taken: • Remain calm. • Keep away from doors and windows. • Lie on the floor, cover children with back packs and coats. Hail Large hail can impact a surface at speeds greater than 100 miles per hour.Move inside to avoid getting hi� Hailstones driven by a storm's high winds can shatter windows; follow the steps above for protection from severe wind. Hail can also be a signal that a dangerous storm or tornado is imminent. Lightning All thunderstorms produce lightning,by definition. If you can hear thunder, you are close enough to the storm to be struck. It need not be raining for lightning to strike. Lightning can strike as far as ten miles away from the rain portion of a storm. The following steps shall be taken: i Page 21 • Remain calm. • All boats will be called in immediately and swimmers pulled out of the water. • Move inside. Stay away from doors and windows. • Do not stand in an open field, on the beach, under an isolated tree, basketball hoop or near the flagpole. • In the woods,proceed immediately back to unit areas. • If thunder is heard in the distance or lightning is seen the Flax Pond Coordinator will make an announcement over the PA and radios to move indoors. • No children or staff will be allowed to leave the buildings for anv reason until clearance is �iven from the Flax Pond Coordinator, this includes bathroom trips. • Outdoor activities will resume if there is no sign of lightning or thunder for over 20 minutes. Extreme Heat On hot days when the temperature is above 90 degrees F, and the relative humidity is high, evaporation slows. The body becomes unable to shed heat through its normal methods of circulatory changes and sweating. To prevent heat disorders: • Slow down. • Drink plenty of water. • Wear lightweight, light-colored clothing. • Stay out of the sun. Heat exhaustion symptoms include heavy sweating, weakness, and cold skin. Heatstroke symptoms include hot dry skin and rapid pulse. Move to a cooler environment, and get immediate medical help. Lost Camper Emergency Procedures • A staff inember shall report a missing camper immediately to the Flax Pond Coordinators, or if absent, the Health and Safety Supervisor. The Coordinators will assess how long the camper has been missing and will respond appropriately, according to these steps: • The siren will sound over the PA system. All counselors will gather their groups and do a head count. Team leaders should listen to their radios for further instructions. All groups should head to the Field in lines. If at Waterfront, children only need to put their shoes on. The children should remain silent in case further directions need to be given. • The Flax Coordinators will assign staff to check all buildings and program areas. This search is limited to 5 minutes. (Please See Primary Search Duties) • Two staff inembers will be assigned to drive a vehicle slowly down the main Flax road, and both left and right one mile on White's Path. • If the missing camper is not yet found, a secondary search will be initiated and designated staff will proceed as instructed. Team Leaders will give their radios to a Junior Staff inember. Missing Child Drill Procedure Primary Search Area Searched bv the following Waterfront Waterfront Supervisor and Lifeguards Changing Room/Portable Bathrooms Boating Junior Counselor Arts & Crafts Arts & Crafts Supervisar Theatre/Main Building Flaxtivities Supervisar � � Pa�e "�2 �pc�rts at�d ��JeIls��ss Supe�isc�r, a�d tlze Health Su�er�di�or��°iIl�i� z�z ccantact��Tit1� tl�e �I�x P�z�d C'ac�rt�in�tc�r b}F r�dic�s. S��ondarv�earch " ~� A.t-ea ��=��1�'t C:. 11�.��Yt� �Gedar S��}�r�t� C�.��C���. ��';:� Ini�i��i��s Sup�r�=isc�r ��' Juni�r Cc�un��1€�r_ Tr��fi� Junic�r Cc�unseior —Tirr� 12va d �.�d tr�:ils l��a�ure Sup��~�=isor Jun��r +��unseior — �a�ie 'Fraiis to I�-�� Fl���ivitie� Super���c�r Arts and Craft� Sup�i�°isor .Tu�ia�r �ounselor —�lex Juni+�r Cc�c�nselor --�'I�.kenzie T�ai�� Behin�i the �'�elds A:rcher�= �upe�r�is�r Juni�r Couz�s�I�r— t�►��z�nd� Jun,it�r Counsela►r — Andrew ' �V��e�r�r�nt Gu��-ds �u �n�A.v�I�,�4�h���'� Fatthl�. �4'���n S�t b �"4'�h�cie �pvrts Sup�rvisvr �3e�t�h �nd Sa�e U��c� FI�aI�h and Safet�T �up�r��sc�r Te�n Travel Super�i�or A11 Prograrn �u��rvis�rs shr�uld b�in�c�ntae���ith�he�'Iax Pond Coc�rdinatc�r c�n�he radxos. i Pa�e i� i Crisis lt��nag��nent Pl�.n , I Condi�i�ans ��at��a�= L�efne a Cr�i�i� � A se�ic�u�pa���er f�ilu�°e, u��cc���tr�llable�x�alth �ri�is, terr�rist a�ack, c�r se�rit�u�w•��ther emer�en��= ' • I�eath tar seric�us iz�jury af a ��ild e�r staff znember�� cam� t�r t��l anv�'1ax-�pcar���red�ip �aff ; c�nzp, • L�st ca�����er��t �+�u�ad��ithin�0 n�inute�. ' • �"it-ir��af c���� or��ar� �taff�emt�er�v,�hile caznp is iz� sessi�za. • An i��stai�c�, �usp�cted c�r dacuzx�e�ied, of Child.Alat�.se �� Fl��. ' � �ia�c�tl��r situatioi� tl�at, i�a tl�e opi��i�n c�f t��� �Iax Pflnd C�t�rdir��t�ar�defines a crzsis. ' �nez-�1�'reparedz��ss � , • l��aintainiza�;a list of aIl miz�or�taff zui�i��are�t��one nur�ab�rs a�ad cm�r�erzcyg co�atact ' nun�bers, � Maintaini��a Iist of all cazu�ers. 1�=itT��are�t p�c�ne numbers �a�d�r-ner�enc��o��t�act nurx�bers. t �.�:�o��in�all�as�ible n�etlaod� c�f cc�z�tacti�a�the�annou�i P�rl�� ant�R��re�ticar� Dir���a�r and ,: Prc��an� Supervisar at a�l �irraes. , C�-�isis �•S.ar���ern�tit 5tep� I. Tlae �lax Pand Cac�rdiz�at�r��=iI� �oz�tact�e A.s�i�tant Recreatic��Z Direc;t�r((�r Recreation I�irectc�r if x��ces��ry) as sc��n as possible. . : 2. If"t��e c�si� accur�c��'c��za�� t���1ax Pra�d C�c�rdixia�c�r and�s�istant R:�creati�n Di���t�r�-ill ' decicie��i�ether it is appropriate tc� se�d� Fl�� Pond staff inember to th�scene, a�ad w�iat autl�c�rit�that�ersc�r��ui�l have�€�cQmmunicat�v�ith par�nc�, emer�ency persc�nnel, ar�d��r the n�edia. � 3. Staff`��ail z�c�t talk to a�embers of t1�e metlia. A1� such zz�quir�s sh�l�t�e referred ta the ; i Yar��crta°��Pari�s and Recr�a�iQn Dir�ctcar, or an�other�arc�fes�i�nal s�ecz�call�desi�nated by t�;���n. 6. �hilr�rer� �d staff n�.e�3bers��ili be�.�pt infona��d dur�z��the crisis iz�a��vay that r��c��nizes �eir neec�tn know,takes ir�tt�can�iderati�� fears a�d fe�li���,a.nd miniz�i�es the �pread €��' ����g�n�r�aznar�: �' 7, "The�'��1'c�nd�o�rdi7�atc�r�nd A.ssis�ant Recr�a�ian I�i��ctar�uill cc��rdinat�,plaia,arzd imple�ne��t ax�y and�ll fc�llo�-u� t��xnmunicatic�ns ta parenfis and�ar the put�Iic�t l�rge a�'��r tlie , crisis lia:s p�assed. 8. An a:�sessmen.t c�f th� sit�ation �zat l�d to the cri��s �n�l haw it cauld h�ve been pre°�$e�t�d�ill occux. T1�e Recrea�ic�n I3irectar v�riii design�te a�a�p�re�priate �rcaup ta ��tzdy the ma�ter, co�duct , a��y�c�difiia�al r��ealch��:eded, ar�d m�ke r�cos�endati�ns�or chan��s, ifa�y. 1 ��M� L� Crisis ��ana�ement �DDR.�S�: Flax Ponti Ftecreatic�n �=1.rea 31 Dup�nfi���e {aff af�'�hite's �'ath} S. �'arm�uth, 4266�t Crisis ��anagement Team: ��Iaria Gc��ill ��'�-Ci.-�'1.�; �`�`�.�t"���'� Mil�e Jayce i �ealth��d Safet�j Supervisor �`�`�"`�-�'. �.G�'� Dan Ccsb�Il t,,�,���t,_ �Vlik�Rea�an General Crisis Re�panszbilities; ' '4�ItI.� {�Iax Pond Coordi�ator): I. Caii 9l1 2. C�li Asszsfant Rerre��ion D►irector 3. Cra�7d contral around the scene, Ptrst Inc�dent: 1. Staff Debriefing 2. Fill out C?fficiai Incident Repc�rt 3. Sp�a�to Pc►tice � ��.�����`�'�.r;� 11'��3� (�`Ia�e Yand A�sistant Go�rdinatc�r}: l. ���p �v+�r�fc�ne calm � 2. �ro�vd c���rc�l at the sce�e F'ost Incident. 4. �eep ��edia c�ff pro�pertv 5. Debrief camp�rs U.A�'� (`Travei Supervis�r); 2. �ielp ��ith crov�}d contral 1. I�eep everyone c�im Post Inczdent: 1. �elp o��erse� staff�nd children�vho were no�inti Qlved in fh�cri�is. �IEALT�I A1�►I3 S.A�E'T'S' SLTPERVISOR: l. Resp+�ttd to medical sifuati�n �4 �Archery Supervisc�r}: l. Upen the gafe for Emergency Vehicles 2. I��ip keep media c�ff prc�perty � P��e zS Camp ��p��cuatie�n Pian �easc►ns #'�r���acu�tian filae ciecisic��� ta ev��u�te tl�e c��a�p i�ill be z�ade by tl�e�tecreatit�r� Dir�ctar c�f Yrarn�Qutl�i�1 con�ult��uz�uFith tl��:�lax Fc��d Cc��rdinatc�r, Reasc��s ��1�v th� cai���z�i�l�t l�e eu�cuat�d cciuld include: • A �ta«��z-failure c�f�aa��itude ar d�r�ti�n t�at lea��es t��e �lail�iren at�-isk. � • t11z�a1tl� crisis���at i� de����d unc�a�tr�lI�bl�. • �'���diix�stam�� c�f si�i��.azat �tatus. Gen�ral �"reparedne�s i ���a�u�ti�n c�f a fial�camp durin�slunn°�er sessic�n �s a seric�us d�cisic�z�, z��ade only�� a last res�rt. h�e�er���less, Fla� I�c�nd��ili rezn�in pr�}�ar�d �or s�z��a an �m�r�e�c�b�: 1. ��:i��a�n�ng a lzst af aIl staff'g�rzth c�il����nes, tc�be�s�rl irz ��se land Iznes �'��l �r ar� c�ve�lc�aded. 2. ��in�aizais��a li�t c�f cc��n�a��i�s that prcavide bus transpc�rrtt��i�n. 3. H�viY��up-tc�-da�e �a�zone zaun�bers and emer;ez�����ambers far all mi�lc�rs c�n �ra�erty: �zis is x��t az� extr��re�ar�c�ness ste�; tl�e �xistin�ISealtl� �`c�rms tl°�� camp maint�in� are s�f��ient. �: Call�to parents �c�ti��ing t��m E�=zll�a�rn�de ifpc�ssible. A tn�ssa�e u�x11 b��aut r�n t�7e�I� �'onc� ansur�ri��zn�chiue a�well as th� ans��ering service at tla�I�ecr�atic�x�L7ivisic�r�. C�n��the L7ecisit��t�o E�acuafie is t��ade � 'I'I�e °`L�c�st Camper Sire�`' ��vill t�la�t tl�ree tir��es, tc� s��nal tI7� st�rt oft��e pra�es�. � �11 chr�clren and staff wvill n�e�t t�n the iar��i�ali feld uilless c�t�er wise ir���i-u�t�,d. I?�tazls abc�ut�he�vacuatictn �z'c�cess �ili �ae �ivert here. • The Hea�t�aaazd �afefiy S�zper4�isor,the�an�p'� eon�ultatic�n doctor and H�alth I��partment v�=ill Le cc�nsulted in:tlie evenfi c�fa l�e�lth cri�zs. The �v�cua�ion�'roc��s � �f the cr�sis c�ccur� during a sum�aa�r earn� �essit�n,.. - Th�F�a� Pc�nd Gc��rdir�at�rs, Assistant Recreation I7irec�or, �nd R.�cr�a�ion L�ire�t�r��vill ct��zsuit a�ad decide tc���rhat exte�at,i�'any.th�off�site �ip����ill�e included i���he e��acuatic�n. I£it is de�id�d that tl��y l�ill be included, tlle�I�x Pt�zxd Caardinator�v��l cc�ntact tl�ei��. . -T'he�'Iax C'oQrdinaficiY vvill begzz�cc�nt�ct�ng th� li.st crf sc��c�c�l �u� service�ra;riders, �tarti�g�rith the ca�np's r��larly cc�n�ract�d service provider. The�'ir�t a�ailable buses �=iIl be engaged,up ta t�e��umber requir�d to e��acua�e ev�ryone on camp prc��aei°�}r�°��t dc�e�nat hav� c�t��r means �f�rans��rt. - Lir�der�e�upervisian�fthe Assistar�t Cc�nrd.in�tor, �taf���ill be a.ssi��ed t� cc�ntac� parenfi� by phane to noti�jr th�m of the �ituati��x, start�ng t�rith the par�nts t�f the y��un�est campers. Par�nts �v'tIl be as�e�i to pi�k up th�ir�hildreaa immediateiy. Par�nts��la�a can't�be �or�tacted vcrill mc�ve ta th� e�d o�tkie list, ta be contaeted aga�n lat�r. A�er three pass�s tl�rough�he entire lis�, the remainiza�par�nt Iist vvili lae�anded c�ver t�the Recrea�i�n �}irector, urho will designat�stafftc�ma�e arraa�gemezats far erner�e�cy eva.cuatic�n�f rer�ainir��carnper�. -Under th� supervision �f t��e F�ax P�nd Co�rdinatt�r,staff car��nls ��viil be arranged.No 1 ���� �� staff�����leave the can.�� ui�til an a�prc��aY-i�te zau��al�ez=of cai�z�aer�I�ave b�ez� ���'eIy �va�z�at�d. Sc����e s�aff�n�y eieet, r�r lae assi�n�d,tr� �ak�tlae bus, Kev�t�ff znay rezn�iz� �n can�ap prc�p�i-�y. - A.t all ti��e�pi�ior t� tl7eir e���cuatic�n, c�sx�pez-s�ill be �u��rv��ecl by a�tzlt sta�£ia� a 10;1 r�tit?. - As �arents arri�e ta�ick u�t�ieir children, the cl�itdrez� ti�vill l�e si��ed out as dc�r�e iz�z a z�c�rmal F1a:� day. Eacla cl�ild r��u�t si� �ut v�Pi�h their cc�uliselc��. All c�uzzselors�u�t I�eep ���cord af ca=l�ic1� cl�ildre��l�a°cpe si�n�d aut ai�d l�eez�r�n�o�F�cl frc���� ti��prc��rarr�. �i.11 pa��ticipatats z�lao ar�s��t���acu��ed c�r��l��se��rei�fis i�=er�a�c�t c�ntact�d wil� board a laus tt� bri��,�t�iem tc� a e��si��at�d sl�eit�r.,T��Recre�tit���irectc�r��i11 cc��rdinat��n��in� �t�f� � �.ssi�nr�lezxts and��roc�du��es ft�r z�c�tif�=in�parents a�ld���e�tina tlae bu�es. � i ; A lY��lt�i crisis n�ay requzre additio�al �n�asure�, iz�pl�t�nented iz� cc�z�sultaxi�z� ��Ti�ii i�l�c H�aI�� and ��fe�y�up�r�ris€�r az�dlc�r Tc���n �nd Cc�un�y Hea�t17 �epartn�tent t��at mu�t t�e�alce� �iurin�evacuatic�al, znciudi���bu�z1c�t linait�d to: j - C�r�si�erati�z�c�f�rhzcb partici�ar�t�ta evacu��e �rst. - C�nsider�tic�n�f urhether l�ealt�v p�t��le c�.n b��lac�d on t�ie sammc�bus ���ith sick �eo�l�. - �c�nsideration ofl�c�e�v��i�:ty at�tzlts ta pl�ce�n eacl�l�us that�arries childr���, - ��r�sideratita� of°vvhet�er te�I�ave c�r�or vans fi�Ilo���acl� b�s to as�ist wt`t1� szck pe��le, • O�ce tl�e�vacu�:tioz�:�roeess is ui�d�z���ay{�rst b�s 1€�aded �nd disp�tcl�ed}, a deci�ia�x tc� cancel t�� ��!acu��ic�n (i.e. in the e�=ent p�wer is restt�red� ��n o��y L�r��cie by�l�e Re�:reat�c�z� T.�irector. I 1'c�e 15 �c�l�+�ies +�. E�n�er��r�cy P����� �I 5�+ct�c�� 4 E First A.id and ��f�ty Pr���dures: ' S�fet l. A��iareness con�zes frst - t�Vat�r�c�nt, Ss°�i�i�tiv�s, a��d A�•claery are �t I�.i�l�est z�sl� fc�r ac�idez�ts: -�'l�e���un�er tl�e child,�e st��za�er th� su�aer��ision. 2. �v�eryane, it��Iud���staf�",u�ears shoes�t a�i ti�n�s (��e.ept�t��°at�rfrr�nt.} 3. ��Jer}rc�ne,itxcludi��staff,�?ears slair-t� at�11 tizxaes ta�?re��exlf burnin�{e�cept at , �?�'aterf�-c���t.)B�t�ii�g��its ���ne arc nc�� suitat�le ��r ehz�dren�c���ear�.rc�uz�d , �ro�,,�rry. 3. Ides�ti�'}t pc�i�an i�my�ca children. 4. Ca�duct fr�quent�i�k cl�ecks ��rfonn�d��veekly by the �ealtk� a��d Saf�h� Su�er4�isc���. �.epc��rt I. �ny i11 t?r i��urecl ehilti�ust re�c�rt to �e�u�•s� f�r a�s��s��aent. -,AII sta�f rnust 1€�e� a docume�t�tiar�lc���n°l�er�t��e�dacurnent aIl i��cide�ts ax�d i�ljuries that may t�ce�zz�durin�tl���lax d�y, 2. +��ui�sei�rs must�ring a�y m��icati�ng staff�r�hild's,ta�h� Heal�l �nci Safet�r �u�e�visnr e�rery day. 7'h�c��seinrs are respo�sible to remi��d c�aildren whe� it %s ti;m� t� ��t el�eir znedicati�ns. �. Ln t1°�e���ezxt o�a major accidei�t or incici�z�t, �i In�:ident Re�c�rt�c�rm�nust i�e filed��it�Z�h�c��i�e. Sev�r�I �n`uar�d Chiid� l, Re�aaiu ��lrrn. �:, D+a u�t move t�e i���red chiidi A ��nerai r��zle i��h�t ti�e child must�et�ap on fh�ir o�n, if th�� c���t��,t'hey nced to r�main��herc ti�ey are�'ounci. 3. �t�y���the child and �e�d anc�ther staff�n��nber for�e He�Ith �n�i �af�ty �u�ervis�r. Ur,call th�Heal�:ar�d��fety �upen=i�arl�Ia�Pand Goc�rdinatc�r aiZ}1c��r�nit radio. A.��la�t r��c�rt, s�nd an�ti�er ch�id f��he1p. � I�o 91 l call shauld b� �n�de �it��c��.t expre�sed permissi�r�. fr�m �'Ia� Pand ��c�rd���atc�r� I � i � � � k'a€�e 16 Ra�i�es ����rot � R�bies has b�c�oine a inajc�r prable��a in all tl°�e tr�w�as c�i�tl�e Ca�e, and son�e c�ses I���#e l�een Ia�at�d i��h�to�r�s of L�e�is and�a��out13. � Ra:ba�s is a disease t�at can t�e spz-e�d°���rou�h ��in��� ;aliva. ���1ai1 anin�a�s sucl�as raccc�t�ns, �quirrel�, �kk�:uil� anci ba�� can b�ca��riers fc��•�he disease. �'recautit�na��y��e�.surc� * I�� z�at t�rtder a�xv�ircuz�s�a�ces �l1c�z�v th� �hi��r��� in�•our�roup ta rl�as� after, t�aucl�, ar pic� up a li�re or dead�inaal�sat is�zc�t p�rt�f�he I�atur� A3�a�a�als, �.s�u�z�e t�at a�l t�<�i1d a:aaiznals �a-��.�aza��r�tts. ; • Waz-cx t��e ck�il�re�7 in yc�ur�roup befc�re �oziaQ o��natttr���ralks a�d t2a�•ou�ka tl�e trails i�c��to �o near an}t r�f the anin�als�h�t�l�ey inay s�e, If�rou see a suspicious animal: • Contact the Fla� P�nd C`�a€az-dina�or or tlae Healtl°��nci S�fe�y T�ir�ctar irnn�.ediately. + I�e�p �11 tl�e children �c�ay frc�n�t�e anisnal. *� In tl�e �vent cx�l�er��a�anirrz�l rta�y b�r�bxd,�I�e Fl�x�'t�zac��c�c�rdinator v�=il1 s4�iitch t� a rainv da��cl��dut� {�ca rnatt�r�vhat tl�e�ve�ther) �d�ut aIl childrer� ii�doars. °T�is wiil continue until tlze I�atural R.esourc�l.�nin�al Contrc�I �taf�`caz� deal��ith tl�e�t�imal. �f a chil.d ��bit: +► Rem��=e aIl o��r campers fr�m the sc�ne. * Gal1 f��the Fl�x Fc��d C�ardinator 1 Healt�i and�afetiy ��ectar inxn��c�iately. • T�y tc� find aiaot�er staff ineinbes��c� sta��=ith��our�r�aup ar�d k�e�a th�zn calrn. • T�II the Flax �'���d C�c�rdinat�r t��e��tails of�l�a�happen�d� �3�pr�p�red t�tel�: What h�pp�ned? Hc��`? Whe�? ��ier�'? Wher�is the a�zn�al nac�? ,Aizd wkaere are the ath�r�hildr��an��ur grc�up`? ' � �� � Tra�ff'ic�Cc�ntr�r[c�urlr�g pragram hour�: Re�ular drap nff ti�re of 8am: all cars are heid o�f until c�ur sta�f(s r�ady to reeeive chiidren.The vehicles are then a�lc�wed to come through parking(ot in two lan�s�o dre�p chiid{r�n�.A staf�member vaifl assist�hi#d tt�sidev�r��k fr�rn car.The st�ff ct�ntrt�ls the fit�w o#cars, R�gular pict�up tim�e af 4�arn:a�l cars are h�id off unti!sta�f is ready to rele�s�children.AI!chi�dren wait behind�h�v�rat�den fencing nex�to p�rk�n�1ot.�'he v�hic�e�are re��ased and a staff rr�erryber ch�cks with each vehicle and calis cF�iid name.�hi4d signs out with their co�nse�or and gets escorted by anoth�r �t�ff rnember t�►the avsr�itin�c�r.The flc�vtr oftraf-�ic is again coratr�#!�d by th�staff, i ff� par�nt needs to speak tt� cour�selor c�r Administra�ion they�are asked tt�pull#o the side and park s€� that th�y d�ncrt hr�(d t�p the Iine, AIE€�ther�ickup�and drops€��fs are si,gneci in and r�ut at the camp windc�w. Cc�r�tin�er�cy fc�r Registere�!and Man-regist�red children: If a child is registered and dc��s not show fc�a-the day a sta�rn�rnt�er will make nc�t�far att�ndance. If th�t same child is c�ut a secor�d day in a row without notification uve will call th� p�rent/gua�dian t�z checl�up, If a chi[d i�nat registered and st��tws up for the day we have them sit in th�c�ffice ar�d uve calt the parent and the main Reereatian o�ce as they m�y h�ve registered late car�arty morning.They are nat c�ut o� pr€�perty�ntil all paperwork has been prcacessed and tnoney has been �aid� Prirr�itiv�,Trip or firavel Camp: . t7nce a wee#c�ur oidest group of participants 12-15 year aids�o c�ff pr���rty.We have eac�r child bring in a sign�d perrr�issit�n trip exclusive ta that specifii�trip,AI1 staff have their list o#kic�s to craur�t at each stop an� before getting on the bus and aft�r.The progr�m uses focai sc�ool bu�comp�ny for aEt tr�ps�ff property, A fi�st aid kit traveis wit�t the group.The frip leader has a cell phone to cammunicate tn the Adminis�ratian at the camp pr�perty if anything arises. lf an ir�jury occc�r�they�can ca11 the camp to get emergency contact informati�n.Th�tr[p l��der is�ware o#eacE�locati��s closest ho�p�tal. 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CEIt�u41 1 $ 1 � ' �-_�___ _-__ . rl _J �-J I I i � c I � I � N; I I U� ` -_ � � 9�F R �; I I _ I I m I I m I j j . � � f o 2 N g e � 1�:."::.:.. ; _ � - PROPOSED BROWW 111J0AU15I FENUCCIO&RFlBER ,�-� D _ � � T m�m�,��,E�rS.��. o LODGE BUILDING @ - ° FLAX POND RECREATION AREA .� - S TOWN OF YARMOUTH,MA � � ,�. . : � YARMOUTH FIRE DEPARTMENT 96 OLD MAIN STREET - SOUTH YARMOUTH,MA 02664 PH.:508-398-2212 /FAX:508-760-4861 FIRE AND SAFETY INSPECTION REPORT ADDRESS OF INSPECTION: ;;�' � '�U �.�. ��I 1 ��e � YARMOUTH PORT. � SOUTH YARMOUTH � WEST YARMOUTH � NAME: 1_L_A �C �O�I � � OWNER � MANAGER � TENANT OTHER(explain): � ,�� �� �_ �`��v�� �� i i DATE: I f " 3` I� TIME: �'t�3�� PHONE NAME: PHONE: � �� ' ZZ ,� IL,�'/-$`ZU OWNERS MAILING ADDRESS: An inspection of the above captioned property was conducted by the undersigned during which the following fire or safety deficiencies (D)or violations (v)were observed and noted for correction: V 'Dt".�ICic.n��crS n��Tu�� CACK � J ' �� ,� �� �.z� You are hereby ordered to abate or correct the deficiencies or violations within days. Failure to do so may result in civil and/or criminal complaints being filed. Signed: si �,�,L_._-- Title: � � _�L� ,� L /�� ! q I et ., � _I Copy Received By: '` ,. ,�- ? ;u - � ,� G�_.__ Original-Owner/Tenant �Yellow Cop -Fire De artment _ Y p FBP 99 1 ����f� �.- �' � �� �, ��_f-���'�,�' ,�-� �.�� �����:������ �7 `� (/ � �' p ^ l� .Sy.-1.��� . 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'-: :-1 _._. ..._ _._ ._ __. _. n thi ;Iu. uri, ahs,• i;;�• ,��.:li�i _ _. r _. � � un iii:l lui ui,i tJi�..iir;l ihr:c. � I I rt�n� tti cr�� in �ti t,��+d s i ..i��crrl �u ,�.:rini�n<< �.�iEh i�` � __ � - � f � nn y��r��„"�:FI'.1 fti �� t � > � � o I �u U}���a ___ f�� 1! � .r• �,t.Fu u.ii. irh th. �� uii., ,, � � � r — ___.r-� �_�:_e �.�_ �' �"•�� ° ` - � �-d�l �C:."I 1 T�C'�f�,�lr M �;�i _ ' = �� �� .� ui = u •:. _ � , � � 17�<> br I (f a� _ __ q � � , „,� �,rr i C I a`� i 1�,, � � 1 f `91�v-i[ t; .!��t�*Iltl)1;!/I t�l,�f I:I `�E�`�'t �,:,, ,:«,�; , , .,, - __..__... � ..,�.. <<J.�.�.t:u�j � �:.r:•en�l�/t„/r,.r��c�r�. �r'r.srnrct(h�r'i���r��.°t'�rrtrdlr.,�.,di�>tid1tt,,:rs;�rG-: -r.�r_r,.�...s<<,��. . J_ '" .. , r I11 , , „ a Kenneth P.Colmer,MD Bass River Pediatric Associates P.C. Lori Zito,MD � Paul L.Ma�z,MD 237 Station Avenue South Yarmouth MA 02664 I{arin R.Gilbert,Nm (508)394-2116 (Fax)760-1919 MAthew H.BaldasAro,DO Michaei J.Dillon,PA-C Mielce Ackcll,CPNP Sandy Hebenstreit,NP i Ms. Patricia M. Armstrong Director of Parks and Recreation 428 Route 28 West Yarmouth, MA 02673 October 31, 2016 Dear Pat, This is just a quick note to confirm that I am agreeing to be the medical consultant for the Flax Pond summer camp program in South Yarmouth for the upcoming year (2017). ' Sincerely, '������� ��2�.--/'�7 Kenneth Colmer, MD . . } • Swim and Fit Test Model Documentation Form . 105 C M R 432.000 Municipal and Recreational Program or Camp: Address: Operator/Director: Phone Number: SWIM TEST FIT TEST Name and Age of Child: Date: PFD Provided by Parent? (circie� Yes / No Swim LeveL PFD Required Per Swim Test? (circie) Yes / No Swim Test Location: Type of PFD: Size of PFD: CSI or Swim Assessor - Print NAME: Individual conducting Fit Test - Print NAME: SWIM TEST FIT TEST Name and Age of Child: Date: PFD Provided by Parent? (circle) Yes / No Swim Level: PFD Required Per Swim Test? �circie) Yes / No Swim Test Location: Type of PFD: Size of PFD: CSI or Swim Assessor - Print NAME: Individual conducting Fit Test - Print NAME: SWIM TEST FIT TEST Name and Age of Child: Date: PFD Provided by Parent? �circie� Yes / No Swim LeveL PFD Required Per Swim Test? 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