Loading...
HomeMy WebLinkAboutRequired Documentation Required Documents 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 Documents 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)) V *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) *Written statement of compliance from the local fire department(105 CMR 430.215) ,r *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 (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 means 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. 04/30/15 BASS RIVER I T I ASSOCIATES ren th Cot mer, M.D. Paid L Marx, WU. � nLori Zito, M.1 e Karin x Gilbert, M.D. 231 Station Avenue _ 5 ttr rr� t . Mich i e Onion, (500)1141116 E Mieke Aiken, P Fan(50 0)760-1914 Sandy t eben tre t, NP Mathew Baida$aro, Sara Plummer, CPNP 03;1 ,2 s19 Yarmouth Recreation o Whom It May Concern: I'will be the Health Care Consultant for the Flax Pond umm r program again this year 2019, If I can be rt r assistance, please do not hesitate to call, Thank you, Ken Coltrier, M.D. FLAX POND CPR/FA POSTION ALLIN LINDSEY 6/23/2020 SENIOR COUNSELOR 4 9 - hg `���� � -q, h^�n '``h` "gra mX yw-7n` .. -.' �` f BRYDEN MARK 6/23/2020 SENIOR COUNSELOR n. epi . . ,, .. •I-- ,.. , ai .z . . s% '£davis ethan 6/23/2020 SENIOR COUNSELOR te. t 'm�fr e4; �'• �5 x. „ "T` .r. 7.4,7e-1,24 E "; f y..yY�$'�^e, ,T t: gray ashley 6/23/2020 SENIOR COUNSELOR healy michael 6/23/2020 SENIOR COUNSELOR � a KARRAS LILY 6/23/2020 PROGRAM SUPERVISOR LONGOBOARDI ANDREW 6/23/2020 SENIOR COUNSELOR lynott samantha 6/23/2020 SENIOR COUNSELOR norman nick 6/23/2020 JUNIOR COUNSELOR O'BRIEN KONOR 6/20/2020 SENIOR COUNSELOR OLIVERIA MARIA 6/23/2020 SENIOR COUNSELOR Y pawlusiak mary 6/23/2020 SENIOR COUNSELOR REID TREVOR 6/23/2020 SENIOR CbC OUNSELOR SULLIVAN MARY 6/23/2020 SENIOR COUNSELOR 1,_,,s-1- � � watt samantha 6/23/2020 SENIOR COUNSELOR ( �l�t cloiyir) ,ei -(1 Y' yzs (Lite fi �� ye a - .,..,-:',-;?_';',_:!-,_.f. * 1 #�t FLAX POND CPR/FA POSTION ALLIN LINDSEY 6/23/2020 SENIOR COUNSELOR ALLIN MATT na SENIOR COUNSELOR IN YELLOW-CLASS BADACH JOSH 6/27/2019 SENIOR COUNSELOR SCHEDULED FOR 6/22/2019 BEGLEY TIMOTHY 6/28/2019 SENIOR COUNSELOR BENKIS JOHN PROGRAM SUPERVISOR BRYDEN MARK 6/23/2020 SENIOR COUNSELOR COBILL MARIA 6/27/2018 DIRECTOR COBILL DANIEL 6/27/2018 ASSISTANT DIRECTOR COLLUCCI VINCENT 6/28/2019 SENIOR COUNSELOR COYLE MEGHAN 6/27/2019 SENIOR COUNSELOR CRARY KATELIN 6/28/2019 ASSISTANT DIRECTOR DALLACOSTA COLIN 6/27/2019 SENIOR COUNSELOR davis ethan 6/23/2020 SENIOR COUNSELOR FEINSTEIN SAMANTHA 6/27/2019 SENIOR COUNSELOR fellow cory 6/27/2019 SENIOR COUNSELOR FLAMMOND CHARMAGNE 6/27/2019 SENIOR COUNSELOR GOLDSTEIN JADEN 6/27/2019 SENIOR COUNSELOR gray ashley 6/23/2020 SENIOR COUNSELOR healy michael 6/23/2020 SENIOR COUNSELOR HOGAN JOANIE 6/28/2019 PROGRAM SUPERVISOR KARRAS LILY 6/23/2020 PROGRAM SUPERVISOR LONGOBOARDI ANDREW 6/23/2020 SENIOR COUNSELOR lynott samantha 6/23/2020 SENIOR COUNSELOR norman nick 6/23/2020 JUNIOR COUNSELOR O'BRIEN KONOR 6/20/2020 SENIOR COUNSELOR OLIVERIA MARIA 6/23/2020 SENIOR COUNSELOR passos mariana 6/27/2019 SENIOR COUNSELOR pawlusiak mary 6/23/2020 SENIOR COUNSELOR REID TREVOR 6/23/2020 SENIOR COUNSELOR , { SULLIVAN MARY 6/23/2020 SENIOR COUNSELOR ,.._,I4i 1 travers Jessica 6/27/2019 SENIOR COUNSELOR ; 4\ WAKEFIELD TREVOR 6/28/2019 SENIOR COUNSELOR i1 1�:1C-C1 watt samantha 6/23/2020 SENIOR COUNSELOR C it 1i t`> i JUNIOR COUNSELOR NEW HIRE li )11i -c^ JUNIOR COUNSELOR NEW HIRE JUNIOR COUNSELOR NEW HIRE 014 JUNIOR COUNSELOR NEW HIRE ;l����� �� ( JUNIOR COUNSELOR NEW HIRE JUNIOR COUNSELOR NEW HIRE JUNIOR COUNSELOR NEW HIRE JUNIOR COUNSELOR NEW HIRE JUNIOR COUNSELOR NEW HIRE JUNIOR COUNSELOR NEW HIRE PROGRAM SUPERVISOR NEW HIRE PROGRAM SUPERVISOR NEW HIRE PROGRAM SUPERVISOR NEW HIRE PROGRAM SUPERVISOR NEW HIRE E-p\v) lt4 ) , , rrstable , , 4 1I e V s' t,'' 11 ,.4 * S Office of Student Services Maria 1 Cobill has completed a workshop entitled: Non-Violent Crisis Intervention - Initial 1/31/2014 12 Professional Development Points Instructor Gina Hurley Expires 7/15 ci,vo HurLetj EoLD Provider #1-0020-950 Gina Hurley, Ed.D. Director of Student Services ,01:\'-',. -,, - //)--7,- --, _ ..... ----,- -7--- - ---,- i 1:1 1 I --. .. I-- , Cff 7' ----- ----- ------- - ------- -------- ---- -- --- ------------ - -- , i4 i/ ..._ „..4.,,,,li, Walt MitrittrAfiltimaymay ;,•77,i7;•,;72•:. gh 'titliktidagitalIff 1:NOV•:1 ........, ,-"* ON=•Y., i 1% virionnevv" ,,,,,,..-.,,.;:- ,d'' -'...• . 0-,T.: •-.,i • 'row.d-4•jerr_Alhaii:.. !.t..,,,. ,irp-,34,-...i.,ni.,r koi • `.T.,-*:.7-7*-iiit 4.LigkkeP lil'e 1 ,a6-40,..P.:1',' ,:t1142.:::iIi': ‘;;:ji14:3,tilj:!t•Fi'r.--Ar%;:r1.;, :ikl?, Mei" 4q(4. ''tl I ..:`:• 1.-Ere.f .igli chi ,N4 ia-::12Y ein.P.iti, Ii re avt tY6.1 el dr) ,, - 1 la , 1., ,. a Milrfl: i.-. , 4___ 1__.t.., • :7 r n s t oie Ail) 1 . .. ifilk.‘1, ,ttifrirar ,i'' ' iq .4txdtivq, ..:,etwl.i. -V Sc -01 • 401T*• I, de.414. ' 4s11-0,2 ' ' AID 1, ,.. i of Student Services 11".-"Tlee ..-st-i:7. ri ...„.-_. ..A. , ,I 11 g e4131! Aiakti,v,!. I le2p3,:i0- , . 41:1 • 4 '' ' fog 4 . ,,, 4: .„.. do, •I''' ,li 4; d° IV . . . .. . . '.1470 • .fttlil, • Itth_ i'.';'•. . in. -44 01 .r.r.t., ,t•-i has completed a worlcshop entitled: -... .,. . : •,.-1 /NV ,8.j.,W • ,-.i...1.4: ite NVCI - initia1 Ogg SAP' 1,-,44,,g g if? June - 2014 y, '0.. „i 8 Professional Development Points <lb ,ov-Ithi 4066-.4111 kit,eil a . . '... r InstructoIt George Kostinas —_ lif:gif,F. ..,•r,'.''''.!1;!3. • , ...- , ,...,kii . . - • ,. . „ Exp. 11/2016 6i LIA4 l-fiA.(Le • " • - . . ._ .. ....._. . . ....., : w Li i- Lft_ .- - Pr ovider,#1-0020-950-.-- ----- -.-.---. Gina.littrley,_F'd.D._Director_of_St,i,i,tfient_Sermes___. -b--, ....; ...... q 1:4 p•'.:.2::; Vi • N it: ---------- ----------- ---------- ----- ----- - --- - .!1.?I.,'.•_;‘.:,-:.T . , ... ,: .. ...,.........: ...,........,....i:..:: :. ..- 1 , , ,, .,. rvi•' Irg, ,i-,...„,;- ,Q. 1 4:14-q !? rag ...., , ...::!:',:;',-.!....i%*:::.• '%:...:::•-, i, ••';.;"'";:: , -1.t' 4tfigtilittiv., ilkt Ci..0, ./.-:.f!;„:7 4-k4,• dig% . _ .„.- - ,., 04'44. "I`,1 ,f, 4... ti-7 ver•,••-= '4 1 -,,"'';• 'Al' Aff_Atiikilte,.....A: ,;-,:%-i ..ofear •• ... / ! ....":'........:.(...,,;,'•..,.. mt'�f "''Wr, y v" •4" I.vo"�tt,�m� 'Wwu4 uuv+„ir ..eq�s 'r.:.,, . ,. t p "11 H s Y. 4 1P',• i'h "a P l ♦•rr ii A., Jf t ��{ all I n / lit 1 pi 'AA, • �� �rx1 ��' Il � i „,„-As,.,em, � ° svw• �” ,�r t � ,� ��' •h ( 1� A .I ! tr/i rb .nn p 1 111 .,Y(rA r I . � Or I !Q' Tt , t � �r�.sx 4�i� r���� ! ,, .' Jl t��y/t ! liar' � � { F � �., *YI� 1 ,�. �\ ly. ,�f1, 41. 1.,�, t� � 1 �� , e'/' -r u 1 ".-,f 1_”. � �L W I a k:. Iy t� ?p 99jzr��°l.�j7� Fife r• ,-.-.'5V_.\,1'4, . :- ", h '#� 1•r Il fa n ;'.4 rad dUl �`ti,S 1 :Pir .rri�. .� 447.- r .. ��".11 ..-� l r.. �I r r'R..rl/r. ,lr tr fr TA1•n,t . . .‘64 ' �'�` 'fi1�4�N`d:/T?7'P�'6�o.,xilr �frA�}uix�Jt57s!tFlxnc„r4:SR?'r nryl....:.'>1:..ixL4'�'�!�?3•T"SLFYA:$5,.�?P.�.'1,....rl3n*:P4'?2�?f4{4".Sy'�'1!;Sr_I�IS�!)ulJ!'�T.Y1n^&g!!ITS:!.gT34Y�FF."rc)3:;Yn�3.2TFFNkF'F3:fptcA�?r?!+�{gs!Ylfi4sSs9,tki?�i,4G�'9.�;v,:vul�tr �'� V � IA t* Ili v ' a t•`4G 1 -,4. r S ; f ' ,g1 fit': I, 0 Pa1 , �` '.1 •V--• `esti , ,' w (!J ()8 O - 1 • / - { > C\I - --- , ,)'•• ', ,-,,E1 v7 -t,.%1 to • 1 � qg ��� -U t Uikaipi.3s. q+ al o ,;i'' aCc:. °e�1 Ii(:'1 .,. .,: +a -, -I—. -4—,..., 01" -'" '%''' 0. X11e IavZ ¢ .003P '3 ; 4,Y blz ❑.. ,f. 4.4 Aira I I rc kit. r 0 IkIP .: l'i,;, ,i l ,4 ,k LIV � Irl''r IE', a •••;;:H' t y r I .rte I. �- 4 rr 1,�.4I t 3. . i• }�' ::,:•:', ',...a5oYt t ,,.J...„.„?,,,d:".,,...SFY8T4i31i'v,`'iYni ,Y&Cir97,„,,2iiTGf3."ttil'P6b:iii:ifLSa"t' mhy,6l�kily,!".ifiiiYin't'did:EiF 1:t..9?yuy Y:AxtIVIywayr.tlb.Ua.yalt:fy nfA1kY7L'i9.CtTgeo t'citi+J?J.7Rvixtui+ZS,Rft'i;k,.r'4+ 1_ ,..�!�I "li ` .:•/ } 1 1+ , ` 7rd„Ii ry4..A r �y✓ „*.OP'',i t, CCn,IH T. r t�t t, `�{fi- .'i L JI^ ,o s Ir, y=l)Y - , �2'�`.YJI':1 „ ������'if UI'( � �.1 'F �i1`AS ,y,�';l, Ir:ri'-4.,���,k\��� ,,:...I�I•��U.i"r��� �Y�r J6 �y� .f�`�1��i` , ' ,�`cpp jj —e ; "s0Y tl I E, yJ. s d FL 2' '0 1.41% 4 TheMO Vmmonwealth of Massachusett l ti Dell,'rtme ,t of Elementstry&Secondary Education lip y Commonwealth s'Liicense THIS IS TO CERTIFY THAT THE PERSON NAMED HEREON IS QUALIFIED UNDER THE PROVISION OF GENERAL LAWS,C.15,5.1G,C.69,S.1H,C.71,5.300,C.71A,71B AND/OR C.74 AS AMENDED AND UNDER THE REGULATIONS PRESCRIBED E •BOARD OF ELEMENTARY AND SECONDARY EDUCATION,AI'ID IS ELIGIBIE FOR APPOINTMENT IN THE PUBLIC SCHOOLS OF MASSACHUSETTS TO SERVE IN THE CAPACITY INDICATED.THE LICENSE IS VALID AS ISSUED UNLESS REVOKED FOR CAU. Attached is the duplicate of your certificate which you requested, John Denkis . P,O, Box 26 South Dennis, 11A 02660 . kx y_ 90„, ,,_ • . . .. . • . Mitchell D.Chester COMMISSIONER OF EDUCATION Sit:::, we 1 r�,1 The Commonwealth of Massachusetts k � �° Depar°tment t►f le scatlry Secondary, 'daac,.tion ,;�,,J� ,. Educator's License • kitto v),,, THIS IS O CERTIFY THAT THE PERSON NAMED HEREON IS QUALIFIED UNDER THE PROVISION OF GENERAL LAWS,C.15,S.IG,C.69,S.IH, C.71,S.3RG,C.71A,715 AND/OR C.74 AS AMENDED AND UNDER THE REGULATIONS PRESCRIBED BOARD OF ELEMENTARY AND SECONDARY EDUCATION,AND IS ELIGIBLE FOR APPOINTMENT IN THE PUBLIC SCHOOLS OF MASSACHUSETTS TO SERVE IN THE CAPACITY INDICATED.THE LICENSE IS VALID AS ISSUED UNLESS REVOKED FOR CAU Educator: John Benkis Certificate Il: ****411773 SSD: XXX-XX-7200 Original Certification Date: 06/252007 Issuance No: 1837374 FICLII(LEVEL) CATEU0RY` JOE ISSUED EXPIRES r ACADEMIC ;I:gitial 04/03/12 kk Physical Education 11 12� .. 80 ENTRIES BELOW '1'IIIS I,I11E • Valid for five(5) yearn.of 'employment. • Mitchell D.Chester .. COMMISSIONER OF EDUCATION r • r, h Page 8 bring portable chairs or any other devices that would hinder their ability to interact and engage directly with the children. Volunteers: All volunteers on the property must be CORI and SORI. checked before entering the property. Visitors: If a staff merriber would like to have a visitor on property they must ask permission • from the Flax Fond Coordinators prior to the person's visit, this includes impromptu visits from past staff or programparticipants. At any time Flax Supervisors or Coordinators reserve the right to ask any and all visitors to leave the property. Background Checks: All staff must complete the proper paperwork to have their criminal background checked. No staff member will be allowed to work without a CORI and SORT background check. Staff Medical: Staff members are not allowed to keep any medication on their person except for personal inhalers and Epi Pens. If a staff person needs to keep one of these items with them, the Health and Safety Supervisor must be informed. If a staff member needs to take medication or supplements during the clay, they shou.l.d be kept in the locked medication box in the Health and Safety Office. No staff member will be allowed to work.without a completed Staff Medical. Form, as well as a.copy of the staff member's immunization records that is to be kept in the Health and Safety office. Pictures: Staff are allowed to take still pictures while on the camp property. No videos of children are permitted unless cleared by the Flax Pond Coordinators. In order to respect children's privacy and protect children from unwanted predators, staff are not permitted to post pictures of children on the Internet. This includes sharing of pictures on Facebook, Twitter, YouTube,MySpace, SnapFish and other social websites with anyone who is a non-staff member. If this policy is violated, disciplinary action will be taken. If this policy is violated in the off- season, rehire employment may be iinpacted. Office: Office supplies are for the use of the Coordinators only, this includes the use of the Internet. Staff personnel files are confidential. If you would like to see your personnel file you may do so by making a request, in writing, to the Recreation Director. Community Relations: Staff are asked to be sensitive to the people living in the communities near the property. Each staff member represents the program in his or her dealings with the members of the local community, as well as behavior off the Flax Pond property. Tips/Gratuities: Staff members are asked not to accept any tips or gratuities from relatives of children. Any money collected will go towards a Flax Pond scholarship fund. Parents should be informed of this policy if they try to give staff any sort of gratuity. Evaluations: In the effort to help each staff member perform his or her duties to an optimum • FLAX POND 2019 SUMMER CAMP CALENDAR 3.29.2019 6/24/2019 6/25/2019 6/26/2019 6/27/2019 6/28/2019 Monday Hot Dog/Wheat Roll Explorer Field Trip All Camp Sunbutter/Jelly/Wheat WEEK 1 Sky Zone Special Event Baby Carrotts Hall of Fame Day Fresh Fruit Snack/Milk 7/1/2019 7/2/2019 7/3/2019 7/4/2019 7/5/2019 Tuesday CAMP IS OPEN Cheeseburgers NO LUNCH All Camp Sunbutter/Jelly/Wheat WEEK 2 PROGRAM Special Event Baby Carrotts Explorer Field Trip Carnival Day Fresh Fruit Snack/Milk 7/8/2019 7/9/2019 7/10/2019 7/11/2019 7/12/2019 Wednesday Chicken Patty Explorer's All Camp Turkey&Cheese Goosebump Overnight Special Event Sunbutter/Jelly/Wheat WEEK 3 Wild West Day Baby Carrots Fresh Fruit C..-..L/PANT, 7/15/2019 7/16/2019 7/17/2019 7/18/2019 7/19/2019 Thursday Turkey/Cheese Explorer Field Trip All Camp Ham/Cheese Paw Sox Special Event Subutter/Jelly/Wheat WEEK 4 Disney Day Celery Sticks Fresh Fruit Snack/Milk 7/22/2019 7/23/2019 7/24/2109 7/25/2019 7/26/2019 Friday Papa Gino's Pizza Explorer Field Trip All Camp Sunbutter/Jelly/Wheat PINZ Special Event Celery Sticks WEEK 5 Winter Wonderland Fresh Fruit Quest Seeker Snack/Milk Overnight 7/29/2019 7/30/2019 7/31/2019 8/1/2019 8/2/2019 Age Groups Pioneers Explorer Field Trip All Camp 1st-2nd grade WEEK 6 Tree Top Special Event Trail Blazers Adventures Super Hero Day 3rd-4th grade 8/5/2019 8/6/2019 8/7/2019 8/8/2019 8/9/2019 All Camp Age Groups Explorer Special Event Quest Seekers WEEK 7 Overnight Wet Wild Water Day 5th-6th grade Explorers 7th-9th grade 8/12/2019 8/13/2019 8/14/2019 8/15/2019 8/16/2019 All Camp Explorer Field Trip Special Event WEEK 8 Sky Zone Aloha Day Last day of regular Flax 8/19/2019 8/20/2019 8/21/2019 8/22/2019 8/23/2019 WEEK 9 Gym Class Day Music and Art Day Fall Sports Day Reading and Ice Cream Technology Day Sundae Party School's in 8/26/2019 8/27/2019 8/28/2019 8/29/2019 8/30/2019 No lunch Program No Lunch Program No Lunch program No Lunch program No Lunch Program WEEK 10 Kid's Care r r Flax Pond Camp FLAX POND SUMMER ADVENTURE PROGRAM Updated '#1—June 24—June 28 11/26/2018 #2-July 1—Julys 31 DUPONT AVENUE S. YARMOUTH, MA 02664 #3—July 8—July 12 In season Camp Phone: 508-760-4815 orflaxpond@yarmouth.ma.us NEW RATES #4—July 15—July 19 #5—July 22—July 26 CHILD'S INFORMATION: Resident(PROOF CHECKED) or Non-resident #6—July 29—August 2 #7—August 5—August 9 Name: #8—August 12—August 16 TIME: Address: School's Out Program Grade Entering in FALL Date of Birth: 1.August 19—August 23 2.August 26—August 30 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"d 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 Insect Wipes 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 r F yavv,s, & Recreati0„, Yarmouth (ape(n(1 Within Reach Flax Pond Adventure Program Consent and Sign Off Forms Consent & Release Form: I (parent/grandparent) 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 Yarmouth,Board of Selectmen,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 from my child's participation in the Town voluntary 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 participation 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 Policy: 1. NO refund for removal from the program due to disciplinary problems. 2. Refunds will be given for medical reasons ONLY with a Doctor's note submitted when notified immediately. , Consent Release Signature Date: Behavioral/DisciplineBullving Sign off: I,the parent/guardian,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 Behavioral/Discipline 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: FLAX POND SUMMER PROGRAM vc.\Ac•, & l�f:'�'rr�cip����� 31 DUPONT AVE, SOUTH YARMOUTH MA 02660 Flax Pond Phone: #508-760-4815 Yarmouth ATTENDANCE LINE: 508-760-4815 ONLINE REGISTRATION: www.yarmouth.ma.us RECREATION OFFICE: 508-398-2231 EXT 1520 FLAX 2019SUMMER NEW RATES 2019 SUMMER! AGE GROUPS FOR CAMP PROGRAM REGULAR CAMP HOURS: #1—June 24—June 28 8AM TO 4PM (Grade your child is going into in Fall 2019) #2—July 1—July 5 Grades 1st_6TH Resident:$150 #3—July 8—July 12 Non-Resident:$185 Pioneers: 1St& 2"d graders #4—July 15—July 19 Grades 7th-9th Resident:$168 Trail Blazers: 3rd&4th graders #5—July 22—July 26 Non-Resident:$205 Quest Seekers: 5th& 6th graders • #6—July 29—August 2 (price varies dependent on field trip) #7—August 5—August 9 Each additional%hour is$15.00 for the week Explorers: 7th to 9th graders #8—August 12—August 18 Early 7:30 to Late 5:30 A Typical Day At Flax Schools Out Program Your child will arrive at either 7:30 AM (Before Care) or at the 1st to 6 grade ONLY regular drop off time of 8:00 AM. He/she will be greeted by 1.August 19—August 23 counselors and escorted safely across the parking lot.All of the 2.August 26—August 30 • children will participate in morning assembly, which includes announcements of upcoming events, skits an.d songs. The Same pricing children are then broken up into their Nations (whole age As the summer winds down so does Flax Pond.The group) and asked to follow their counselors to their meeting school's out program will be a 2 weeks of activities place. Once there, they will be introduced to his or her and swimming on the Flax property.This is a counselor for the week. Your child's counselor will change program with fewer numbers of children but the weekly. schedules schedules will vary by age group. Each child will go c31,10 Oncsratt nc c,IMMO.' swimming, to a program area (Arts & Crafts, Archery etc.), or FREE LUNCH PROGRAM play games on the fields. All children will have a 2 snack times a day, so please pack accordingly. In the afternoon they will repeat a similar schedule as they did in the morning, going to a • A Bag lunch will be provided each day from DY different program area. Food Service/Project Bread At the end of the day,the children all meet around the parking If you choose to send a lunch please do lot to prepare for pick up.Announcements and permission slips • will be passed out.Those children signed up for the After Care program will be dismissed, and then the cars for pickup will be allowed to enter. SAMPLE SCHEDULE OF THE PROGRAM: 08:00-Drop off Packing List for each day Assembly Must Haves: Attendance **please clearly label your child's name on all items** Program Area Snack Time(bring a snack) * Back pack *Snack(2) * Swim Suit,Towel and Adventure Time Change of clothes Swimming *Sneakers(open toed shoes not appropriate for 12:15-12:45 Lunch(Free Lunch Provided) activities) Adventure Time *Sweatshirt or Jacket * Water Bottle *Sun Block Snack Time(bring a snack) * Bug Repellent Swim Dismissal Prep * Early Dismissal or Health Concern Notes 4:00 Dismissal EXPLORERS VARY DUE TO FIELD TRIPS BEHAVORIAL AND DISCIPLINE AND BULLYING GUIDELINES 4- Flax Flax Office: 508-760-4815(In Season) Dismissal is at 4pm each day or later, Attendance Line: 508-760-4815(if there will be NO early dismissals your child is not attending that day/week) after 3pm. DISCIPLINE GUIDELINES It has become necessary for the Recreation Division to develop a graduated discipline policy for our programs. It is our hope that by involving the parents in the process we will be able to curtail the negative behavior before a one day suspension or ultimate expulsion is necessary. If any child is suspended/expelled from the program due to disciplinary infractions the parent will have already been involved in the discussion.The Town will not be refunding any unused portion of the registration fee. BEHAVIORAL INFRACTIONS 1.Forbidden Articles:Cell phones,knives,hatchets,cutting implements,child-owned water pistols,energy drinks,tape players,radios,walkman,MP3 players,and the like,portable electronic games,playing cards,roller blades and skateboards or any other similar articles not previously identified are strictly prohibited and will be confiscated and returned at the end of the day.Cell phones are not allowed on camp property.New technologies in these devises could lead to poor choices by the carrier which would adversely affect the privacy and comfort of other children.If you require your child to carry a cell phone please discuss the issue with the Director and make special arrangements. 2.Leaving Property Unexcused:The child is required to remain on the grounds until their dismissal time unless another arrangement has been coordinated through the Office by his/her parent or guardian. 3.In Parking Lot or Other Unauthorized Areas During the Day: All children are required to stay with their assigned group at all times.The parking lots, well fields,and other unauthorized areas are clearly marked as off limits during the day. 4.Insubordination to Authorities:Mutual respect of all staff and participants is the foundation of the Flax Pond Program. 5.Verbal Abuse/Inappropriate Language:Cursing,swearing,and aggressive verbal attacks toward others will not be tolerated. 6.Destruction to Property:Willful destruction of the natural environment as well as property and buildings will be cause for suspension/expulsion from the program. 7.Fighting and/or Actions Dangerous to the Physical Welfare of Others:Immediate suspension/expulsion will be implemented based on a thorough investigation. 8.Harassment/Hazing:Our goal is to teach children from all socio-economic,religious,and national backgrounds to blend into a cohesive group. We will be stressing acceptance of all members of our program and we will not allow put-downs,threats,or taunting of others. 9.Violation of Other's Civil Rights:Immediate suspension/expulsion will be implemented. 10.Theft of Property and/or Other's Belongings:Taking property that does not belong to you will not be tolerated. BULLYING POLICY: "Bullying"is defined as the REPEATED use of written,verbal or electronic expression(including cyber-bullying)or a physical act directed at another that: Causes physical or emotional harm of damage to the other's property. Causes reasonable fear of harm to the other individual or their property. Creates a hostile environment in which the bullying causes the program to be permeated with intimidation,ridicule or insult that is sufficiently severe or pervasive to alter or inhibit the individual's participation Materially and substantially disrupts the operation of the program Serves to retaliate against those who report or witness incidences of bullying. Bullying,as defined above,is strictly prohibited by the Yarmouth Parks and Recreation Division and the Flax Pond Adventure Program.Incidences of bullying that are reported to the staff will be fully addressed in a timely manner with consequences following the established participant discipline policy.In dealing with issues of bullying the staff will seek to employ conflict resolution,mediation,parent conferences,and other related tools to facilitate the best outcome for all participants involved. Progressive Discipline Plan Step One:Counselors are trained to set clear boundaries and reinforce those boundaries with the children in their group. If a child continues to test those boundaries the counselors are instructed to bring the child to the office. There they will Meet with one of the Flax Pond Administrators who will reinforce appropriate behavior standards and file a written note regarding the incident. Step Two:If the child is returned to the office the Flax Pond Administrator will once again meet with the child and develop a behavioral contract with clear consequences for future positive and negative behaviors. Both the counselor and the child will sign the contract and a copy will be sent home for the parents to review. It is at this point that we encourage the parents to contact the staff at Flax Pond so that we can discuss the history of the incidents and develop a plan of action together for the future.It should be clearly understood that if the child continues to act out suspension and or expulsion from the program will be the next step. Step Three:If your child is brought once more to the office for inappropriate behavior then you will be called at work or home and asked to come and remove your child from the program immediately. That removal may be for one day or permanently based on the incidents in question.The Recreation Director or representative will be present at the meeting to discuss the history with you as well as any future plan of action.Any appeal for a modified action plan can be made at this time. The decisions made mutually between all adult parties involved will be the final plan of action for this child. Administration reserves the right to make the final determination in accordance with Massachusetts state law and local school district policy. • Page 31 Child Protection Plan Section 6 Definitions: • "Child" means a person under 18 years of age. • "Child Abuse" means harm or threatened harm to a child's health or welfare by a person responsible for the child's health or welfare which occurs through non-accidental physical or mental injury, sexual abuse, or maltreatment. • "Child Neglect" means harm to a child's health or welfare by a person responsible for the child's health or welfare which occurs through negligent treatment, including the failure to provide adequate food, clothing, shelter, or medical care. • "Mandated Reporters" include(among others) physicians, dentists, nurses, therapists, social workers, school administrators, school teachers, law enforcement officers, child care workers, day care workers, foster parents, recreational program personnel, and, by implication, summer camp counselors. Potential.Indicators of Physical Abuse, Neglect, or Sexual Abuse - Unexplained bruises, welts, bite marks, missing clumps of hair. - Unexplained bums, scalds, fractures, skin lacerations, punctures, or abrasions. • - Self-mutilation, self-destructive behavior, withdrawn behavior. - Uncomfortable or skittish about physical contact. - Complaints of soreness, difficulty in walking or sitting. - Wears clothing inappropriate for the weather to cover the body. - Lack of impulse control, inappropriate outbursts, hysteria - Unexplained, inappropriate knowledge about sexual activity or sexual behavior. - Pain, itching, bruises, or bleeding in genital area - Tendency to become suddenly upset or. aggressive. -A.n unwillingness to shower or participate in physical activities. - Withdrawal, chronic depression, unexplained.crying. - Poor self-esteem, self-devaluation, lack of confidence - Reports that no caretaker is at home. - Suicide attempts, especially adolescents Staff Reporting Procedures • Counselors shall watch for signs of physical abuse,.neglect, or sexual abuse in their campers. • Counselors shall inform the Flax Pond Coordinators on any minor issues that may be connected to abuse such as, a strange bruise, consistent wearing of the same clothes, or lack of food for lunch. • If child abuse is suspected it must be reported to the Flax Pond Coordinators. If a camper confides in an adult staff member of having been abused or neglected, this information must be reported to the Flax Pond Coordinator only--no one else. Confidentiality of I-Iealth Records • Children's records and applications shall be kept confidential. No one shall have unrestricted access to the child's files except the Flax Pond Coordinators, Health and Safety Supervisor and Registration Office. The Health and Safety Supervisor will notify counselors if they .• Page 32 • have a child in their group with special health concerns. Avoiding the Perception of Abuse • Avoid being completely alone with one child,particularly in a place that is not conunonly viewed as a normal meeting area. This includes trips to the bathroom or changing rooms, such trips must include either more than one adult, or the very least another child. This does not mean that you can't take a child aside for a brief confidential discussion about their behavior or some matter that they have asked to discuss with you. It does mean that such a meeting should ideally take place in view of other people, if even from a distance. • Use good judgment about physical closeness. Avoid contact that may be misinterpreted. This does not mean that you can't give a camper a pat on the back or touch their arm to get their attention. • Use discretion when monitoring the changing rooms; please use the stalls to get changed. Use discretion when children are changing clothes. Don't stand and watch; but don't leave the changing rooms unattended and go somewhere else—you must remain within earshot and outside the door. • Use words with care. Never berate, intimidate, harass, or belittle a camper. • Be constantly aware of your responsibilities and position as role models. Reporting Procedures • The Flax Pond Coordinators will report cases of suspected abuse to the Recreation Director, who will evaluate the situation and make the appropriate reports to the designated official offices. • • If the camper seems to have severe injuries, he or she will be taken to the nearest hospital or health facility for appropriate medical treatment. • In the event that there is an accusation against a staff member of child abuse the Flax Program will take prompt and immediate action as follows: - At the first report of a probable belief that a child-abuse incident has occurred, the employed staff person receiving the report will notify the Flax Pond Coordinators, who • will then.review the incident with the Recreation Director. -The Flax Pond Adventure Program will make a report in accordance with relevant state or local child abuse reporting requirements and will cooperate to the extent of the law with any legal authority involved.. - If the reported incident(s) involve a program volunteer or employed staff, the Recreation Director will, without exception, suspend the volunteer or staff person from the program. The parents or legal guardian of the child(ren) involved in the alleged incident will be promptly notified in accordance with the directions of the relevant state or local agency. - Reinstatement of the employed staff person will occur only after all, allegations have been cleared,to the satisfaction of the Recreation Director. All staff and volunteers must be sensitive to the need for confidentiality in the handling of this information and therefore, should only discuss the incident with Flax Pond Coordinators or Recreation Director. Page 33 Caring for The Children Section 7 The Task and Role of the Counselor When you became a Flax Pond counselor you accepted one of the greatest responsibilities there is in life. You will be entrusted with the health, well-being and education of these young people. Your role will be complex. You will be teacher, friend, disciplinarian, mentor, coach and protector to each of them in turn and, sometimes, to all at once. The unit and group is a family and the program is a community. Parents' willingness to place the life, limb and spirit of their child in the sole care of Flax Pond and,its counselors is an expression of trust that you as a counselor must accept with reverence. The task of incorporating Flax's philosophy and objectives in each child's camp experience rests almost completely with you. To do this you must accept the children as you find them and recognize their worth as individuals. The measure of the success of our camping program is not in What we do, but in how we affect the lives of our campers. , Being a sensitive, effective counselor is more art than science. If you approach your-job with a true love for kids, a firm sense of responsibility, a willingness to work hard and a commitment that will allow you to accept nothing but the best from yourself, then you will have the job you have undertaken well begun. Discipline Procedures The Consequences Acceptable Consequences for Rule Breaking • Quiet time, frequently called a"time out". • Restriction from participation in an activity while the rest of the group participates. • Restriction to an area away from the group, with staff supervision. . • Restriction of Camp Store privileges for a specific number of days. (This may only be done in consultation with the child's parents/guardian) • Cleaning a designated. area. (This may only be done with permission of the Flax Coordinators.) • Conference with the Flax Coordinator , Senior Counselor, Program Supervisor, Recreation. Director, or any appropriate combination thereof. • Conference with the parent/guardian at pick up about minor issues. • • Page 34 Unacceptable. Consequences for Rule Breaking • Deprivation of meals. • Isolation of a camper in a place without staff supervision, observation, or interaction. • Subjecting a camper to ridicule, threats, intimidation, or harassment. • • Corporal punishment. • Excessive physical exercise. • Restraint of any kind. Office Discipline Procedure Step One: 1. Time Out at the Office 2. Meeting with the child 3. Reinforce the standards of behavior Step Two: 1. Contact parents 2. Arrange meeting with them and the child • 3. Create Behavioral Contract • Step Three: 1. Call home 2. Child will be sent home 2. Discussion of suspension or expulsion from the program What warrants an office visit? Physical aggression Bolting and running away from the counselor Excessive Swearing or Physical Threats Threats of any kind to staff or other children When all other resources for behavior management have been exhausted (ie. Supervisors and other Senior Counselors) Page 35 What does NOT warrant. an office visit? Ciying and minimal tantrums Not listening Personal dislike or disagreement with the child Not playing fairly or lack of involvement in a game In Minor Discipline Situations: If you have something that you.don't:feel you pan handle or deal with contact your Program Supervisor'first. Then if you feel that you need more support contact the Flax Pond Coordinators to come to your group to speak with the child or give advice on how best to deal with the situation. Do not_just send the child to the office since these visits are considered very serious. General Discipline Guidelines: 1. The counselor who saw the incident occur should bring the child to the office, not some other counselor in the unit. 2. Use discipline office visits sparingly, since the consequences are severe 3. Time outs should be the main consequence for negative behaviors 3. Try to stress positive reinforcement, over punishment as much as possible! Page 36 The discipline guidelines that all parents/guardians are given prior to attending Flax... TOWN OF YARMOUTH. PARTICIPANT DISCIPLINE Due to increased discipline challenges during the past few summers it has become necessary for the Recreation Division to develop a graduated discipline policy for our programs. It is our hope that by involving the parents in the process we will be able to curtail the negative behavior before a one day suspension or ultimate expulsion is necessary. If any child is suspended/expelled from the program due to disciplinary infractions the parent will have already been involved in the discussion. The Town will not be refunding any unused portion of the registration fee. Three major consequences exist as responses to negative child behavior: 1) appropriate disciplinary action as chosen by the counselor, 2) child meets with the Flax Pond Administration and develops a behavioral contract as well as oral and/or written notification of the meeting to the parent/guardian, and lastly, 3) a meeting with the Recreation Program Supervisor, Flax Pond Coordinator, child and parent. BEHAVIORAL INFRACTIONS r, Forbidden Articles: • Cell phones, knives, hatchets, cutting implements, child-owned water pistols, energy drinks, tape players, radios, wallcmau,MP3 players, and the like,portable electronic games, playing cards, roller blades and skateboards or any other similar articles not previously identified are strictly prohibited and will be confiscated and returned at the end of the day. Cel.] phones are not allowed on camp property. New technologies in these devises could lead to poor choices by the carrier which would.adversely effect the privacy and comfort of other children. If you require your child to cany a cell phone please discuss the issue with the Director and make special arrangements 2. Leaving Property Uiiexcused.: The child is required to remain on the grounds until the dismissal time unless another arrangement has been coordinated through the Office by his/her parent and/or guardian. 3. I:n Parking Lot or Other Unauthorized Areas During the Hay: The child i.s required to stay With the assigned group at all times. The parking lots, well fields, and other unauthorized areas are clearly marked.as off limits during the day. •• 4. Insubordination to Authorities: Mutual respect of all staff and.participants is the foundation of the Flax Pond Program. S. Verbal Alin e,/ rtatmropriate Cursing, swearing, and aggressive verbal attacks toward others will not be tolerated. Page 37 6. Destruction to Pro ertv: Willful destruction of the natural environment as well as property and buildings will be cause for suspension/expulsion from the program_ 7. Fighting and/or A.ctioxs Dangerous to the Phyjcal Welfare of Others: Immediate suspension/expulsion will be implemented based on a thorough investigation. 8. HIar-assm.ent/11.azi.ngi. Our goal is to teach children from all socio-economic, religious, and national backgrounds to blend into a cohesive group. We will he stressing acceptance of all members of our program and we will not allow put-downs,threats, or taunting of others. 9. Violation of Other`s Civil }.tights: Immediate suspension/expulsion will be implemented. 10. Theft of Property and/or Other's Belongings: Taking property that does not belong to you will not be tolerated. Progressive Discipline Plan. Step One: Counselors are trained to set clear boundaries and reinforce those boundaries with the children in their group. If a child continues to test those boundaries the counselors are instructed to bring the child to the office. There they will meet with one of the Flax Pond Administrators who will reinforce appropriate behavior standards and.file a written note regarding the incident. Step Two: If the child is returned to the office the Flax Pond A.dni:inistrator will once again meet with the child and develop a behavioral contract with clear consequences for future positive and negative behaviors. Both the counselor and the child will sign the contract and a copy will.be sent home for the parents to review. It is at this point that we encourage the parents to contact the staff at Flax Pond so that we can discuss the history of the incidents and develop a plan of action together for the future. It should be clearly understood that if the child continues to act out suspension and or expulsion from the program will be the next step. Step Three; If your child is brought once more to the office for inappropriate behavior then.you will be called at work or home and asked to come and remove your child from the program immediately. That removal may be for one day or permanently based on the incidents in question. The Recreation Director or representative will be present at the meeting to discuss the history with you as well as any future plan of action. Any appeal for a modified action plan can be made at this time. The decisions made mutually between all adult parties involved will be the final plan of action for this child. Page 17 Aquatic EmergencyPlan • Lost Swimmer in the Swimming Area Overview In the swimini.n.g area., the Lost Swimmer Drill (LSD) is initiated.in the case of a missing or unaccounted for child or staff member. Examples of when this might occur include a missing child during buddy check or report of a child missing. General Description of the LSD in the Swimming Area The LSD is initiated.by the designated Waterfront Supervisor. The LSD begins with three blasts on a whistle. The drill involves a quick and efficient search of waterfront and adjacent areas including underneath the dock. All Senior Counselors should remain with their groups on the beach in a line and keel) them] silent until the siren alarms and then they should follow Lost Child Procedure.. The Team Leader will call on the radio to inform the Flax Coordinator of the procedures. Junior Counselors should.immediately search the changing rooms, porta-johns, Health and Safety Office and bathrooms. The Waterfront Supervisor will stay on land to coordinate water search and to guard water searchers. The Flax Pond Coordinator will. pull the Lost Child Siren. • MISSING PERSONS SEARCH': 1. Get EIS much information as possible. (Gone how long, where last seen, name, wearing what, etc.) Contact the Flax Coordinator immediately. 2. Make land search,utilize staff to search every area possible. 3. If not located during land search, the Flax Pond Coordinator will contact the Assistant Recreation.Director,Recreation Director, and rescue personnel. Clear water of all swimmers. Gather staff and do a walking search of the swimming area consisting of the tallest available on-duty guard positioned at the farthest part of the line. Another Guard will be at the beginning of the beach line. Other guards will be spread out with-in the line. Water Front Coordinator must be in charge of search procedure. One or more available guards will utilize the rescue board in deeper waters if necessary. All search parties should have interlocking arms and does a sweep search from one end of the swimming area to the other. Remain calm and in control of the situation at all times. Search all land areas before commencing water search. Do so immediately if you think the situation requires it. Before doing anything, just stop and think. Accidents in Boating Areas Boating Area (1) The staff member(s) who witness the accident announce "Accident" and maintain sight of the water area. If two staff members are witness one should run over to the lifeguard in the chair. (2) The lifeguard in the water on the board will swim to where the capsized boat is floating. The lifeguard on the beach will blow the whistle and remove all swimmers from the Waterfront area in "swim check" fashion. The lifeguard on the dock will act as a backup for the rescue lifeguard. Page 18 (3) The staff member 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 member 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, firm, 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 1St 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.mass.gov/eohhs/gov/departments/dph/programs/environmental-health/comm- sanitation/christians-law.html • Level 1: 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. • Level 2: Can fully submerge head under water, bobs, rotary breathing, can do front stroke and back stroke but are not extremely strong swimmers. • Level 3: 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 for 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 member 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 Drill—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 members 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. • 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 member in charge should clear campers quickly and safely out of the immediate area. If available, one staff member should accompany the campers to a safe location. • A staff member is immediately dispatched to locate the closest fire extinguishing device and bring it back if appropriate. • A staff member should either be dispatched to notify the Flax Pond Coordinators and Health and Safety Supervisor of the severity of the situation, or if accessible use a radio to contact the Flax Pond Coordinators. • Staff members 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 senior staff member 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, radio, or Internet. 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 hit. 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: 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 any reason until clearance is given from the Flax Pond Coordinators this includes bathroom trips. • Outdoor activities will resume if there is no sign of lightning or thunder for over 20 minutes. Extreme Beat 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 member 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 members 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 wilt be initiated and designated staff will proceed as instructed. Team Leaders will give their radios to a Junior Staff member. Missing Child Drill Procedure Primary Search Area Searched by the following Waterfront Waterfront Supervisor and Lifeguards Changing Room/Portable Bathrooms Boating Junior Counselor Arts & Crafts Arts & Crafts Supervisor Theatre/Main Building Flaxtivities Supervisor Page 22 Sports and 'Wellness Supervisor, and the Health Supervisor will be in contact with the Flax Pond Coordinator by radios. Secondary Search • c•Cee:t C Area - Area L1 Cedar SwanMOI/ 9-e: n) Initiatives Supervisor Veal Junior Counselor — Travis Junior Counselor — Tim Road and trails Nature Supervisor Junior Counselor — Katie Trails to D-Y Flaxtivities Supervisor Arts and Crafts Supervisor Junior Counselor —Alex Junior Counselor — Makenzie Trails Behind the Fields Archery Supervisor Junior Counselor — Amanda Junior Counselor — Andrew Waterfront • Guards Du ont Ave/White's Path/N. Main St b •Vehick Sports Supervisor Health and Safety Office Health and Safety Supervisor Teen Travel Supervisor All Program Supervisors should be in contact with the Flax Pond Coordinator on the radios. • • Page 23 Crisis Management Plan Conditions that May Define a Crisis • A serious power failure, uncontrollable health crisis, terrorist attack, or serious weather emergency • Death or serious injury of a child or staff member at camp or on any Flax-sponsored trip off camp. • Lost camper not found within 60 minutes. • Firing of one or more staff members while camp is in session. • An instance, suspected or documented, of Child Abuse at Flax. • Any other situation that, in the opinion of the Flax Pond Coordinator, defines a crisis. General Preparedness • Maintaining a list of all minor staff with parent phone numbers and emergency contact numbers. • Maintaining a list of all campers, with parent phone numbers and emergency contact numbers. • Knowing all possible methods of contacting the Yarmouth Parks and Recreation Director and Program Supervisor at all times. Crisis Management Steps 1. The Flax Pond Coordinator will contact the Assistant Recreation Director(Or Recreation Director if necessary) as soon as possible. . 2. If the crisis occurs off camp, the Flax Pond Coordinator and Assistant Recreation Director will decide whether it is appropriate to send a Flax.Pond staff member to the scene, and what authority that person will.have to communicate with parents, emergency personnel, and/or the media. 3. Staff shall not talk to members of the media. All such inquires shall be referred to the Yarmouth Parks and Recreation Director, or another professional specifically designated by them. • 6. Children and staff members will he kept informed during the crisis in a way that recognizes their need to know, takes into consideration fears and feelings, and minimizes the. spread of damaging minors. 7. The Flax. Pond Coordinator and Assistant Recreation Director will coordinate,plan, and implement any and all follow-up communications to parents and/or the public at large after the • crisis has passed. 8. An assessment of the situation that led to the crisis and how it could have been prevented will occur. The Recreation Director will designate an appropriate group to study the matter, conduct any additional research needed, and make recommendations for changes, if any. • • • Page 24 Crisis Management ADDRESS: Flax Pond. Recreation Area 31 Dupont Ave (off of White's Path) S. Yarmouth, 02664 Crisis Management Team: • Maria Cobill Mike Joyce Health. and Safety Supervisor Dan Cobill t' Mike Reagan. General Crisis Responsibilities: . MARIA (Flax Pond. Coordinator): 1. Call 911 2. Call Assistant Recreation Director 3. Crowd control around the scene. Post Incident: 1. Staff Debriefing 2. Fill out Official Incident Report 3. Speak.to Police iW3 e."'-ki,IC ► , 1� 'IcE (Flax Pond Assistant Coordinator): 1. Keep everyone calm . 2. Crowd control at the scene Post Incident: 4. Keep Media off property • S. Debrief campers DAN (Travel Supervisor): 1. H..eIp with crowd control 1. Keep everyone calm Post incident: 1. Help oversee staff and children who were not involved in the crisis. HEALTH AND SAFETY SUPERVISOR: 1. Respond to medical situation. . (Archery Supervisor): 1. Open the gate for Emergency Vehicles 2. Help keep media off property Page 25 Camp Evacuation Plan Reasons for Evacuation The decision to evacuate the camp will be made by the Recreation Director of Yarmouth in consultation with the.Flax Pond Coordinator. Reasons why the camp might be evacuated could include: • A power failure of magnitude or duration that leaves the children at:risk. • A health crisis that is deemed uncontrollable. • Pending storms of significant status. General Preparedness Evacuation of a full camp during summer session is a serious decision, made only as a last resort. Nevertheless, Flax Pond will remain prepared for such an emergency by: 1. Maintaining a list of all staff with;cell phones, to be used in case land lines ail or are overloaded. 2. Maintaining a list of companies that.provide bus transportation. 3. Having up-to-date phone numbers and emergency numbers for all minors on property. This is not an extra preparedness step; the existing Health Forms the camp maintains are sufficient. 4. Calls to parents notifying them will be made if possible. A message will be put on the Flax Pond. answering machine as well as the answering service at the Recreation Division. Once the Decision to Evacuate is Made • The "Lost Camper Siren" will blast three times, to signal the start of the process. • All children and staff will meet on the large ball field unless other wise instructed. Details about the evacuation process will.be given here. • The Health and Safety Supervisor, the camp's consultation doctor and Health Department will be consulted in the event of a health crisis. The Evacuation Process • if the crisis occurs during a summer camp session... - The Flax Pond Coordinators, Assistant Recreation Director, and Recreation Director will consult and decide to twat:extent, if any, the off-site trips will be included in the evacuation. If it is decided that they will.be included, the Flax Pond Coordinator will contact.them. - The Flax. Coordinator will begin contacting the list of school bus service providers, starting with the camp's regularly contracted service provider. The first available buses will • be engaged, up to the number required to evacuate everyone on camp property that does not have other means of transport:. - Under the supervision of the Assistant Coordinator, staff will be assigned to contact parents by phone to notify them of the situation, starting with the parents of the youngest campers'. Parents will be asked to pick up their children immediately. Parents who can't be contacted will move to the end of the list, to be contacted again later. After three passes through the entire list, the remaining parent list will.be handed over to the Recreation Director, who will designate staff to make arrangements for emergency evacuation of remaining campers. -Under the supervision of the Flax Pond Coordinator, staff car pools will be arranged. No Page 26 staff may leave the camp until an appropriate number of campers have been safely evacuated. Some staff may elect, or be assigned, to take the bus. K.ey staff may remain.on camp property. - At all times prior to their evacuation, campers will be supervised by adult staff in a 10:1 ratio. - As parents arrive to pick up their children,the children will be signed out as done in a normal Flax day. Each child must sign out with their counselor. All counselors must keep record of which children have signed Out and been removed from the program. All participants who are not evacuated or whose parents were not contacted will board a.bus to bring them to a designated shelter. The Recreation Director will coordinate ongoing staff assignments and procedures for notifying parents and meeting the buses. • A health crisis may require additional measures, implemented in consultation with the Health and Safety Supervisor and/or Town and County Health Department that must be taken during evacuation, including but not limited to: - Consideration of which participants to evacuate first, - Consideration of whether healthy people can be placed on the same bus with sick people, - Consideration of how many adults to place on each bus that carries children. - Consideration of whether to have cars or vans follow each bus to assist with sick people, • Once the evacuation process is underway(first bus loaded and dispatched), a decision to cancel the evacuation (i.e. in the event power is restored) can only be made by the Recreation Director. Page 15 Policies & EmergencyPlans Section 4 First Aid and Safety Procedures: Safety l. Awareness comes first - Waterfront, initiatives, and Archery are at highest risk for accidents. - The younger the child, the stronger the supervision. 2. Everyone, including staff,Swears shoes at all times (except at Waterfront.) 3. Everyone,including staff,wears shirts at all times to prevent burning (except at Waterfront.) Bathing suits alone are not suitable for children to wear around property. 3. Identify poison ivy to children. 4, Conduct frequent tick checks (performed weekly by the Health and Safety Supervisor). Report 1. Any ill or injured child must report to the nurse for assessment. - All staff must keep a documentation log where they document all incidents and injuries that may occur during the Flax day. 2. Counselors must bring any medication, staff or child's, to the Health and Safety Supervisor every day. The counselors are responsible to remind children when it is time to get their medications. 3. In the event of a major accident or incident, an Incident Report Form must be filed with the office. Severely blared red Child: I. Remain calm. 2. Do not move the injured child. A general rule is that the child must get up on their own; if they cannot, they need to remain where they are found. 3. Stay with the child and send another staff member for the Health and Safety Super-visor. Or, call the Health and Safety Supervisor/Flax Pond Coordinator on your unit radio. A.s a last resort., send another child for help. o 91. 1 call should be made without expressed permission • from Flax Pond Coordinators Page r6 Rabies Control . • Rabies has become a..major problem in all the towns on the Cape, and some cases • have been located in the towns of Dennis and Yarmouth. • Rabies is a disease that can be spread through animal saliva. Small animals such as raccoons, squirrels, skunks and bats can be carriers for the disease. Precautionary Measures • Do not under any circumstances allow the children in your group to chase after, touch, or pick up a live or dead animal that is not part of the Nature Animals, assume that all wild animals are dangerous. • Warn the children in your group before going on nature walks and through the trails not to go near any of the animals that they may see. If you see a suspicious animal: • Contact the Flax Pond Coordinator or the Health and Safety Director immediately. • Keep all the children away from the animal. • In the event.where the animal may be rabid., the Flax Pond Coordinator will switch to a rainy day schedule (no matter.what the weather) and put all children indoors. This will continue until the Natural Resource I Animal. Control staff can deal with the. animal. if a child is bit. • Remove all other campers from the scene. • Call for the Flax Pond Coordinator/Health and Safety Director immediately. • • Try to land another staff member to stay with your group and keep them calm. • Tell the Flax Pond Coordinator the details of what happened. Be prepared. to tell: What happened? Ilow? When? Where? Where is the animal now? And where are the other children in your group? Traffic Control during program hours: Regular drop off time of 8am: all cars are held off until our staff is ready to receive children.The vehicles are then allowed to come through parking lot in two lanes to drop child(ren). A staff member will assist child to sidewalk from car. The staff controls the flow of cars. Regular pick up time of 4pm:all cars are held off until staff is ready to release children. All children wait behind the wooden fencing next to parking lot.The vehicles are released and a staff member checks with each vehicle and calls child name. Child signs out with their counselor and gets escorted by another staff member to the awaiting car.The flow of traffic is again controlled by the staff. If a parent needs to speak to counselor or Administration they are asked to pull to the side and park so that they do not hold up the line. All other pickups and drops offs are signed in and out at the camp window. Contingency for Registered and Non-registered children: If a child is registered and does not show for the day a staff member will make note for attendance. If that same child is out a second day in a row without notification we will call the parent/guardian to check up. If a child is not registered and shows up for the day we have them sit in the office and we call the parent and the main Recreation office as they may have registered late or early morning.They are not out on property until all paperwork has been processed and money has been paid. Primitive,Trip or Travel Camp: Once a week our oldest group of participants 12-15 year olds go off property. We have each child bring in a signed permission trip exclusive to that specific trip.All staff have their list of kids to count at each stop and before getting on the bus and after.The program uses local school bus company for all trips off property. A first aid kit travels with the group.The trip leader has a cell phone to communicate to the Administration at the camp property if anything arises.If an injury occurs they can call the camp to get emergency contact information.The trip leader is aware of each locations closest hospital. o C•I1P 0 o C o C Von' sfri to M Z .a A o w o W co o LL •U U N J NO) p r 0 dS 0 y Z I m V co p .0 u U Q m Q a..) O. c 1 CD U la- N .0 o o 0 O i .S o 0 o c as m ^q C 4; Q N 'o (D N CO a) w 3 • CL. cd d Cto 1 •11 v c1., C o `` -2- co -2, UI VI m c aa tu co ":::EEE TTT E co fi p CD 44 ettW Zo al C Z c c c O d c a 43 •m+ �, 0 ° m a m 0 U E E E ..- a)mm 'N CD co en I ' Q ea 15ti as to' pQ 'o o > > 0 E 2 E iii z m c°i } (9 Q Q Q Ut co U C -a m cin I o E � � O w ° o "4... o '5 c •5 UcL6 N Z m 0 03 I` ~ L N o d o4 o a a'o c c k. a c Z m o U 0 C co • vNO co NN Z bA A E y m o c .a N N s, N co cn O O O y N 4. 7 Y. O O O o N W co •E _ o O 'U `+: r0, to 7 C O J W 0_ CI 4'.c 't 2 ncl . N WEa V M O C. f0 74 n a •E 111101111iIIN c H J ? y QQ � H •3 04 M:» II ' o - 0 m heli .,el9. 'O 10 0 ,�,,, N 3111I11u�" i �M o o fra;'• o E c � � c zcn 7. WI'H11101M21VA 10 I\I/'01 g FI 1HD154,1 ••�+•�•-••- Haf111UTIlf= V32Pd nNOI1V3d33 J aNN0d XV:1 o ., »C,J 0" � N7 9NIa31ne 3SOO1 g :a 'OI•X'51330HDLV II u 1.130V11a 0100113/Islnear•m MMOHO,011.4 a3SOdO21d .� a • I I v I N " I I I W I I I I I 14 4 �-1 I ;1 gl--J • �IfIni13J I 1� �$ ••f I I03110>,, I •, I /� T ' V1) 1I I Lilo I A-.fl J / I J-.ax j3 pa 11 111 II 1 a rl-- m ' N • Cr — N:.WIII II1 NI - - - - - - - - 1 "1 -71- 1-F----W Zil �7� s. i • ! g' 1 IIII 1 II III 1;a _j yk I I J N NII NII NI I I i...___,, i . I . y IMI h 10 J-L_J till -,,,,,i 1 151 -1 a• — ''' m �II N N �II 1 1•1--,-„j w? ' " PP L--' F 1 N1 NII a1 / ®1 I • IIII 11 T 1.110 ' u d u d I V LI_ I m a,r;�3.: T 1 O• ' I nv» f IuOI a, I J I —� w, i kg I a- II 1 1 1 1L I a l 1 gY m i, • .a i I a-a . . 1 I .r y r � 1 i ,--HT1 , a fir; a, ; i 1 11 - . I I 1 .!3'',";114.., '_ w j' 1 ?, r .' 1 7 / I I I S is!,,,, L----J I.I. �I I • i —,�{,{f. iE 11 <, aP 11 I' 1 yr� R 1-7,1 as j I ,� { w ; 1 1 w r a'' g� 1 _ _1,;• 4 t- a i —I-_ my ; i b1..0.-1., ggj? 1� • 1ya 9 'W :a I 10, i .I - � 2:1 I a. O \ F.1" O ,3 s' I 3' •LL o #,j: I NNIr I I = I •.a . fiI I.:,EI mvw �� d � . �I I I r —t .f51.e �I.H-,> 1 1 4 = N I ' IO ''gli.° 1. I� I . L----�a atl.la a 4�. 1, ,:,'1'.1'11,1,Q I I \J oi y j I � I i, `! J> s m — 1 p Ol_ W 1—I , �„� • F4 j gt RJ-01� 0 I--rTr IC 4 �v ''t .::•.vr.R•.•—. I I 10 a°'l___Liip, ^ I ` L)Ir ' a' I a I. I F^ :IIJ LL�£ 'I :v.n_^>udTl2: _ 1 Q J F. F I u _d hJf TO • c o IZ J I(_1 11 • o� I El 1 — j- — — —1_to I "1 J—� — —I I I I �� j I I I I I I I I I I 1 ! I J-wE 1 1 J I j, .r .: 1 1 �1 lQ) 11 1.t.,1 v YARMOUTH FIRE DEPARTMENT 96 OLD MAIN STREET ", SOUTH YARMOUTH,MA 02664 t � PH.:508-398-2212 /FAX:508-760-4861 tutik Ltt ,' FIRE AND SAFETY INSPECTION REPORT ADDRESS OF INSPECTION: 3 I b u u 1 1 A v Ei YARMOUTH PORT Fli. SOUTH YARMOUTH 0 WEST YARMOUTH NAME: C A pc) a,,l ❑ OWNER pi, MANAGER ❑ TENANT OTHER(explain): DATE: )0 22 1 A TIME: } D J v PHONE: NAME: \A Z•I j- 12.41 iI, 1 I r( PHONE: 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`/ 0 br1:- ICiLr( C /L _5 r./ 3t (7.- ) 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: /< L � —` Title: C A p! A N' Copy Received By: /[. a L,--/---( ��k_n k L Original-Owner/Tenant Yellow Copy-Fire Department FBP 99-1 ,, o i4--___ TOWN OF YARMOUTH BUILDING ELECTRICAL g_; GAS it '� 1146 ROUTE 28 SOUTH YARMOUTH MASSACHUSETTS 02664-4451 �` = PLUMBING {'ii Telephone(508) 398-2231,Ext.1261 —Fax (508) 398-0836 ease SIGNS BUILDING DEPARTMENT Inspection and License Report /J Date /C1"`.2'. - Address S r DU O✓ T i0e- Business Name 4jC t2eYYO Con /gi/G Phone During the Annual Inspection of your premises,performed in accordance with the provisions of Section 110.7 of 780 CMR(Massachusetts State Building Code),the Board of Selectmen,and/or the Board of Health rules,the following violation(s)were observed: &grass 5(Ditiff ❑Emergency egress signage Location ❑Emergency egress lighting Location ❑Maintenance of exits Location U Guards/handrails Location Zoning ❑Signs Location ❑Parking Location ❑ Other Location Mechanical I] Combustion Air Location ❑Storage in Boiler Room Location ❑Vents Location ❑Automatic door closures on boiler room doors Location ❑ Clothes dryer vents Location Other Location The State Building Code,Section 1001.3-Maintenance,provides that the owner as defined in Section 780 CMR shall be responsible for proper maintenance. In order to abate the above violation(s)you must: o Make corrections immediately and contact this office for a follow-up inspection. o Make corrections prior to,opening and contact this office for a follow-up inspection. o Make corrections prior to your ne annual inspection. o Make corrections within d ys and contact this office for a follow-up inspection. Local Official/I actor ti A , Received By 41O` It' V\ Title. - Reck,-bi ido 'V,— Revised 2/8/13 /�