HomeMy WebLinkAboutApplication for Recreational Camp 67/81/2015 83:69 5863624323 CAPE COD ISLANDS BSA PAGE 01
d TOWN OF YARMOUTH �dof '
� � Health '
1146 ROU7"E 28, SOUTH XARI�OUTH,MASSACHUSETTS 02664-24 51 p����is oD
Telephone(508)398-2231,ext. 1241 D-� �
F�c(sos> �6o-sa�z ��}� b '�°Ibt5
AYPL�CATION FOR A LICENSE TO CONDUCT A HEALTH DEPT.
RECREATIONAL CAMP FOR CHILDREN
(Use brck o(applicallon ff aAdiUonal apace is neceasary) FE$= SSS.OtI
Name ot Camp:
t P�Y M.� a� '
Site Address: ��.�
Site Address:
Tax ID Number(FEIN or SSI�: E-mail ;
Type of Camp: Day(less than 24 hrs.)� Residential (24 hrs.)
Ho��ofo�pon: M- F `da.K.- .�a�-
Dates of Operation: Opening:� T Closing:
lYame of Camp Owner:�np nr� *T�s� s Gau/�i ,,—� ,
or��naa,��:sa�i'��)d/�l�. � St � Po�,_Ly�t oa� s �
Office Telophone Number: ,���,�Q a- 43c�c�
Name of Camp Operator(if different):
Address:
Telephone Number:
Camp Director. 7
Addcess: �r/ ��_��'_��(Z,�_S� �Of� � l7.,1 l�7 J� i
Age:�� i'elephoneNumber: ,��5' ,_, �0��9�7,� �
Courscwotk in Camping Admini5tration: U N , v m p w1 Irt!b�GLt�—
Pre�ious Camp Administration experience:���_,e1�5 (� Cutx�n �I'eP_1v���
ll �
Heslth Care Consaltant: .� ��,p�'�' �'��.�Q,(�
Type of Medical License:�_vi_S 1 C 1 o-Y� MA License number: I
�
Address: Plrnaa,�f la.�IVs�Kal ds3 p/ea� (�lce Aw. J;�r,�.d,Te(ephone: SD�'�iL3a"Ja3.3 ��
o.i�o�is 1 of 3
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67/61/2615 03:09 5063624323 CAPE COD ISLANDS BSA PAGE 02
Hospital for Emergency Services: � ( (��___�1Qs�1
{� ��'� —' 1
Health Snpervisor: �']O�_`I"�1 r f��+° �
Age: � 9� Type of Mcdical License,Registratioa or Training:[] �.'p *1����lv�Y�
Swimmiog Area: Yes 'X No�
If Yes: Fresh Water )C Ocean_ Pool_ CPO_
Specific Onsito Locations: � a�np o�� Qn.��
Water Quality Testing Perfortned By: �a.i'1�S�a1nLt'�ro�r/ ;
Aquatics Director.
Name: �m��n �1l.l�Y Age:�_
Lifeguerd Certificate issued by: A n�,�_� Exp. Date:J¢�l�d!?L(i
�bdw�) Sn�c�y Cwu�f
A�eracaaRed-6te�s CPR Certificate:_ rIo�OI�E Exp. Date: ro o`�/
N.�rw�l cly Cax�cil F+rst�� -�, /,�/
� c�rifi�c�: f�3 '11� Exp. Date: y���
Previous aquatics supervisory experience: �'pwD �fC� A�Y��c�2y � aU/S
� J
Watercraft/Boating Activities: Xes� No� 13escribe:���- I � !
S a�d Rw�c�le qa�a
Compliant witb Christian's Law: Yes� No
Food Servicr.
Is food handles, served or prepared? Yes No_�„_
To what extentT Snacks Cooked and Served by Staff
If cooked onsite, Food Manager(submit copy of ServSafe)
Catered if so,by whom?
Is refrigeration available for perishable foods? Yes ( No
Fire Arme Instructor:
;� i ' I ��i t�l�I f i� Mrmf�--
Name: ZJC�n�I g WQ CZe,w uN�c�. �.x. `�l�
National Rifle Assn. Instructor's Card(or equivalent) G �� 1d.�doib
Date certified: �i�do f a�lb / L/ Expiration Date: $ .3 ��
ou3ais 2 Of 3
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07/01/2015 63:09 5963624323 CAPE CAD ISLANDS BSA PAGE 63 '
Background C6ecks: '
Has the Camp Owner or Director obtained and reviewed the CORI end SORI of each staff
person and voluntaer who may have contact with a camper? Yes X No
IMPORTANT! CONTACT THE YARMOUTI� HEALTH DEPARTMENT ONE (1)
wEEK PRIbR TO OPENIIVG TO SCHEDULE AN INSPECTiON! THIS IS
MANDATORY! OVERNIGHT CAMPS MU5T ALSO SCHEDULE AN INSPECTION
WITH THE BUILD�NG AND FIRE DEPARTMENTS.
By slgning tkis application, I acknowledge tkal !have submilted a([ reqrired documentatlon
�
and I am in rnmp/iance wllh the Stafe's inr►eimum standards jor Recrealiona! Cwe�ps for
Ckildre►e,State Sanitnry Code Chapter IV, 105 CMR 130.000.
SIGNED: ( ��.�w /!'���x.kx�— [��
- l7 )
PRINTEb:�m��Yl� Ztt�LVn _DATED: �13(�I/S
See the next page attac6cd for a Hst of docnments tLat wust be completed end submitted
before your applicallon can be fully procesaed. You an strongly encauraged to rnmplste
tLe�e dceomeots as soon as possible and aubmit them ia advanee. Thia will e=pedite the
procesa. '
I
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anons 3 of 3 '
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67/61/2015 63: 09 5863624323 CAPE COD ISLANDS SSA PAGE 04
Reauired Document� I
See the MA Regulations for Minimum Standards for Itecreational Camps for Chi(dren,
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.
cn«r
n«wnrnts
Subntitted
'Staffinfmmation forms(sce attached).............................•.--•---.............................
'Procedures for the backgroued review of staff and volu�teers(105 CMR 430.090).............
'Copy of promotional literatuce Q OS CMR 430.190(C)).............................................
•Procedures for reporting suspectad child abuse or aeglect(105 CMR 430.093)..................
'Heakh care poticy(105 CMR 430.159(B)), including immuni7ation reeords...................
*Discipline policy(l05 CMR 430.191).................................................................. i
'Fire evacuetion plan—approved by locel fire departntent(105 CMR 430.210(A)).............. �
*Disaster plan(105 CMR 430.210(B))....................................�----......................... '
•Lost camper plan(IUS CMR 430.Z10(C)).............................................................
'Lost swimmer plan(105 CMR 430.210(C))........................................................... ,
•Traffic control plan(105 CMR 430.210(A))...........................•..............................
•Day Camps—contingency plan(105 CMR 430.211)................................................. ,
'Primitive, Trip or Travel Camps — Written itinerary, including sources of emergency csre I
and contingency plans(105 CMR 430.212)..............................................................
*Current certifieate of oceupancy from local building inspector(105 CMR 430.451)............
•Written statement of compliaoce firom the loca] fue department(105 CMR 430.215)........... '
"Aquatic plen,including Christian I.aw, PFI7 fitting tests, water testing and swim tests......
Attsch 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 eomplete this.
Please: If you are applying for an original cam� 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, stzuctures, facilities and �xtures
➢ Proposed source of water supply
➢ Works £or disposal or sewage and waste water
Sune�visory staff means those persons with the responsibility, suthority and ttaining to
provide direct supervision to caxnper groups. This may include counselors, junior �
counselors, general activity leaders or other staff who provide supervision to campers
without assistance.
�w„
�. °� `� TOWN OF YARMOUTH Boazdof
Health
= 1146 ROUTE 28, SOUTH YARMOUTH, MASSACHLJSETTS 02664-24451 -
�w..e Telephone(508)398-2231, ext. 1241 Health
Fas(508)760-3472 Division
G�C�C�l�O�C��
APPLICATION FOR A LICENSE TO CONDUCT A �;t;l
RECREATIONAL CAMP FOR CHILDREN � � 2014
(Use back of application if additional space is necessary) ��pEP1.
NameofCamp: � v.np (�s �,noucR`n
SiteAddress: c�icl� PtYI� 5�" �'Qcmno� �O�'�'. 1�.� ��(e'7.5�
Site Address:
Taz ID Number�I or SSI�: �a1'!$�lo�J�U E-mail Q„„,�, Zaan;��5[��r+c{�o�g
V
Type of Camp: Day(less than 24 hrs.)� Residential (24 hrs.)
HoursofOperation: (�-' r gwm." �ov.ti
DatesofOperation: Opening: _����� a0�� Closing:� 7, ao�y
Name of Camp Owner: ('rLno � °' S�Cw 5 .n+�nc,�� �'S o��c�
OfficeAddress: c1i ��7 WI ��OW �� ��i��'�1�avY�k ��r91� �OT fid�r���
-�
Office Telephone Number: 'rv 2f' ,���' ��c�l c�
Name of Camp Operator(if different):
Address:
Telephone Number.
Camp Director: ,�vti�v ��`��
_ _ `,� J�- -- — __
Address: ��� �,ti'���n r.�.: i5�" �/n1 Yvl nu�vl 1'�0��1� ��� ln��
Age: .�r; Telephone Number: J�U�- �3(0��� �oZ
Coursework in Camping Administrarion: �,�� l[,pt� ����uNlql S�cr77dl
Previous Camp Administration experience:�5 0.S g�T '(P_�
Health Care Consultant: �� ��.n`}'�" �IY1Q�
Type ofMedical License:����V /�'IP.iillf l✓(_ MA License number:
Address: i'�YC:,Sc.r�i �c�ke h��lcR� �53 ��fas�v�i �a� 1�U� Telephone: �Gn�y��a'"���3
�u;1 �
,oa9n, 1 of 2
Hospital for Emergency Services: �ctfae, �'o� ��5 o1fcL.1
Health Supervisor. � �'}�I L ��PAI��P
Age: LI� Type of Medical License, Registration or Training: ('p hfs�./4����n /�ao��n D�KeG
Tu tvt i✓t�
Swimming Area: Yes '� No_
IfYes: Fresh Water v Ocean_ Pool_ CPO_
Specific Onsite Locations: 1v51ano �rA, �I,�iruinai� .`ft'2as .91' �'�r�E✓iov4�n Yo� �
Water Quality Testing Performed By: UdS'11S'tA�91� �t�uP1 �vc�1`�-
AquaticsDirector: 1�061V1 I�lr �lV
Submit Certifications: CPR ✓ First Aid� Water Safety_
OtHee Lifeguards and Credentials: �fr"� !*?�OP� _ L t��rc� �'p��7�i hr�+� --
Watercraft/Boating Acrivities: Yes ✓ No_ Describe: 0 9 �y��
Food Service:
Is food handles, served or prepared? Yes � No_
To what extent? Snacks f Cooked and Served by Staff�
If cooked onsite,Food Manager(submit copy of ServSafe) �v 7�.�n✓� " $e rv Scc�P.
Catered_ If so, by whom?
Is refrigeration available for perishable foods? Yes V No_
Background Checks:
Has the Camp Owner or D'uector obtained and reviewed the CORI and SORI of each staff person and
volunteer who may have contact with a camper? Yes � No_
_ - _ __
IMPORTANT! CONTACT THE YARMOUTH HEALTH DEPARTMENT 48 HOURS PRIOR
TO OPENIlVG TO SCHEDULE AN INSPECTION! TffiS IS MANDATORY! OVEItNIGHT
CAMPS MUST ALSO SCHEDULE AN INSPECTION WITH THE BUII.DING AND FIItE
DEPARTMENTS.
SIGNED:
PRIN'I`ED: Z. DATED: )1��`a 01�
See the nest page attached for a list of documents that must be completed and submitted before
your applicaUon can be fully processed. You are strongly encouraged to complete these documents
as soon as possi6le and submit them in advance. This will expedite the process.
asrzaio 2 of 2
Required Documents
See the MA Regulations for Minimum Standards for Recreational Caxnps for
Children, State Sanitary Code, Chapter N-105 CMR 430.000 and the guidance
docuxnents issued by the Department of Public Health, Division of Community
Sanitation for additional assistance with developing the following docuxnents.
➢ Staff information forms (see attached)
➢ Procedures for the backround 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))
➢ Discipline policy (105 CMR 430.191)
➢ Fire evacuation plan—approved by local fire department (105 CMR 430.210
(A))
➢ Disaster plan (105 CMR 430210 (B))
➢ Lost camper plan (105 CMR 430.210 (C))
➢ Lost swimmer plan (105 CMR 430210 (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)
➢ Lab analysis of private water supply (if applicable) (105 CMR 430300,
.303) _
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
-�-- BOY SCOUTS OF AMERICA
'� CAPE COD£7 ISLANDS COUNCIL, INC. #224
Hiring Procedures & Backgrounds checks:
All staff must complete an application for employment that inciudes 3 references.
Staff references aze called and all applicants aze interoiewed for their position.
Staff are required to become registered with Boy Scouts of America. This membership
will include a national criminal background check and Massachusetts CORI� So tZ 1
Results from these investigation can result in the termination of offer of employment
247 Willow Street
Yarmouth Port MA 02675
P(508)362-4322
F(508)362-4323
wwwscoutscapecod.org Prepared. For Life:"
�
-�-� I BOY SCOUTS OF AMERICA
'�� CAPE COD£7 ISLANDS COUNCIL, INC. #224
Procedures for reporting suspected child abuse or neglect:
Any staff member suspecting that a child has been abused in any manner must
immediately make a report to their supervisor.
Frist Priority will be if the child needs immediate medical treahnent, in which case
appropriate treatment will be sought.
Suspected abuse'will be immediately reported to the proper authorities: child services
and/or local police.
The staff member will not engage in"investigating"the abuse. That task is left to the
professionals. The staff's job is to recognize and report the suspected abuse while
keeping the safety of the camper as their primazy concern.
247 Willow Street
Yarmouth Port MA 02675 .
P(508)362-4322
F(508)362-4323 -
www.scoutscapecod.org Prepared. For Life:"
�
�--�-- BOY SCOUTS OF AMERICA
' "�' _' CAPE COD C�r ISLANDS COUNCIL, [NC.#224
_.�.,.
Authorization for health caze and medicines:
Basic emergency medical care will be administered by the camp medical of6cer.
Injury and treahnent will be listed n the First Aid Log
Medicines to be administered during camp will be kept locked (refrigerated if necessary)
Medicines must be in their original container with the child's name and dosage
instntction clearly identifiable
247 Willow Street
Yarmouth Port MA 02675 �
P(508)362-4322
F(50S)362-4323 n
www.scoutscapecod.org Prepared.For Life.
� �
IBOY SCOUTS OF AMERICA
CAPE COD F� ISLANDS COUNCIL, INC. #224
Traffic Control:
Camp Parking lot is labeled with a one way traffic pattern.
Parents must enter the pazking lot,park their car, and walk their child to the check in
table.
At dismissal,parents/guardians must park their car and walk to check out table at which
time the camper will be brought forwazd to meet their parent and leave with them.
NO camper is allowed beyond the check in/out tables without being in the care of an
adult
247 Willow Street
Yarmouth PoR MA 02675
P(508)362-4322
F(508)362-4323
www.scoutscapecod.org Prepared. For Life:"
�
m � � YARMOUTH FIRE DEPARTMENT
'� 96 OLD MAIN STREET
�-` SOUTH YARMOUTH,MA 02664
PH.:508-398-2212 /FAX:508-760-4861
_ e�
FIRE AND SAFETY INSPECTION REPORT
ADDRE55 OF INSPEC710N: �� '�- I-I�l�7L t S �
a
,�YARMOUTH PORT � SOUTH YARMOUTH � WESTYARMOUTH
NAME: � ��cen-� �
� OWNER � MANAGER �TENANT OTHER(explain):
DATE: � �j�- TIME: �� . C,� PHONE:
�
NAME: �y�yy z�b1 PHONE: ���c���,-y3a3-
OWNERS MAILING ADDRESS: ` /a
r?N� G�l�aw .S� �G�wto�t�n. Par�'
An inspection of the 6bove 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:
��� w ' ry
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: � 6 � — Title: �,,,�
�1 �
� / l
CopyReceive ����, f�� � nR
��" �
Original-Owner/Tenant ��.1 Yelloc4 Copy-Fire Department FBP 99-1
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Cape Cod&Islands Council Boy Scouts of tlmerica
D►ay Camp Emergency Procedures
All leaders and campers are briefed on emergexicy procedures shortly after arrival at
camp.
The camp emergency signal is a sireu wksich, will signal for all camp participants and
visitors to assembly on the parade field for roll call.
1 LightningJSevere Storm
a) At the first sign af lightening ali waterfrront aetivities stop. All swinuners out of
the water,all boats beached. Boaters walk back to waterfront.
b} Everyone in camp seeks shelter in a buiiding or vehicle until the stnrm subsides.
i) Program activi�ies will be maved to the dining hall and/or pavilion as
apprapriate.
ii) Secure camp for high winds and raiil
(1) Llrop and secure ail temporary structures as apprapriate
(2) Secure non-essential electricai equipment
2 Missing Camper 1 Lost Bather
a) Missing CampeN
3} Report missing oamper to Camp Director
ii} Sound emargency siren
iu) Assembie aii campers, visitars and staff on parade field for mll cait.
iv) Commence search as necessary and appropriate.
v} Notify Scout executive if lost camper is nat located within fifteen min�rtes.
b) Lost Bather
i) Report last bather to Canap Director
ii) Sound emer$ency siren and announce for lost bather divers to report to the
water&ont.
iii) Assemble a1I campers,visitors and staff(excluding divers)on pazade field for
roll call.
iv} Aquatics staff conduct lost bather search.
v) Notzfy Scout executive if lost canaper is not lacated within fifteen minutes
3 Major Accident
a} Report ali accidents ta the Camp Director
b) Camp Director reports Ya the Scout executive any accident involving
i) Loss of cansciousness
ii) Hospital admission
iii) Fatality
c) Execute emergency plan as appropriate
Fage i of 2 Rev DA 711312012
Cape Cod&Islands Council Boy Scouts of Axnarica
Day Camp Emergency Procedures
4 Hurricane
a) Weather service reports will he monitored thraughout the camping season.
b) Communicate staius and intenY with the Scaut executive
c} If camp is in the expected storm irack
i) Call all familias to cancel gragram for tYta following day
ii) Secure caxnp for high winds and rain
(1} Drop and secure a11 temporary structures
(2) Secure non-essentSal electrical equipmeat
rii) Assemble carnpers in the dining hall
(i} Ca11 all families for early pick up
(2} Evacuate to sceure shelter if so iristructed by emargency services.
5 Fire
a) All campfires are contained in fire rings and attended per BSA fire guard
procedures.
b) Wild fires and building fires aze npt fought by campers or leaders.
c} All uncantrotled fires are reparted to the camp director
d) All campers and staff report to the parade field for rall call.
6 Earthqnake
a} At tkie first sign of ground tremar
i) exit any building
ii} stay clear of
{1) overhead wires and electrica!equipment
(2) buildings,vehicles and tall trees
{3) Pxopane tanks and tlammab2e Iiquids.
b} After tremors stop
i) assemble on parade field for ro11 call
ii} Stay'ang away fram buildings,tall frees and downed wires,
iii) Camp director will ensure main power breakers ore off and check telephone
service.
7 Train Derailment
a) Repart derailment to Camp Director
i} Assemble campers for roll call
ii) Ca21911 praviding as much location information as possible
b) Provide assistance as requested by emexgency services.
c} Be prepazed to evacuate camp
8 Plane Crash
a) Repart crash to Camp Director
i} Assemhle campers for roll call
ii} Ca11911 providing as much locatiou infarmation as possible
b) Provide rescue assistance as requested by emergency services.
c} Be prepared ta evacuate camp.
Page 2 of 2 Rev DA 7/13/2012
Cape Cod&Islands Council Boy Scouts of America
Procedure for Release of or Absentee Camper
1. No camper will be released to person(s)without the appropriate release form.
2. In the event any person(s)attempt to remove a camper without authorization:
a. Escort the person(s) off camp property
b. Notify local police as needed
c. Inform camper parenbguardian
d. Inform ScouYs unit leader
e. Inform the Scout Executive
3. In the event an unauthorized person(s)removes a camper$om camp property,the Camp D'uector
will
a. Notify local police
b. Inform the Scout Executive.
Absentee Camper
In the event a camper is absent from transportation to or from camp,the Camp Directar or Program
Director will
1. Call the parenUguazdian
2. Nofify local police if the situation dictates
3. Infoim the Scout$xecutive.
Rev RA 7/23/2010
RALPH J. PERRY, INC.
P.O. BOX 339 • HYANNIS, MA 02601 • 508-775-3473
MA-CRJ{017 • DOT CERT#A-850
FIRE PROTECTION INSPECTION REPORT/WORK ORDER# N� 4 4 5 3 0
NAME: � DATE T�/�'I ACCOUNT#
LOCATION `c��� � Y",!ae� S�-+ NEW CHARGE � COD
1.w .� ANNiJAL � NEW EQUIP SERVICE RETURNS �
TOTAL#OF EXTINGUISHERS � �
BILL TO �o �� ✓�/1-t�il J -C7'+ #EXTINGUISHERS DUE SERVICE NEXT YEAR �
-rca-� CUSTOMER PO# INSPECTION DUE ���
CONTA � !�f'��/- PAONE CELL SERVICE/LABOR
�:
NEW EQUIPMENT
DRYCHEM2'/zABC � SABC � lOABC 20ABC lOBC 20BC IOPK 20PK
CO2516 1016_151b_201b_PW_CLASSK_HAL011ZON2'klb _ 516_ 1116_15.S1b _
MARINE SYSTEM EMERGENCY LIGHTS EXTT LIGHTS OTHER
INSPECTION / RECERTIFICATION
DRYCHEM—KCLASS�PW_HAI.ON/HALOTRON—0O2 CONDTEST MARINECYLINDER
EMERGENCY LIGHTS EXIT LIGHTS OTHER
RECHARGE / SERVICE / HYDROTEST
RECHARGES � SERVICE
DRY CHEM 2�h lb _96 101b_201b 6 YEAR MAINTENANCE � HYDROTEST �
PW K CLASS.61 2.SG HYDROTEST
HALOTRON 2'/z Ib Slb_ 11]b_ IS 4x 16 6 YEAR MAINTENANCE HYDROTFST
CO2 5 lb 1016 _ 1516 201b COND TEST HYDR01'EST
No[es:
PARTS
SERVICE COLS,AR WALL HOOK Ml-Slb Other
ORING � VEHICLEBRACKET M2-1016
CHECK STEM HEAVY DUTY BRACKET 2016
PULL PIN B[1L,BS REPLACEMENT COVER
GAUGE BATTERIES BATTERY DISPOSAL FEC COVER
SIGNS/ LABELS FIRST AID
DOT OSHA PWM 90 FTKST AID KTT 8161_8162_8163_J-KTT_REFILL
BL SERIES VINYL TYPE EYEWASH STATION_REFiLL_INSPECTA SH�,LD
RPSERIES PLASTIC TYPE OTHER
FIRE EXTINGUISHERS ARE IN COMPLIANCE WITH NFPA10 CODE YES NO ❑
RECOMNNffiNDATIONS:
On this date e bov d 5re equipmen[were inspected or serviced in aceordance with proceduces of the NFPA 10 and the manufacturer's manual,with the resul[s
indicated abov .
� ��� �
SERVICE TEC CI LIC# CUSTOMER 5 A D REPRESENTATIVE
The abwe service rechnician cerfifies tMtthe fire ee[inguishers and emergency lights were persowUy inspecfed ound conditions ta 6e as indimted above.
�'f�EAr�E�FC'2 6L c Nc I 8C0 <�P.G'!'J �:�.o �em�maa
Cape Cod& Islands Council Boy Scouts of America
. Camp Greenough Scout Reservation �'��`�
:`. .„�., c3 � G�
Code of Conduct �-,,.,, ..� ��<
���aF�.�
We strive to provide a safe outdoor experience for all Scouts and families
.SCoi[t Dat/1 participating in program at Camp Greenough. The Scout Oath and Scout
Law are our guiding principles. Additionally all staff and participants in
On my honor, I will Cape Cod and Islands Council program aze expected to abide by the
do my best following:
To do my duty to `� All participants will be respectful of others and their
God and my couniry property.
and to obey the
Scout Law, ✓ All adults, including leaders and pazents accompanying
youth participants, aze expected to support camp and
To help other people program staff by maintaining discipline and activity-
at all times, and specific rules.
To keep myself
physically strong, � Corporal punishment, including spanking,is prohibited.
mentally awake and
morally straight. ,i No camper shall be subjected to cruel or severe
punishment, humilia6on, or verbal abuse from camp staff,
�; participants or visiting pazents.
✓ No camper shall be denied food or shelter as a form of
punishment
SC011I LllW
A Scout is `� No child st�all be punished for soiling,wetting or not using
a toilet.
Trustworthy�
Loya1 ✓ The Buddy System is in effect at all times while in camp.
Helpful No youth may travel on]us own or leave his group without
Friendly - permission of the group leader.
Courteous
Kind
Obedient ✓ In accordance with National BSA policy, use of alcohol,
Cheerful illegal drugs, and tobacco products is expressly prohibited
��, on any Council property.
Brave Violafion of any of these policies may result in the individual
Clean being removed from the activity or program and possibly sent
Reverent home.
Rev. 17Jan2013
--,�,�n-- I BOY SCOUTS OF AMERICA
� CAPE COD C7 ISLANDS COUNCIL, INC. #224
Waterfront:
All campers must complete a swim test immediately upon entering the water
Non-swimmer, beginners and swimmers will have buddy tags coded with their ability
Campers must have a buddy of the same or lesser ability and will be required to stay in
that azea at all times while at the waterfront
A buddy boazd is used to track the children while at the waterfront
PFDs aze auailable for any child needing one regardless of ability.
All boating activities require the use of PFDs and can be used only by"swimmers"
Those campers boating will have their tags listed on the buddy board for boating while
using the boats then move tags to the swim board if they choose to remain at the
waterfront after boating
See aquatics attachment
247 Willow Sheet
Yarmouth Port MA 02675
P(508)362-4322
F(508)362-4323
www.scoutscapecod.org Prepared. For Life:�
�
�, I BOY SCOUTS OF AMERICA
�' CAPE COD f7 ISLANDS COUNCIL, INC.#224
v'
PFD proper use:
As part of the aquatics program, all campers will be instructed on the proper usage of the
pfds. They will learn how to wear and secure the pfd properly
Campers will be encouraged to hy out a pfd and experience the effect of wearing one.
This will help children who need to wear the pfd feel more comfortable about putting one
on.
247 Willow Street
Yarmouth Port MA 02675
P(508)362-4322
F(508)362-4323
www.scou�scapecod.ory Prepared. For Life:"
�
� Camp Gteenough
� Scout Reservation
J
,��. r�5,
':�. �:+�,� .
CUB SCOUT DAY CAMP �..,. `� �
��
Information for Parents and Guardians
STE ���� ���.� ����� �� .��� ����
.�� �.��� ��������� �� .�����
Five full days in the great �
Cub Scouts Investigate outdoors are packed with
• Science activityandFUN!luNBth
• Technology through August 9th at Camn
GreenouEh.Asmall amount
• Engineering of preparation in advance will
• Mathematics help ensure an exciting and
enjoyable Scouting experi-
ence.There are a few things
parents should rememberto .�
WHATTO BRING TO DAYCAMP help their Cubs get the most - �
outofsummercamp. �
� • Comtetednedlcal}arssoodav � ,qrriyeontime.Program
' °�B begins at 9:00 AM and �'� � ��
4 I
• Comkrtablefaotwearwlthsocks— endsat4:00PMAvoid �ke�
Noopen-toedshoesorSanda/s your5on havingto locate � �r , +.
his den after the program . °�- - ��������
• Slrimsuitandtowel—wearsuitdry starttimeorwaitingin _ �
tocamp—changejustance � the parking lot worried Cvs ScOUT DAY CAMP
that his parents are not Everyone Ioves fishing in Greenough Pond.
• Sunblcek—SPF15o�higher iheretotakehimhome. .
• Wearahat � Ex[endedHoursforearly bytakingappropriate naiseandeasilyperish-
drop-off and/or late pick- precautions ipeluding a able foods in lunch
• Baglunch(beverageprwided) up are available(8:00 thorough body inspection preparation. Lunch bev-
AM to 5:00 PM)and when you get home.Con- erage will be provided.
• Water6ottle(tull)-wlllberefilled mustbepre-arran2ed sultyourphysicianbe- � FirstAidtreatmentof
asneeded with the camo Proeram fore using DEET-based
- injuries will be handled
• Insectrepellent—Noaerwolcans Director.Anadditional repellants. bycertifiedcampstaff.
please fee of$35 per week ap- � Refrigeration may be Parents will be called
plies. provided for camper bag immediately in the event
• Poncho(raingear) � Wood and DeerTicks are lunches.Parents should of serious injury�or if
• TradingPastspenaingmoney presentthroughoutthe stillavoidegg-based transporttoamedical
camp. Protectyour child products such as mayon- faciliry is necessary.
• Keep it all in a smail 6ackpack.
• Fritlayisthemecostumetlay COMPLETED MEDICAL FORMS AND IMMUNIZATION RECORDS ARE
. REQUIRED OF ALL PARTICIPANTING YOUTH, ADULTS, AND STAFF.
WHATN07T0 BRING
Participation requirements for medical form is available on- KrEt�E'ObflMlff�"CaAiper's
�Iectronicgamesantltoys Cub Scout summer camps, line or at the Council Service name and any doctor's
include completion of a BSA Center.Particioants must instructions for
• Areheryequlpment Annual Healih History. comolete Parts A and C ofthe administration.Campers may
• FlshingGear Medical information required mediCal historvform. keep with them onlyinhalers
is a current BSA health Any and all camper (forasthma and allergies).
• PersonalBBguns historysignedbyaparentor medicationsmustbe
guardian. You must attach a presented to the camp nurse,
• Celiphones certificate ofimmunization in the original container,
from your doc[or.The current �
Rev.Ol/17/2014
n
rt �eV�5< � o`!Oi�f
���'�°�a�g���'��' "Thexe is no greater task,no raore noble endeavor than to rafse oiu
BUYSroubofAmadea
, young people to Ee adulrs ofhrgh standing and goad character"
247 Willawst. -Tecumseh(17.50-1812), Chiefofthe Shawnee
Yaemou�Pai,MA 02675
Phone:508-362�4322
. Helping tum youth into honorable aduits has been thc mission of the Boy$couts of America
CampGneenougA ScoutReservtrtlon since 1910.BSA and the Cape Cod 8c Islan3s Cauncil fiilfill that mission by developing high
quaGty,values-based,chuactet educarion pragtams to be used as tools by parents as they fulfill
227 Pine Street theit tesponsibility fot theix childxen's chaxactez education.Day Camp is an important part of the
Yamrovth Pa�f,MA 028?5
Phane 508-362�3428 Cub Scouk pxogxam and is one of thnse educational tqols.Decanse it is a high enexgy,out oor,
xecreational pFogrenx,campexs just see it as FTTN!
5eming Cape Gbd,Nanturkef,amd � 11111111���
h4ariba"s Vimryard C fl l`'�P �i'��' .���U��"�
TxA�z�tG Pos'r Is ��'
PRBPARFD Td SERVE
CAMPER NFEI�S
From wallcing staves to whittling projects,
pins and patches to snacks of all kinds,
Trading Post manager Ed Matthews is
ready with every camper's every nead.
. � Parents shouid visit the tradine pnst at
IC83t 6IlCQ t1UC10�Y�iC WCCk. 'T}Y¢�Tmdiug Poat is wcll stocked and open evary day.
I ' 111 '
� . � --
, , � � �. �'�� ������ �� �.����
�g�p • Camper drop-off and pazents may call the
� • Puents aze invited to Council Service Center
pick-up is in tha camp
parking lot.Please, For participate with Yheir camper (508-3d2-4322).
the protection of all the in the weekly Sncial heId on
- campers and staff,do not Friday at the end of the • Join us for two fanlily
drive into the camp. camp day. camping weekends July 8-
1 l and August 6-&.lVhat
• Campers will check in better way to get away
• Pazent volunteers aze withoui gaixg away?
Mcet the Key Staff and out and assembYe far �,elcome to spend th�day
opening and closing and assist the pro�am staff.
Reservation director ceremonies daity at tUe • Farents may request
q�y Z� 1lagpale adjecent to Ehe All first grade campers copies of background
parking azea. t�IBet�bs}musr be check,health cara,and
D Cam Director accompanied by an adult �'rsciplina policies.
aS' P paztner.
+1�ielleul�e�r • For your cbild's safety,
campers will not be • Parents may address
allowed to]eave camp • The Camp Greenough phone concerns or griev�nces
with anyone othex than (508-362-3428}may not with tha Camp Director
you,unless you provide, always be sttended as the during camp operations or
in advance,a completad staff is busy providing daily in wriring to the Council
and signed Authariaation P�'Q��for your child.In Scaut Executive.
ta Release 1?ay Camper. �e evant of an amergency,