1. Healthcare

2015 CAMP OJIBWA ENROLLMENT FORM
Check One
Session
___ Full Session
___1st Session
___2nd Session
Dates
6/22/15 to 8/12/15
6/22/15 to 7/17/15
7/19/15 to 8/12/15
2015
Base
Tuition
$8,700
$5,350
$5,350
Enrollee__________________________________________________________
Last name
First name
Date of Birth______________ Present School_______________ Current Grade____
Cabin Mate Request (one only)_________________________________________
For mailing purposes please indicate: Married____ Single____ Separate mailing____
Mothers Name_______________________ Fathers Name_____________________
Campers Address_____________________________ City___________________
Home
Business
State____ Zip________ Phone (
)_____________ Phone (
)____________
Fax Number______________________ E-Mail______________________________
Mothers Cell (
)_________________ Fathers Cell (
)___________________
Other Mailing Address_________________________________
City__________________State____ Zip_______ Other Phone (
)____________
$1,000.00 Deposit at time of enrollment. No credit cards. Balance due by February 1,
2015.
Return to: Camp Ojibwa, 1549 Arbor Ave., Highland Park, IL 60035
ph 847-831-5374, fax 847-831-2445
Method of Payment: Cash___ Check___ Check #____________________
Amount $_______________ (payable to Ojibwa Enterprises, Inc.)
YOUR SIGNATURE INDICATES THAT YOU HAVE READ AND ACCEPT SAID
ITEMS IN THE TERMS AND CONDITIONS.
_______________________________________________ __________________
Signature of Parent or Guardian
Date
Office use only: 2015 Tuition________ Full session___1st Session___ 2nd Session___
Brother Discount_____ Travel Discount_____ Hosted Party_____ Referrals_____ Total Billed_____________
TERMS and CONDITIONS
*This agreement covers the full enrolled camp session. No refunds will be made for late
arrival or early departure of the enrollee without approval of the Director.
*Ojibwa Enterprises, Inc., is authorized to use photographs or other media
reproductions of any camper for its brochures or other advertising.
*Medical, prescription and dental expenses with respect to the treatment of a camper
are not included in the tuition and remain the financial responsibility of the parents or
guardians of the camper.
*Completed medical health history, insurance, participation and hospital forms will be
provided by the camp and must be completed by parents or guardians of the camper
prior to the camp season. CAMPERS WILL BE WITHHELD FROM ALL CAMP
ACTIVITIES WITHOUT THESE FORMS.
*The right is reserved to sever connections with any camper whose presence and/or
behavior is determined by the Director to be detrimental to the best interests of camp.
No refunds will be given under such circumstances.
*Ojibwa Enterprises Inc., is not responsible for any lost or damaged personal
belongings.
*Camp does not accept credit cards.
DEPOSIT, CANCELLATIONS & CHANGES
Deposit
$1,000.00 deposit at time of enrollment. Balance due by February 1, 2015. Tuition
includes laundry, canteen, yearbook and video but does not include transportation,
baggage transfer, spending money, camp wear, and special trips.
Cancellations & Changes
*A $250.00 processing fee will be charged for all cancellations before December 1,
2014.
*Forfeiture of $1,000 deposit for cancellations on or after December 1, 2014.
*Changing from a full session camper to a one session camper only after
December 1, 2014, will incur the full half session tuition plus a $500.00 change fee.
*Changing from a full session camper to a one session camper only after February 1,
2015 will incur the full half session tuition plus a $1,000.00 change fee.
*NO REFUNDS FOR CANCELLATIONS AFTER MARCH 1, 2015.
CAMP OJIBWA CHECK LIST
TUITION PAID ___
AREAS OF SPECIAL INTEREST___
Please read and save
EAGLE RIVER HOSPITAL FORM
(both sides) ____
Signature of parent & camper for emergency treatment
COPY OF INSURANCE & PRESCRIPTION CARDS
MANDATORY (both sides) ____
PARTICIPATION CONSENT FORM ____
Signed by parent
CAMPER QUESTIONNAIRE ____
Travel plans to and from camp
VISITING WEEKEND HOTEL RESERVATIONS
MADE (if attending)____
PACKING LIST____
Clothes and other items
CAMP CLOTHES ORDER FORM ____
Add 6.0% tax when calculating total
CAMPER HEALTH FORM - MANDATORY ____
First three pages completed YEARLY and signed by parent.
Immunization information required
Including documentation updated Pertussis "whooping cough" immunization
Page four (MD Physical) to be filled out by the doctor once every 24 months.
MAIL FORMS before 5/28 to:
1549 ARBOR ST., HIGHLAND PARK, IL 60035
ph. 847-831-5374, fax 847-831-2445
after 5/28 to:
CAMP OJIBWA, 4040 OJIBWA DR., EAGLE RIVER, WI 54521
ph. 715-479-8611, fax 715-479-1858
IT IS STRONGLY RECOMMENDED
THAT THE FORMS BE SENT ASAP!
COPIES OF ALL FORMS CAN BE FOUND AT WWW.CAMPOJIBWA.COM!
AREAS OF SPECIAL INTEREST
Directors are Sandra and Denny Rosen and Rachael and Joel Losoff.
For any medical questions, please contact our Medical Director, Dr. George Sachs.
The office at camp is open Monday through Friday from
9:30 a.m. to 12:00 noon and from 7:00 p.m. to 8:00 p.m. The weekend schedule varies but we check for
messages frequently. Please check the web site www.campojibwa.com frequently as we work hard to
post daily pictures and other information. CAMPS PHONE NUMBER IS 715-479-8611.
Phone calls are permitted to campers on their birthday and other special occasions approved by the
Directors. Faxes and e-mail's to campers are allowed only when a parent is out of the country. Cell
phones are not permitted. If your son is traveling to camp from outside the Chicago land area and he
has a cell phone for safety and communicating, please notify us and make sure he turns the phone into
the office upon arriving at camp. We will keep it safe and return the phone to him for the trip back home.
Luggage space on the buses is reserved for staff and out of town campers. Limited other space may be
available upon request only.
FOOD AND DRINKS OF ANY KIND ARE NOT PERMITTED AT CAMP.
Food for the bus trip must be consumed prior to arrival. Establishing proper eating habits must begin
immediately for your sons healthful well being. Ojibwa takes great pride in our food. Three meals a day,
an afternoon snack and a bedtime snack keep our boys well fed.
Campers celebrating their birthday at camp will have a camp sponsored party, receive a camp present
and a cake for the celebrant and his cabin. Phone calls only from the parents and grandparents are
encouraged.
One of the unique aspects of camp is the avoidance of material things. No packages without permission
from the Directors. Books, magazines, etc., are not considered packages for our purposes. Playing cards
are also prohibited. Additionally, during our Collegiate Week no team related items will be permitted
including items sent to staff. Camp is a place for sharing, being treated equally and living under the same
set of expectations. Thank you for your cooperation. As always, if you have any questions call the Directors
at 715-479-8611
Please feel free to call if you have questions, concerns or comments regarding the information on this
page. Your cooperation in following camps rules gives your sons’ the right message.
Please share this information with other members of your family. Thank you.
CAMP OJIBWA PARTICIPATION CONSENT FORM
I UNDERSTAND THAT MY CHILDʼS PARTICIPATION IN CAMP OJIBWA AND
ITS ACTIVITIES IS COMPLETELY VOLUNTARY AND I HAVE FAMILIARIZED
MUYSELF WITH THE CAMPʼS PROGRAMS AND ACTIVITIES IN WHICH MY
CHILD MAY BE PARTICIPATING.
I RECOGNIZE THAT CERTAIN HAZARDS AND DANGERS ARE INHERENT IN
THE CAMP OJIBWA EVENTS AND PROGRAMS, PARTICULARLY, BUT NOT
LIMITED TO, THE ACTIVITIES OF WATER SKIING, SWIMMING, SAILING,
CHALLENGE COURSE, TUBING, BANANA BOAT, WEIGHT TRAINING, THE
CLIMBING WALL, TRAMP BALL AND ZIP LINE. I ACKNOWLEDGE THAT,
ALTHOUGH CAMP OJIBWA HAS TAKEN SAFETY MEASURES TO MINIMIZE
THE RISK OF INJURY TO CAMP PARTICIPANTS, CAMP OJIBWA CANNOT
INSURE NOR GUARANTEE THAT THE PARTICIPANTS, EQUIPMENT,
PREMISES AND/OR ACTIVITIES WILL BE FREE OF HAZARDS, ACCIDENTS
AND/OR INJURIES. I FURTHER RECOGNIZE AND HAVE INSTRUCTED MY
CHILD IN THE IMPORTANCE OF KNOWING AND ABIDING BY THE CAMPʼS
RULES, REGULATIONS AND PROCEDURES FOR THE SAFETY OF CAMP
PARTICIPANTS.
I CONSENT TO ALLOW OUR SON(S) TO LEAVE CAMP GROUNDS FOR
SUCH SPONSORED ACTIVITIES AS SOCIALS, TOWN TRIPS, OVERNIGHT
TRIPS, ETC. I FURTHER AGREE TO PERMIT MY SON(S) TO PARTICIPATE
IN ANY AND ALL OFF THE GROUND ACTIVITIES HE HAS SHOWN THE
ABILITY TO PERFORM SAFELY. SUCH THINGS AS THE AQUA TOWER,
WATER SKIING, CLIMBING WALL, ROPE COURSE, ZIP LINE, ETC.
WE WILL DISCUSS WITH OUR SON(S) THE IMPORTANCE OF USING
CAUTION AND BEING SAFETY CONSCIOUS AT ALL TIMES INCLUDING BUT
NOT LIMITED TO SUCH AREAS AS CROSSING THE STREET, STAYING
WITH THE GROUP, FOLLOWING CAMP RULES, ETC.
NAME OF
PARENT__________________________________________DATE__________
SIGNATURE______________________________________________________
SIGNING AS THE PARENT OR LEGAL GUARDIAN FOR:
CAMPERS NAME(S)
2015
a mp O j ibwa Cl ot hing O r de r For m
Campers Name________________________________________________________
Please check attending session: Full Session____, First Session____, Second Session____
R e qui r e d C l ot hi ng I t e ms :
*Two shirts, choose any combinati on of two or more of the following: ($14.50 each)
- Gray T - shirt with red lettering
- Black sleeveless muscle shirt with red lettering
- Black sleeveless muscle shirt with silver lettering
*One Pair of shorts, choose at least one of the following: ($20.50
each)
- One pair of red mesh shorts
O pt i ona l I t e ms :
Crew Neck Sweatshirt
- $24.50
Hooded Sweatshirt - $31.00
Winter Style Knit Cap
- $16.00
Plaid Flannel Pants - $28.00
Gray Sweatpants - $21.75
Baseball Jersey - $15.50
Most items come in the following sizes:
Small (6 - 8)
YOUT H S I Z E S
A DU L T S I Z E S
Small
Medium (10 - 12)
Medium
Laundry Bag - $12.00
Baseball Cap - $15.75
Large (14 - 16)
Large
X- Large
All items ordered will be given to the campers at camp. When ordering, please specify an a
pproximate size. A l l
i t e ms wi l l be t r i e d on f or s i z e a nd y our c a mpe r wi l l be pr ovi de d wi t h t he c or r e c t s i z e , no ma t t e r
t he s i z e or i gi na l l y or de r e d. Their names will be placed in their items after proper sizing. Ojibwa items are
sold exclusively through Ojibwa Enterprises, Inc.
I TEM
R E Q UI R E D I T E MS :
Gray T - Shirt
Black Muscle Shirt with Red Letters
Black Muscle Shirt with Silver Letters
Red Mesh Shorts
O P T I O NA L I T E M S :
Crew Neck Sweatshirt
Hooded Sweat Shirt
Gray Sweatp ants
Plaid Flannel Pants
Baseball Jersey
Laundry Bag
Baseball Cap
B l a c k W in t e r K n i t C a p
P R I CE
Q U A NT I T Y
S I Z E(S )
TOTAL
$14.50
$14.50
$14.50
$20.50
$24.50
$31.00
$21.75
$28.00
$15.50
$12.00
$15.75
$16.00
Sub Total:
x .06 Sales Tax
Grand Total Due:
= ________________
_
Sales tax must be added to all orders inclu
ding out of state orders.
Prices may change after January 1, 2015 due to market costs.
Method of Payment: Check
Cash
We do not accept credit cards.
R e mi t t o: O j i bwa E nt e r pr i s e s , I nc .
From August 31 - May 31: 1549 Arbor Ave., Highland Park, IL
60035 Ph one: 847 - 831- 5374, Fax: 847 - 831- 2445
From June 1 - August 30: 4040 Ojibwa Dr., Eagle River, WI, 54521
Phone: 715- 479 - 8611, Fax: 715 - 479 - 1858
E - ma i l A ddr e s s : c a mpoj i bwa @ a ol . c om W e b S i t e : www. c a mpoj i bwa . c om
**Please send in clothes orders as early as possible**
Camp Ojibwa Packing List
CLOTHING
Sweat Shirts
Sweat Pants
Cap or Hat
Shorts
Poncho/Rain Gear
Jacket
Jeans
Polo Type Shirt
T-Shirts
Underwear
Socks
Swimming Trunks
Bathrobe
Sleepwear (Optional)
Flannel pants (Optional)
Jerseys (Optional
NO.
4
4
1
7
1
1
2
2
10
12
12
3
1
PACKED
SHOES
Tennis Shoes
Flip-Flops/Shower
Shoes
NO.
2
1
PACKED
BAGGAGE
Duffels (No Trunks)
Travel/Carry-on
NO.
2
1
PACKED
BEDDING & LINEN
Blankets
Twin Flat Sheets
Twin Fitted Sheets
Pillow Cases
Towels
Laundry Bags (Nylon)
Mattress Pad (Optional)
NO.
2
2
2
2
6
2
PACKED
TOILETRIES
Toothbrush
Toothpaste
Shampoo and Body Wash
Brush/Comb
Cup
Shower Bucket
(Except 1st Yr. Campers)
PACKED
SPORTS EQUIPMENT
Tennis Racket/Balls
Baseball Gloves
Flashlight/Batteries
Fishing Equipment (Optional)
Ping Pong Paddles/Balls
(Optional)
Protective Eye Goggles
(Required)
PACKED
MISCELLANEOUS
Stamps, Stationary, Pens,
Pencils
Deodorant
Camera/Film
Insect Repellent
Books/Magazines
Suntan Lotion, Sunscreen &
Chapstick
Address List
Kleenex
Battery Operated Fan
(Optional)
Pillow (Optional)
Water Bottle
(Except 1st Yr. Campers)
PACKED
FATHER & SON PROGRAM
ENROLLMENT FORM
Three days, two nights of fun and frolic. Activities include: Waterfront, climbing wall, miniature golf,
floor hockey, soccer, tree planting, camp tour, big brother, trampoline basketball, T-ball, kick baseball,
neucombe, pinners, fun and more fun. Enroll today to insure your son a place for this limited and
awesome program.
Session 1: 6/26/2015 to 6/28/2015
Session 2: 7/31/2015 to 8/2/2015
Son's Name Son’s Birth Date Mother’s Name Father’s Name Son’s School Grade Home Address City State Zip Home Phone (
) ) Mobile Phone (
Special Needs Email Father’s T-Shirt Size Son’s T-Shirt Size $400.00 nonrefundable registration fee by cash or check only.
Checks payable to: “Camp Ojibwa”
Note: Please include “Father/Son” on the memo line
Mail this form with payment to:
Dennis Rosen, 1549 Arbor Avenue, Highland Park, IL 60035
For more informations, please contact: Denny Rosen, Director
Phone (847) 831-5374 Fax (847) 831-2445 Email [email protected]
Stu Nitzkin, Director of Recruiting and Development
Phone (773) 875-2425 Email [email protected]
Check us out online at: campojibwa.com
PREP CAMP PROGRAM
ENROLLMENT FORM
Our Prep Camp Program is a unique opportunity for boys 7 to 9 to participate in a four day, three
night experience just like the big boys. This is a great opportunity to relieve anxiety in going away for
longer periods. Your son won’t stop talking about the fun he had. Occurs during regular camp and a
motor coach is included both ways. Enrollment is limited so sign up today!
Day 1 - Arrive at camp. Check in, cook out dinner, orientation and welcome tour, big brothers, early evening activity,
welcoming pizza party, bedtime.
Day 2 - Breakfast, cabin clean up, swim test, basketball game, pinners, lunch, rest period, climbing wall & zip line,
neucombe ball game, afternoon snack, waterfront, dinner, archery, smore’s campfire, bedtime.
Day 3 - Breakfast, cabin clean up, pontoon boat ride through the largest inland chain of lakes in the world, soccer game,
lunch, rest period, floor hockey, snack, free choice, dinner, flag football, movie night, bedtime.
Day 4 - Late sleep. World renown Camp Ojibwa Sunday Brunch, pack up, good-byes, depart by 10:00 a.m. for return trip
home with arrival about 3:30 p.m. Exact departure time will be posted on the internet.
Session 1: 7/9/2015 to 7/12/2015
Session 2: 7/23/2015 to 7/26/2015
Son's Name Son’s Birth Date Mother’s Name Father’s Name Son’s School Grade T-Shirt Size Home Address City State Zip Home Phone (
) ) Mobile Phone (
Special Needs Email $525.00 nonrefundable registration fee by cash or check only.
Checks payable to: “Camp Ojibwa” Note: Please include “Prep Camp” on the memo line
Mail this form with payment to:
Dennis Rosen, 1549 Arbor Avenue, Highland Park, IL 60035
For more informations, please contact: Denny Rosen, Director
Phone (847) 831-5374 Fax (847) 831-2445 Email [email protected]
Stu Nitzkin, Director of Recruiting and Development
Phone (773) 875-2425 Email [email protected]
Check us out online at: campojibwa.com
CAMP OJIBWA POLICY ON CELL PHONES AND OTHER VOICE/DATA COMMUNICATION DEVICES
Preface
As children learn to trust other caring adults, they grow and learn to solve some of their own challenges. This
emerging independence is one of the greatest benefits of camp. It is an important way your son learns to become
resilient, community-oriented, and develop a true sense of camaraderie. Use of unproved electronic devices aids in
defeating a sense of independent growth and, also, in allowing the people entrusted with your child’s well-being the
ability to solve situations properly.
Ask an Ojibwa camper what makes camp so special and invariably the response will be, the friendships and
camaraderie. This is what we are all about,
THE OJIBWA WAY
Kindness, Respect, Fair Play and Trustworthiness.
Policy
No campers are allowed cell phones or other voice/data connections, including, but not limited to laptops, netbooks,
tablets, iPads, and other communication devices. iPod and iTouch devices are acceptable, if the ability to send text
messages is removed while at camp.
Campers traveling to camp from out of state are allowed these devices but once at camp they must turn their devices
into the office. Cabin 13 campers will be allowed the use of their cell phones in certain situations, but the phones will
be kept in the cabin safe and distributed by the counselors when appropriate. Cabin 14 members are allowed cell
phones with usage determine by the cabin counselors.
Comments
Throughout the camping industry camps have adopted strict, no devices with screens, etc. policies forbidding all
electronic devices. We prefer to have policies that develop responsible use of approved devices as well as expecting
our camp families to have a unified front. Since one cannot legislate common sense and integrity Ojibwa has chosen
the path of being proactive with our parents, staff and campers in the development of a policy that insures the
greatest levels of independent growth. Your cooperation is an integral part of this success.
Acceptance
We have read the above Preface, Policy and Comments and agree to abide by the policy as stated.
Camper’s
Signature(s)_________________________________________________________
Parent’s
Signature___________________________________________________________
Signed policy must be returned by e-mail, fax, or mail.
E-mail - [email protected]
fax - (prior to May 28) 847-831-2445 (after June 1) 715-479-1858
Mail (prior to May 28) 1549 Arbor Ave, Highland Park, IL 60035
(after June 1) 4040 Ojibwa Dr., Eagle River, WI 54521
Director Dennis Rosen, Director Joel Losoff, Assistant to Director Stu Nitzkin
CAMP OJIBWA
STAFF APPLICATION
Name_________________________________________________________Date of Birth______________________
Permanent Address_________________________City___________________State_______Zip________________
School or Business Address_______________________________City_______________State____Zip__________
Home Phone (
)______________School/Business Phone (
)______________E MAIL____________________
Drivers License#__________________ State____ Social Security #_____________________
Sex____ Marital Status________ Do you smoke? _________
EDUCATION
COLLEGE MAJOR YEARS DEGREE
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
CAMP EXPERIENCE ( AS EMPLOYEE AND CAMPER)
CAMP POSITION DIRECTOR PHONE DATES
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
REFERENCES: ( USE EMPLOYERS, COACHES, TEACHERS, ETC. BUT NOT RELATIVES)
NAME POSITION or RELATIONSHIP PHONE
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
What type of position are you applying ?________________With what age group do you prefer to work?___________
Write a brief biographical sketch, including specialized training and/or experience which might have a bearing on this application. Also indicate why we
should hire you.
NAME__________________________________________________________Yr. at camp___ Yr. on staff___
In the following list put a “1” before those activities you can organize and teach as an expert; “2” for those activities in which you can assist in teaching;
and, “3” for those you would be willing to learn to assist.
SPORTS WATER FRONT ACTIVITIES ARTS and CRAFTS
___Archery ___Boat Driving ___Cartooning
___Baseball ___Canoeing ___Ceramics
___Basketball ___Diving ___Darkroom
___Floor Hockey ___Fishing ___Drawing
___Football ___Knee Boarding ___Indian Lore
___Lacrosse ___Row Boating ___Jewelry
___Roller Blade Hockey ___Sailing ___Lanyards
___Soccer ___Skurfing ___Metal Work
___Softball ___Swimming ___Nature Crafts
___Tennis ___Tubing ___Newspaper
___Track ___Water Safety Skills ___Painting
___Volleyball ___Water Skiing ___Photography
___Weight Training ___Wind surfing ___Plastics
___Radio
CAMP CRAFT ___Sculpture
MUSIC and DRAMA ___Camp Craft ___Video Production
___Acting ___Hiking ___Wood Carving
___Dancing ___Orienteering ___Yearbook
___Directing ___Outdoor Cooking
___Drums ___Overnight Camping NATURE
___Guitar ___Ropes Course with Climbing Tower ___Animals ___Minerals
___Piano ___Story Telling ___Astronomy ___Rocks
Other Musical Instruments: ___Birds ___Trees
______________________ ___Conservation ___Shrubs
___Set and Costume Design ___Flowers ___Weather
___Singing ___Forestry
___Skits and Stunts ___Insects
MISCELLANEOUS
___Badminton ___Bingo ___Board Games ___Campfires ___Frisbee ___Golf ___Horseshoes ___Jogging ___Juggling ___Karate ___Kayaking
___Magic ___Marbles ___Ping Pong ___Pinners ___Rocketry ___Tumbling and Gymnastics ___Wrestling
UMPIRE and REFEREE: LIST THOSE ACTIVITIES YOU ARE QUALIFIED AND INDICATE ANY CERTIFICATION
SPORT CERTIFICATION SPORT CERTIFICATION
___Baseball __________________ ___Basketball _____________________
___Football __________________ ___Hockey _____________________
___Soccer __________________ ___Softball _____________________
___Volleyball __________________ ___Water Front _____________________
_____________________
_____________________
COACHING PREFERENCES (check sports you would like to coach)
SPORT BACKGROUND/EXPERIENCE
Basketball _____________________________________________________________________________
Flag Football _____________________________________________________________________________
Floor Hockey _____________________________________________________________________________
Soccer _____________________________________________________________________________
Softball _____________________________________________________________________________