DONALD B. SMITH COUNTY GOVERNMENT CAMPUS 110 Old Route Six ~ Building Three ~ Carmel, New York (845) ~ Fax (845)

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1 MARYELLEN ODELL County Executive MICHAEL PIAZZA, JR. Commissioner YOUTH BUREAU JOSEPH DEMARZO Deputy Commissioner JANEEN CUNNINGHAM Executive Director February 2018 Dear Camper: The Putnam County Youth Bureau and the Putnam County Sheriff s Department will be participating in Sheriff s Camp (week #5) from Sunday, July 22 to Saturday July 28, Children must be between the ages of 9 to 12 years old. Transportation will be provided by the Sheriff s Department to and from camp. You are responsible for getting to the Sheriff s office in Carmel. More information about drop off and pick up will be sent at a later date. If you are interested in signing up, please complete all the necessary forms in BLUE ink. Putnam County has only 16 slots to fill. All forms must be signed by the parent or legal guardian and a complete immunization record and physical with the doctor s signature ONLY on the forms. The physical must be valid through July 28, For more information about Sheriff s camp please refer to the website Please return all forms by March 23 to: Janeen Cunningham, Executive Director Putnam County Youth Bureau 110 Old Route 6, Building Three Carmel, NY Some items your child should take to camp are: sleeping bag or sheets and a blanket, pillow, soap, toothbrush, toothpaste, comb or brush, towels, swim suits, change of clothes for one week, raincoat, heavy jacket, sweatshirts and sneakers for hiking. WATER SHOES highly recommended. Some items your child should NOT take to camp are: money, there is no place to spend it, meals will be provided throughout the entire week. Also, please do not bring fishing poles since they can be damaged in the van storage compartments. Please provide snacks and lunch for your child for the ride to camp. If your child is bringing any medication you should pack it in a separate bag with their name on it and hand it to their deputy on the van. If you have any questions, please call Janeen Cunningham at (845) x46120 or Sergeant Michael Szabo at (845) x Sincerely, Janeen M. Cunningham Executive Director Sergeant Michael Szabo Putnam County Sheriff s Department DONALD B. SMITH COUNTY GOVERNMENT CAMPUS 110 Old Route Six ~ Building Three ~ Carmel, New York (845) ~ Fax (845)

2 Camp Safety Are the camp facilities and activities safe? The camp operator must develop a written plan to include maintenance of facilities, provisions for training staff members and orientation of campers, supervision of campers, campsite hazards, emergency procedures and drills, safety procedures and equipment for program activities. Swimming Are waterfront personnel qualified? Are campers always supervised while in the water? All waterfront activities at camps in New York State must be supervised by an experienced certified lifeguard or water safety instructor. On site, one qualified lifeguard is required for every 25 bathers. All aquatic staff are required to be trained in cardiopulmonary resuscitation (CPR). Camps that use off-site pools or beaches operated by others must make special arrangements to provide a safe activity. Even off site, the camp remains responsible for supervising campers. Some children s camps use sites for swimming that are not inspected by local health departments. Parental permission is required in these instances, and the camp must follow established guidelines to protect campers. While campers are involved in aquatic activities on site, there must be one counselor for every 10 campers eight years or older; there must be one counselor for every eight children aged six and seven; and one counselor for every six children younger than six years old. When swimming off-site, there must be one counselor for every eight campers six years or older and one counselor for every six campers younger than six years. Are bathing areas marked off for various swimming skills? Are campers tested to determine their level of swimming ability before participating in aquatic activities? Are nonswimmers kept in water less than chest deep? Is the buddy system used? Are campers required to wear life preservers when boating or canoeing? New York State regulation requires that the answers to all these questions must be yes. Camp Trips Are camp trips supervised by counselors who have the maturity and experience to make decisions that could affect the safety of campers? All trips must be supervised by a trip leader who is at least 18 years old and competent in the activity. Counselors must accompany trips and all staff must review the safety plan prior to the trip. Counselors should have the skills and expertise in the camp activity (canoeing, rock-climbing, etc.) to handle any emergency that might arise. Ask whether the camp has conducted similar trips in the past without incident. In New York State, the drivers of camp vehicles must be licensed and at least 18-years-old. Seat belts must be worn when provided and vehicle capacities not exceeded. When transporting children in a truck, only a truck cab can be used. Sports and Activities How are activities in craft shops supervised, especially when campers are using dangerous tools, such as power saws and lathes? Are archery and rifle ranges at a safe distance from activity centers? Are spectators protected at baseball fields and similar areas? Do players wear protective equipment? State regulation requires that archery, riflery and horseback riding be supervised by counselors with special training in those activities. Fire Safety Are there periodic fire drills for both campers and staff? Does each floor of every building have fire exits in two different locations? Are flammable materials (gasoline, pool chemicals, etc.) stored away from activity centers and kept under lock and key? Are functioning smoke detectors located in every sleeping room? All of the above are mandatory in New York State. Location and Facilities Are barriers erected against such natural hazards as cliffs and swamps? Are foot trails located away from such dangerous areas and from heavily traveled roads and highways? Do the camp facilities (bunks, bathrooms, mess hall, recreation facilities) meet your aesthetic tastes and those of your child? Is the camp located in an area that will not aggravate your child s allergies? Will your child be required to perform chores, such as cleaning or cooking? For information on the camp s location and facilities, visit the camp or interview the camp operator by telephone, prior to making a decision to enroll your child at the camp. Nutrition Are good health practices observed in the camp kitchens, dining areas and food services? Does the camp serve food your child likes? At camps in New York State, food must be prepared from inspected sources. Food preparation and handling activities are reviewed to assure safe and sanitary practices. Kitchen employees must be healthy and follow hygienic practices. Potentially hazardous food must be maintained below 45 F or above 140 F. Rights and Responsibilities The regulatory program of the New York State Department of Health places specific responsibilities on camp operators, and on local health departments that enforce department regulations. Following is a summary of rights and responsibilities: Rights of Parents and Guardians To be informed by the camp director, or his or her designee, of any incident involving your child, including serious injury, illness or abuse. To review inspection and investigation reports for a camp, which are maintained by the local health department issuing the camp a permit to operate (present and past reports are available). To review the required written camp plans. These are on file at both the camp and the health department issuing the permit to operate. Responsibilities of the Camp Operator To inform you and the local health department if your child is involved in any serious injury, illness or abuse incident. To screen the background and qualifications of all staff. To train staff about their duties. To provide supervision for all campers 24 hours a day at overnight camps, and during hours of operation for day camps. To maintain all camp physical facilities in a safe and sanitary condition. To provide safe and wholesome meals. To have and follow required written plans for camp safety, health and fire safety. To notify the parent or guardian, with the enrollment application or enrollment contract, that: the camp must have a permit to operate from the New York State Department of Health or the designated permit-issuing official;

3 the camp is required to be inspected twice yearly; and the inspection reports and required plans are filed (address of state, county or city health department) and available for their review. Responsibilities of Local Health Departments To review and approve the required written camp plans for compliance. To inspect camps to assure that: (1) all physical facilities are properly operated and maintained; and (2) adequate supervision exists to provide a healthy and safe environment in accordance with the New York State Sanitary Code. To issue a permit to operate when the required plans and inspection results are satisfactory. To investigate reports of serious incidents of injury, illness and all allegations of abuse or maltreatment. When requested, to provide parents or guardians of prospective campers an opportunity to review inspection reports and required plans. The time and effort spent in selecting the camp your youngster will attend is important. Keep in touch, especially if it is your child s first camp experience. If possible, visit the camp before and during the camping season. Information For further information about New York State health laws relating to summer camps, call the State Health Department s Bureau of Community Environmental Health and Food Protection in Troy at 1-(800) , ext State of New York Department of Health /08 Children s Camps in New York State In New York State, summer camps must have a state, city or county health department permit to operate legally. These permits are issued only if the camp is in compliance with the state s health regulations. The permit to operate must be displayed in a conspicuous place on the premises. The camp must be inspected twice yearly by a health department representative. At least one inspection must be made during the time the camp is in operation. Each camp is checked to make sure that the physical facilities are safe and that supervision is adequate. When choosing a summer camp for your child, consider the following: Staff Credentials/Supervision What are the qualifications of the camp director? The New York State Health Code requires that the director of an overnight camp be at least 25-years-old or hold a bachelor s degree; a day camp director must be at least 21-years-old. All directors must have experience in camping administration or supervision. Camp directors backgrounds are screened by the Office of Children and Family Services Central Register Database for reported incidents of child abuse and maltreatment. Their backgrounds are also screened by the Health Department for criminal convictions. Only individuals who are considered to pose no risk to campers are accepted by the Health Department as camp directors. What are the qualifications of the camp counselors and how are campers supervised? Counselors must have experience in camping and supervision of children or have completed an acceptable training course. Stringent counselor-tocamper ratios and staff qualifications are mandated for supervision of swimming, archery, riflery and camp trip activities. At overnight camps, 80 percent of the camps counselors must be at least 18-years-old; up to 20 percent may be 17-years-old. There must be at least one counselor for every 10 children aged eight years or older, and one counselor for every eight children younger than eight years old. At day camps, counselors must be 16 years of age or older. There must be a minimum of one counselor for every 12 children. Camps that must provide at least 10 counselors may choose to use counselors-in- training (CITs) to meet 10 percent of the required number of counselors. These CITs must be at least 16 years of age at an overnight camp and 15 years of age at a day camp. They must work with senior staff, have had previous experience as a camper and complete a training program. Ask the camp operator if any of their counselors are CITs and how they are used to supervise campers. Ask about the camp s staff and supervision procedures, including discipline policies. Do they meet your expectations? Health Ask about medical coverage and when you will be notified if your child becomes ill or injured. Is a doctor or nurse in residence or on call for campers at all times? Physicians or nursing services must be available. All summer camps in New York State are required to have a health director and a written medical plan approved by the Health Department. The written plan must include, among other things, provisions for medical, nursing and first aid services. Injuries and illnesses must be reported to the Health Department and are thoroughly reviewed. Does the camp require medical records for campers? Camps must keep current medical history reports on file for all campers. Be sure to detail your child s history of immunization, illness, disability or allergy. Specify special diets and activity restrictions. Provide instruction for any medication your child must take.

4 NEW YORK STATE SHERIFFS INSTITUTE, INC SUMMER CAMP APPLICATION PLEASE FILL OUT IN BLUE INK ONLY Week #: CAMP HEALTH EXAMINATION FORM This side to be filled in by parent (please print) or adult camper and checked with physician at time of examination Name: Birth Date: Gender: Age: Last First Middle Initial Parent or Guardian: Phone: Home ( ) Cell ( ) Cell ( ) Home Address: Street & Number City State Zip Code County If not available in an emergency notify: Phone: Name Area and Number Street & Number City State Zip Code Phone: Name Area and Number Street & Number City State Zip Code HEALTH HISTORY: (Check - giving approximate dates) Convulsions Diabetes Behavior Issues Chicken Pox Asthma IMPORTANT: Please notify the camp if this camper is exposed to any communicable disease during the three weeks prior to camp attendance Operations or Serious Injuries (dates): Chronic or Recurring Illness/Medical Issues: Other Diseases or details of above: Any allergies?: Special Diet Information: Any medications that will be brought to camp?: Suggestions from Parents: PARENT S AUTHORIZATION This health history is correct so far as I know, and the person described herein has permission to engage in all prescribed camp activities, except as noted by me and the examining physician. In the event I cannot be reached in an EMERGENCY I hereby give permission to the physician selected by the camp director to hospitalize, secure proper treatment for, and to order injection, anesthesia or surgery for my child as named above. In addition, I give my permission to the NYS Sheriffs Association Institute, Inc. to use any pictures taken of my child while attending the summer camp. SIGNATURE: DATE:

5 IMMUNIZATION HISTORY: PLEASE REFER TO THE ATTACHED SHEET PROVIDED BY THE NEW YORK STATE DEPARTMENT OF HEALTH FOR REQUIRED IMMUNIZATIONS. Diphtheria Toxoid - Containing Vaccine (DTP) Polio (IPV or OPV) Measles, Mumps, Rubella (MMR) Hepatitis B Haemophilus Influenzae type b (Hib) Tetanus, Diptheria, and Pertussis Booster (Tdap) Varicella Meningococcal Vaccination (recommended/not required) TO BE FILLED OUT BY A LICENSED PHYSICIAN, PHYSICIAN ASST. OR NURSE PRACTITIONER. This examination must be performed within 12 months of arrival at camp. Physical Examination for some other purpose within this period is acceptable. Examination is for determining fitness to engage in strenuous activities. CODE: S - Satisfactory - X - Not Satisfactory - O - Not Examined Hgt: Wt: BP: Hgb. Test Urinalysis: Eyes Glasses: Extremities Ears Posture (Spine) Nose Skin Throat Allergy Teeth Please Specify: Heart Lungs General Appraisal: Abdomen Hernia (FOR GIRLS AND WOMEN): Has this person menstruated? If not, has she been told about it? If so, is her menstrual history normal? Special considerations: Recommendations and restrictions while in camp: Special Diet: Special Medicine (name) (attached separate sheet if needed) Swimming, diving Strenuous activity Other I have examined the person herein described and have reviewed his/her health history. It is my opinion that he/she is physically able to engage in camp activities, except as noted above. Telephone: Area code and Number Date: M.D. Examining Physician Date of Physical: Address:

6 School Year New York State Immunization Requirements for School Entrance/Attendance 1 NOTES: Children in a prekindergarten setting should be age-appropriately immunized. The number of doses depends on the schedule recommended by the Advisory Committee on Immunization Practices (ACIP). For grades Pre-k through 9, intervals between doses of vaccine should be in accordance with the ACIP-recommended immunization schedule for persons 0 through 18 years of age. (Exception: intervals between doses of polio vaccine DO NOT need to be reviewed for grades 4, 5, 10, 11 and 12.) Doses received before the minimum age or intervals are not valid and do not count toward the number of doses listed below. Intervals between doses of vaccine DO NOT need to be reviewed for grades 10 through 12. See footnotes for specific information for each vaccine. Children who are enrolling in grade-less classes should meet the immunization requirements of the grades for which they are age equivalent. Dose requirements MUST be read with the footnotes of this schedule. Vaccines Prekindergarten (Day Care, Head Start, Nursery or Pre-k) Kindergarten and Grades 1, 2 and 3 Grades 4 and 5 Grades 6, 7, 8 and 9 Grades 10, 11 and 12 Diphtheria and Tetanus toxoid-containing vaccine and Pertussis vaccine (DTaP/DTP/Tdap/Td) 2 4 doses 5 doses or 4 doses if the 4th dose was received at 4 years or older or if 7 years or older and the series was started at 1 year or older Tetanus and Diphtheria toxoid-containing vaccine and Pertussis vaccine booster (Tdap) 3 Not applicable 1 dose Polio vaccine (IPV/OPV) 4 4 doses or if the 3rd dose was received at 4 years or older 4 doses or if the 3rd dose was received at 4 years or older Measles, Mumps and 1 dose 2 doses Rubella vaccine (MMR) 5 Hepatitis B vaccine 6 or 2 doses of adult hepatitis B vaccine (Recombivax) for children who received the doses at least 4 months apart between the ages of 11 through 15 years Varicella (Chickenpox) 1 dose 2 doses 1 dose 2 doses 1 dose vaccine 7 Meningococcal conjugate vaccine (MenACWY) 8 Not applicable Grades 7 and 8: 1 dose Grade 12: 2 doses or 1 dose if the dose was received at 16 years or older Haemophilus influenzae type b conjugate vaccine 1 to 4 doses Not applicable (Hib) 9 Pneumococcal Conjugate 1 to 4 doses Not applicable vaccine (PCV) 10 Department of Health

7 1. Demonstrated serologic evidence of measles, mumps, rubella, hepatitis B, varicella or polio (for all three serotypes) antibodies is acceptable proof of immunity to these diseases. Diagnosis by a physician, physician assistant or nurse practitioner that a child has had varicella disease is acceptable proof of immunity to varicella. 2. Diphtheria and tetanus toxoids and acellular pertussis (DTaP) vaccine. (Minimum age: 6 weeks) a. Children starting the series on time should receive a 5-dose series of DTaP vaccine at 2 months, 4 months, 6 months and at 15 through 18 months and at 4 years or older. The fourth dose may be received as early as age 12 months, provided at least 6 months have elapsed since the third dose. However, the fourth dose of DTaP need not be repeated if it was administered at least 4 months after the third dose of DTaP. The final dose in the series must be received on or after the fourth birthday. b. If the fourth dose of DTaP was administered at 4 years or older, the fifth (booster) dose of DTaP vaccine is not required. c. For children born before 1/1/2005, only immunity to diphtheria is required and doses of DT and Td can meet this requirement. d. Children 7 years and older who are not fully immunized with the childhood DTaP vaccine series should receive Tdap vaccine as the first dose in the catch-up series; if additional doses are needed, use Td vaccine. If the first dose was received before their first birthday, then 4 doses are required. If the first dose was received on or after the first birthday, then are required. A Tdap vaccine (or incorrectly administered DTaP vaccine) received at 7 years or older will meet the 6th grade Tdap requirement. 3. Tetanus and diphtheria toxoids and acellular pertussis (Tdap) vaccine. (Minimum age: 7 years) a. Students 11 years or older entering grades 6 through 12 are required to have one dose of Tdap. A dose received at 7 years or older will meet this requirement. b. Students who are 10 years old in grade 6 and who have not yet received a Tdap vaccine are in compliance until they turn 11 years old. 4. Inactivated polio vaccine (IPV) or oral polio vaccine (OPV). (Minimum age: 6 weeks) a. Children starting the series on time should receive a series of IPV at 2 months, 4 months and at 6 through 18 months, and at 4 years or older. The final dose in the series must be received on or after the fourth birthday and at least 6 months after the previous dose. b. For students who received their fourth dose before age 4 and prior to August 7, 2010, 4 doses separated by at least 4 weeks is sufficient. c. If the third dose of polio vaccine was received at 4 years or older and at least 6 months after the previous dose, the fourth dose of polio vaccine is not required. d. Intervals between the doses of polio vaccine do not need to be reviewed for grades 4, 5, 10, 11 and 12 in the school year. e. If both OPV and IPV were administered as part of a series, the total number of doses and intervals between doses is the same as that recommended for the U.S. IPV schedule. If only OPV was administered, and all doses were given before age 4 years, 1 dose of IPV should be given at 4 years or older and at least 6 months after the last OPV dose. 5. Measles, mumps, and rubella (MMR) vaccine. (Minimum age: 12 months) a. The first dose of MMR vaccine must have been received on or after the first birthday. The second dose must have been received at least 28 days (4 weeks) after the first dose to be considered valid. b. Measles: One dose is required for prekindergarten. Two doses are required for grades kindergarten through 12. c. Mumps: One dose is required for prekindergarten and grades 10 through 12. Two doses are required for grades kindergarten through 9. d. Rubella: At least one dose is required for all grades (prekindergarten through 12). 6. Hepatitis B vaccine a. Dose 1 may be given at birth or anytime thereafter. Dose 2 must be given at least 4 weeks (28 days) after dose 1. Dose 3 must be at least 8 weeks after dose 2 AND at least 16 weeks after dose 1 AND no earlier than age 24 weeks. b. Two doses of adult hepatitis B vaccine (Recombivax) received at least 4 months apart at age 11 through 15 years will meet the requirement. 7. Varicella (chickenpox) vaccine. (Minimum age: 12 months) a. The first dose of varicella vaccine must have been received on or after the first birthday. The second dose must have been received at least 28 days (4 weeks) after the first dose to be considered valid. b. For children younger than 13 years, the recommended minimum interval between doses is 3 months (if the second dose was administered at least 4 weeks after the first dose, it can be accepted as valid); for persons 13 years and older, the minimum interval between doses is 4 weeks. 8. Meningococcal conjugate ACWY vaccine. (Minimum age: 6 weeks) a. One dose of meningococcal conjugate vaccine (Menactra or Menveo) is required for students entering grades 7 and 8. b. For students in grade 12, if the first dose of meningococcal conjugate vaccine was received at 16 years or older, the second (booster) dose is not required. c. The second dose must have been received at 16 years or older. The minimum interval between doses is 8 weeks. 9. Haemophilus influenzae type b (Hib) conjugate vaccine. (Minimum age: 6 weeks) a. Children starting the series on time should receive Hib vaccine at 2 months, 4 months, 6 months and at 12 through 15 months. Children older than 15 months must get caught up according to the ACIP catch-up schedule. The final dose must be received on or after 12 months. b. If 2 doses of vaccine were received before age 12 months, only are required with dose 3 at 12 through 15 months and at least 8 weeks after dose 2. c. If dose 1 was received at age 12 through 14 months, only 2 doses are required with dose 2 at least 8 weeks after dose 1. d. If dose 1 was received at 15 months or older, only 1 dose is required. e. Hib vaccine is not required for children 5 years or older. 10. Pneumococcal conjugate vaccine (PCV). (Minimum age: 6 weeks) a. Children starting the series on time should receive PCV vaccine at 2 months, 4 months, 6 months and at 12 through 15 months. Children older than 15 months must get caught up according to the ACIP catch-up schedule. The final dose must be received on or after 12 months. b. Unvaccinated children ages 7 through 11 months of age are required to receive 2 doses, at least 4 weeks apart, followed by a third dose at 12 through 15 months. c. Unvaccinated children ages 12 through 23 months are required to receive 2 doses of vaccine at least 8 weeks apart. d. If one dose of vaccine was received at 24 months or older, no further doses are required. e. For further information, refer to the PCV chart available in the School Survey Instruction Booklet at: For further information, contact: New York State Department of Health Bureau of Immunization Room 649, Corning Tower ESP Albany, NY (518) New York City Department of Health and Mental Hygiene Program Support Unit, Bureau of Immunization, th Street, 5th floor Long Island City, NY (347) New York State Department of Health/Bureau of Immunization health.ny.gov/immunization 5/17

8 New York State Sheriff s Camp T-Shirt Form CAMPER S NAME PARENTS ADDRESS Adult T-Shirt Sizes (Please circle which size you prefer) SMALL MEDIUM LARGE X-LARGE ***Reminder: Water Shoes are highly recommended***