Fillable May 2021 Boston Centers for Youth & Families (City of Boston)

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May 2021 Boston Centers for Youth & Families (City of Boston)

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May 2021
Dear Camp Joy Parents/Guardians:
Boston Centers for Youth & Families (BCYF) is committed to providing high-quality
programming for residents of all ages and abilities in Boston. Since 1946 the Camp Joy
program has provided thousands of Boston’s youth with special needs an enriching summer
camp experience.
The BCYF Camp Joy Summer Program focuses on the principles of inclusion, learning and fun.
Trained, highly-skilled staff works to create a safe and nurturing environment for all
participants. The BCYF Camp Joy Summer program is for Boston residents’ ages 3—15 with
disabilities and their siblings, 3-5 years old. The 4-week summer program provides structured,
daily opportunities for participants to engage in recreational activities designed to promote
peer-to-peer socialization, foster relationship building and support individual growth.
Activities range from group games to gym time and arts and crafts.
For 2021, The BCYF Camp Joy Summer Program will be in session Monday-Friday from July 12-
August 6, 2021 from 8am-2pm at the following sites: BCYF Ohrenberger Community Center.
Enrollment is on a first come, first served basis based on a completed application. The parent
fee for the first child is $250.00 and $75.00 for each sibling or Agency fee of $300.00 per
child. Money orders only, NO REFUNDS. Please include Camper Photo along with Camp Joy
Application.
Program Requirements:
Be between the ages of 3-15 for youth with disabilities;
Be able to interact in a 4:1 participant to staff ratio;
Be a Boston resident (proof of residency required );
Complete application with all documentation and signatures
Campers that are not utilizing the bus will be assigned a time for arrival to camp due to
social distancing
For more information about the BCYF Camp Joy Summer Program or to request an application
please contact me at Roberta.Smalls@Boston.gov or (617) 635-4920 ext. 2402.
Sincerely,
Roberta Smalls
BCYF Camp Joy Program Manager
BCYF does not discriminate on the basis of race, creed, color, national origin, ability, sex, secular preference, sexual orientation,
marital status, age, political affiliation or religion, in accordance with the non-discrimination requirements of applicable statutes.
“This camp complies with regulations of the Massachusetts Department of Public Health and is licensed by the local board of health.”
Session Dates: July 12, 2021 – August 6, 2021
Boston Centers for Youth & Families (BCYF) is
committed to providing high quality programming for
Boston residents of all ages and abilities. To this end,
BCYF offers Camp Joy for Boston residents ages 3 to 15
with disabilities and their siblings 3 to 5 years old. The
four-week summer camp provides structured, daily
opportunities for participants to make new friends,
have fun, learn and grow during the summer months.
The summer offers a variety of enrichment activities
designed to promote peer-to-peer socialization, foster
relationship building and support individual growth.
For more information or for an application, please call Camp Joy
at (617) 635-4920 x2402 or email Roberta.Smalls@boston.gov
Program Requirements:
Camper must be able to interact in a 4:1 participant to staff ratio;
Parent or guardian must complete all required documentation;
Payment is due at enrollment to ensure a slot. NO REFUNDS
Participant Fees:
$250.00 for 1
st
child, $75.00 for each sibling OR Agency fee: $300.00 per child.
This camp complies with regulations of the MA Department of Public Health and is licensed by the local board of health.
Please mail or drop-off original applications to:
Faxed applications will not be accepted
Boston Centers for Youth & Families
1483 Trem
ont Street
Boston, MA 02120
Attention: Roberta Smalls
(617) 635-4920 ext. 2402
INCOMPLETE OR ILLEGIBLE APPLICATIONS WILL NOT BE ACCEPTED.
Enrollment will remain open until Friday, June 18th, 2021 or until all slots are filled.
Please include a photo of the camper you are applying for along with the completed application.
Enclosed medical section and camper immunization form must be completed by a physician.
“This camp complies with regulations of the MA Department of Public Health and is licensed by the local board of health.”
Session Dates: July 12, 2021 – August 6, 2021
CAMPER APPLICATION
CAMP JOY SUMMER
2021 CAMPER APPLICATION
CAMPER INFORMATION:
Camper’s Name: ____________________________________________________________________________
Age: __________ Date of Birth: ______/______/______ Gender: Male Female
Home Address: _____________________________________________________________________________
City: ____________________________________________ Zip Code: _______________________________
Camper’s Home Language: ______________________ Race (for State report only): _____________________
Camper’s T-shirt size: Child S M L Adult S M L XL
BUS PICK- UP/DROP- OFF MUST BE THE SAME ADDRESS (an adult must be present):
Address: __________________________________________________________________________________
City: ____________________________________________ Zip Code: _______________________________
**NO ADDRESS CHANGES WILL BE ACCEPTED AFTER FRIDAY, JUNE 22, 2021.
AN ADULT MUST BE PRESENT AT PICK-UP/DROP-OFF LOCATION
Name of Parent/Legal Guardian: _______________________________________________________________
Home Phone: (_________)______________________ Cell Phone: (_________)______________________
Email address: _____________________________________________________________________________________
EMERGENCY CONTACTS (must be someone besides the parent/guardian):
In case of emergency if parent/guardian is unavailable, please contact:
Contact Name: _____________________________________________________________________________
Home Phone: (_________)______________________ Cell Phone: (_________)______________________
Home Address: _____________________________________________________________________________
City: ____________________________________________ Zip Code: _______________________________
Contact Name: _____________________________________________________________________________
Home Phone: (_________)______________________ Cell Phone: (_________)______________________
Home Address: _____________________________________________________________________________
City: ____________________________________________ Zip Code: _______________________________
BCYF Camp Joy 2021
Camper’s Name: _______________________________________________________________________
EMERGENCY CONSENT AND RELEASE
If a situation arises in which my child is in need of prompt medical attention and I, or my designee (emergency contact),
cannot be contacted, I hereby grant permission to a responsible member of the Camp Joy staff to authorize treatment
for my child.
__________________________________________
____________________________
PARENT/GUARDIAN SIGNATURE
DATE
ACKNOWLEDGEMENT
The undersigned acknowledges that, in consideration of the opportunity to participate in the City of Boston’s
therapeutic recreation program, neither the City nor any of its employees are liable in the event of illness, injury,
accident or death which may occur while my child or the participant is engaged in the program, is traveling to or from
the program, or is engaged in any function of the program. This acknowledgment does not relieve the City or its
employees from claims based on gross negligence, or intentional or reckless conduct.
The undersigned further acknowledges that if any child or the participant does not conform to the standards and
organization of the program or if the directors of the program judge that the behavior of my child or the participant
endangers himself/herself or the welfare of others in the program or the program itself, (s) he may be dismissed from
the program upon written notice.
__________________________________________
____________________________
PARENT/GUARDIAN SIGNATURE
DATE
PHOTOGRAPHIC RELEASE
Please read and sign this photographic release. Please note that it is not necessary for you to sign this portion of the
release for your child to attend Camp Joy. However, it would be to our convenience if you would sign this section.
I hereby give my consent to Camp Joy to photograph my son/daughter without limitation to use such pictures and/or
stories in connection with any of the work of Camp Joy without consideration of any kind and I do hereby release Camp
Joy and Boston Centers for Youth & Families from any claims whatsoever which may arise in said regard.
__________________________________________
____________________________
PARENT/GUARDIAN SIGNATURE
DATE
BCYF Camp Joy 2021
Camper’s Name: _______________________________________________________________________
GENERAL INFORMATION:
Does your child use any of the following?
Glasses? Yes No Hearing Aid? Yes No Walker? Yes No
Does your child use any other type of adaptive equipment? Yes No If yes, please explain: ______________
_________________________________________________________________________________________________
Does your child have Allergies? Yes No If yes, please explain: ______________________________________
Does your child have any dietary restriction?_____________________________________________________________
Will it be necessary for your child to take medication during the camp day? Yes No
**If your child requires medication during camp hours you must complete the Authorization to Administer
Medication to a Camper Form, and attend a mandatory orientation before the child can attend Camp Joy.
Does your child have a sibling attending Camp Joy? Yes No If so, what is his/her name?
_________________________________________________________________________________________________
What school does your child currently attend? ___________________________________________________________
Does your child communicate verbally? Yes No ___________________________________________________
Does your child need assistance using the bathroom? _____________________________________________________
Did your child attend Camp Joy last summer? Yes No What location? ________________________________
Please list any compulsive behaviors and appropriate responses for staff to take: _______________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
Please list any other precautions or behaviors that the camp staff should be aware of: ___________________________
_________________________________________________________________________________________________
Can your child participate in other physical activities? Yes No If yes, list any necessary
accommodations:___________________________________________________________________________________
_________________________________________________________________________________________________
Does your child have a special toileting procedure? Yes No If so please describe:
_________________________________________________________________________________________________
Does your child use a wheelchair? Yes No If so, please identify the level of support needed: ____________
_________________________________________________________________________________________________
BCYF Camp Joy 2021
Camper Application—Medical Section
APPLICATION WILL NOT BE ACCEPTED WITHOUT THIS FORM COMPLETED
Camper’s Name: ___________________________________________________________________________________
Diagnosis: (Medical Term) ___________________________________________________________________________
(Layman’s Term) ___________________________________________________________________________________
Is camper subject to allergic reactions? Yes No If so, please specify: ________________________________
_________________________________________________________________________________________________
Is camper medicated? Yes No
Type: ___________________________________________ Dosage: ________________________________________
Type: ___________________________________________ Dosage: ________________________________________
Time(s) administered: ______________________________________________________________________________
How is medication administered? _____________________________________________________________________
Will it be necessary for camper to take medication during the camp day? Yes No
Is camper subject to seizures? Yes No Are they controlled? Yes No
To your knowledge, is the camper suffering from or has (s)he recently been exposed to any contagious disease?
______________________________________________________________________________________________________
_________________________________________________________________________________________________
Does camper have any dietary restrictions? _____________________________________________________________
May camper participate in carefully supervised swimming activities? Yes No
May camper participate in a physical education program? Yes No
Are there any precautions that should be noted? (PLEASE SPECIFY) __________________________________________
_________________________________________________________________________________________________
Does camper live in a group home: ____________________________________________________________________
Camper’s height: _________________________________ Weight: __________________________________________
Does the camper use any other type of adaptive equipment? Yes No
If yes, please explain: _______________________________________________________________________________
Camper/Family Caseworker: __________________________________________________________________________
Agency: ________________________________________ Telephone: ________________________________________
Date of Physical Examination _____/_____/_____
Print/Type Physician’s Name
COVID-19
Parents/Guardian Permission to Use Hand Sanitizer
I, Parent or Guardian of (Name of Child)
______________________________________
give permission for BCFY Camp Joy to allow my child to use hand
sanitizer with an alcohol content of sixty percent (60%) or more
periodically throughout the camp day in addition to soap and
water to clean his/her hands.
Hand sanitizer is always kept out of the reach of children.
Children will be monitored closely with the use of hand sanitizer.
Parent/Guardian full name (print): _________________________________
Parent/Guardian signature: ___________________________ Date: _____________
430.163:
Parent’s/Guardian’s Permission to Apply Sunscreen to
Child
(Name of Child) ________________________________________________________________________
As the parent or guardian of the above child, I recognize that too much sunlight may
increase my child’s risk of getting skin cancer someday. Therefore, I give my permission
for personnel at:
(Child Care Business) __________________________________________________________________________
to apply a sunscreen product of SPF‐15 or higher to my child, as specified below, when he
or she will be playing outside, especially during the months of March through October and
between the daily times of 10 a.m. and 4 p.m. I understand that sunscreen may be applied
to exposed skin, including but not limited to the face, tops of the ears, nose and bare
shoulders, arms, and legs. I have checked all applicable information regarding the type and
use of sunscreen for my child:
❑ I do not know of any allergies my child has to sunscreen.
❑ Staff may use the sunscreen of their choice following the directions or
recommendations printed on the bottle.
❑ I have provided the following brand/type of sunscreen for use on my child:
❑ For medical or other reasons, please do not apply sunscreen to the following areas of
my child’s body: _________________________________________________________________________________
_____________________________________________________________________________________________________
Parent/Guardian full name (print):
___________________________________________________________________________________________________
Parent/Guardian signature: _______________________________________________Date:______________
Vaccination is critically important to control the spread of vaccine-preventable disease. In 2017, a
single case of mumps at a summer camp in Massachusetts resulted in isolation of ill individuals,
vaccination of those without evidence of two doses of MMR vaccine at several camps, and quarantine
of those who did not have evidence of immunity to mumps and who could not get vaccinated.
International staff and campers with missing or incomplete vaccination records made rapid
implementation of disease control measures very challenging.
Required Vaccines:
Minimum Standards for Recreational Camps for Children, 105 CMR 430.152, has been updated.
Beginning in the summer of 2018, immunization requirements for children attending camp will follow
the Massachusetts school immunization requirements, as outlined in the Massachusetts School
Immunization Requirements table. Children should meet the immunization requirements for the grade
they will enter in the school year following their camp session. Children attending camp who are not
yet school aged should follow the Daycare/Preschool immunization requirements included on the
School Immunization Requirements table.
Campers, staff and volunteers who are 18 years of age and older should follow the immunizations
outlined in the document, Adult Occupational Immunizations.
The following page includes portions of the Massachusetts School Immunization Requirements table
and Adult Occupational Immunizations table relevant for camps.
If you have any questions about vaccines, immunization recommendations, or suspect or confirmed
cases of disease, please contact the MDPH Immunization Program at 888-658-2850 or 617-983-6800.
The Commonwealth of Massachusetts
Executive Office of Health and Human Services
Department of Public Health
Bureau of Infectious Disease and Laboratory Sciences
305 South Street, Jamaica Plain, MA 02130
To:
Camp Directors
From:
Pejman Talebian, MA, MPH, Director, Immunization Program
Date:
March 2018
Subject:
Required Immunizations for Children Attending Camp and Camp Staff
CHARLES D. BAKER
Governor
KARYN E. POLITO
Lieutenant Governor
MARYLOU SUDDERS
Secretary
MONICA BHAREL, MD, MPH
Commissioner
Tel: 617-624-6000
www.mass.gov/dph
Division of Epidemiology and Immunization
Tel: (617) 983-6800
Fax: (617) 983-6840
www.mass.gov/dph/epi
www.mass.gov/dph/imm
BCYF Camp Joy 2021
Grades Kindergarten – 6
Kindergarten requirements apply to all students ≥5 years.
DTaP
5 doses; 4 doses are acceptable if the 4
th
dose is given on or after the 4
th
birthday. DT is only acceptable
with a letter stating a medical contraindication to DTaP.
Polio
4 doses; 4
th
dose must be given on or after the 4
th
birthday and ≥6 months after the previous dose, or a 5
th
dose is required. 3 doses are acceptable if the 3
rd
dose is given on or after the 4
th
birthday and ≥6 months
after the previous dose.
Hepatitis B
3 doses; laboratory evidence of immunity acceptable
MMR
2 doses; first dose must be given on or after the 1
st
birthday and the 2
nd
dose must be given ≥28 days after
dose 1; laboratory evidence of immunity acceptable
Varicella
2 doses; first dose must be given on or after the 1
st
birthday and 2
nd
dose must be given ≥28 days after
dose 1; a reliable history of chickenpox* or laboratory evidence of immunity acceptable
Grades 7 – 12
In ungraded classrooms, grade 7 requirements apply to all students ≥12 years.
Tdap
1 dose; and history of DTaP primary series or age appropriate catch-up vaccination. Tdap given at ≥7 years
may be counted, but a dose at age 11-12 is recommended if Tdap was given earlier as part of a catch-up
schedule. Td should be given if it has been ≥10 years since Tdap.
Polio
4 doses; 4
th
dose must be given on or after the 4
th
birthday and ≥6 months after the previous dose, or a 5
th
dose is required. 3 doses are acceptable if the 3
rd
dose is given on or after the 4
th
birthday and ≥6 months
after the previous dose.
Hepatitis B
3 doses; laboratory evidence of immunity acceptable
MMR
2 doses; first dose must be given on or after the 1
st
birthday and the 2
nd
dose must be given ≥28 days after
dose 1; laboratory evidence of immunity acceptable
Varicella
2 doses; first dose must be given on or after the 1
st
birthday and 2
nd
dose must be given ≥28 days after
dose 1; a reliable history of chickenpox* or laboratory evidence of immunity acceptable
Campers, staff and volunteers 18 years of age and older
MMR
2 doses, anyone born in or after 1957. 1 dose, anyone born before 1957 outside the U.S. Anyone born in
the U.S. before 1957 is considered immune. Laboratory evidence of immunity to measles, mumps and
rubella is acceptable
Varicella
2 doses, anyone born in or after 1980 in the U.S., and anyone born outside the U.S. Anyone born before
1980 in the U.S. is considered immune. A reliable history of chickenpox or laboratory evidence of immunity is
acceptable
Tdap
1 dose; Td should be given if it has been ≥ 10 years since Tdap
Hepatitis B
3 doses for staff whose responsibilities include first aid; laboratory evidence of immunity is acceptable
BCYF Camp Joy 2021
March 2018 Page 1 of 3
(completed by parent/guardian)
Camper and Parent/Guardian Information
Camper’s Name:
Age:
Food/Drug Allergies:
Diagnosis (at parent/guardian discretion):
Parent/Guardian’s Name:
Home Phone:
Business Phone:
Emergency Telephone:
Licensed Prescriber Information
Name of Licensed Prescriber:
Business Phone:
Emergency Phone:
Medication Information 1
Name of Medication:
Dose given at camp:
Route of Administration:
Frequency:
Date Ordered:
Duration of Order:
Quantity Received:
Expiration date of Medication Received:
Special Storage Requirements:
Special Directions (e.g., on empty stomach/with water):
Special Precautions:
Possible Side Effects/Adverse Reactions:
Other medications (at parent/guardian discretion):
Location where medication administration will occur:
Medication Information 2
Name of Medication:
Dose given at camp:
Route of Administration:
Frequency:
Date Ordered:
Duration of Order:
Quantity Received:
Expiration date of Medication Received:
BCYF Camp Joy 2021
Authorization to Administer Medication to a Camper
March 2018 Page 2 of 3
Special Storage Requirements:
Special Directions (e.g., on empty stomach/with water):
Special Precautions:
Possible Side Effects/Adverse Reactions:
Other medications (at parent/guardian discretion):
Location where medication administration will occur:
Authorization Information
I hereby authorize the health care consultant or properly trained health care supervisor at
_________________________________________
(name of camp)
to administer, to my child, ____________________________________ the medication(s) listed above, in accordance with 105 CMR
(name of camper)
430.160(C) and 105 CMR 430.160(D) [see below].
If above listed medication includes epinephrine injection system:
I hereby authorize my child to self-administer , with approval of the health care consultant □ Yes □ No □ Not Applicable
I hereby authorize an employee that has received training in allergy awareness and epinephrine administration to administer
□Yes □No □ Not Applicable
If above listed medication includes insulin for diabetic management:
I hereby authorize my child to self-administer , with approval of the health care consultant □Yes □No □ Not Applicable
Signature of Parent/Guardian:
Date:
** Health Care Consultant at a recreational camp is a Massachusetts licensed physician, certified nurse practitioner, or a physician assistant
with documented pediatric training. Health Care Supervisor is a staff person of a recreational camp for children who is 18 years old or older; is
responsible for the day to day operation of the health program or component, and is a Massachusetts licensed physician, physician assistant,
certified nurse practitioner, registered nurse, licensed practical nurse, or other person specially trained in first aid.
BCYF Camp Joy 2021
BCYF Camp Joy
March 2018 Page 3 of 3
105 CMR 430 References
105 CMR 430.160(A): Medication prescribed for campers shall be kept in original containers bearing the pharmacy label, which shows the
date of filling, the pharmacy name and address, the filling pharmacist’s initials, the serial number of the prescription, the name of the
patient, the name of the prescribing practitioner, the name of the prescribed medication, directions for use and cautionary statements, if
any, contained in such prescription or required by law, and if tablets or capsules, the number in the container. All over the counter
medications for campers shall be kept in the original containers containing the original label, which shall include the directions for use.
(M.G.L. c. 94C § 21).
105 CMR 430.160(C): Medication shall only be administered by the health care supervisor or by a licensed health care professional
authorized to administer prescription medications. If the health care supervisor is not a licensed health care professional authorized to
administer prescription medications, the administration of medications shall be under the professional oversight of the health care
consultant. The health care consultant shall acknowledge in writing a list of all medications administered at the camp. Medication
prescribed for campers brought from home shall only be administered if it is from the original container, and there is written permission from
the parent/guardian.
105 CMR 430.160(D): A written policy for the administration of medications at the camp shall identify the individuals who will administer
medications. This policy shall:
(1) List individuals at the camp authorized by scope of practice (such as licensed nurses) to administer medications; and/or other
individuals qualified as health care supervisors who are properly trained or instructed, and designated to administer oral or topical
medications by the health care consultant.
(2) Require health care supervisors designated to administer prescription medications to be trained or instructed by the health care
consultant to administer oral or topical medications.
(3) Document the circumstances in which a camper, Heath Care Supervisor, or Other Employee may administer epinephrine injections. A
camper prescribed an epinephrine auto-injector for a known allergy or pre-existing medical condition may:
a) Self-administer and carry an epinephrine auto-injector with him or her at all times for the purposes of self-administration if:
1) the camper is capable of self-administration; and
2) the health care consultant and camper’s parent/guardian have given written approval
(b) Receive an epinephrine auto-injection by someone other than the Health Care Consultant or person who may give
injections within their scope of practice if:
1) the health care consultant and camper’s parent/guardian have given written approval; and
2) the health care supervisor or employee has completed a training developed by the camp’s health care consultant in
accordance
with the requirements in 105 CMR 430.160.
(4) Document the circumstances in which a camper may self-administer insulin injections. If a diabetic child requires his or her blood sugar
be monitored, or requires insulin injections, and the parent or guardian and the camp health care consultant give written approval, the
camper, who is capable, may be allowed to self-monitor and/or self-inject himself or herself. Blood monitoring activities such as insulin
pump calibration, etc. and self-injection must take place in the presence of the properly trained health care supervisor who may support the
child’s process of self-administration.
105 CMR 430.160(F): The camp shall dispose of any hypodermic needles and syringes or any other medical waste in accordance with 105
CMR 480.000: Minimum Requirements for the Management of Medical or Biological Waste.
105 CMR 430.160(I): When no longer needed, medications shall be returned to a parent or guardian whenever possible. If the medication
cannot be returned, it shall be disposed of as follows:
(1) Prescription medication shall be properly disposed of in accordance with state and federal laws and such disposal shall be
documented in writing in a medication disposal log.
(2) The medication disposal log shall be maintained for at least three years following the date of the last entry.
BCYF Camp Joy 2021
Provided by the Massachusetts Department of Public Health in accordance with M.G.L. c.111, s.219.
Massachusetts Department of Public Health, Division of Epidemiology and Immunization, 305 South Street, Jamaica Plain, MA 02130 October 2016
Meningococcal Disease and Camp Attendees: Commonly Asked Questions
What is meningococcal disease?
Meningococcal disease is caused by infection with bacteria called Neisseria meningitidis. These bacteria can infect the
tissue (the “meninges”) that surrounds the brain and spinal cord and cause meningitis, or they may infect the blood or
other organs of the body. In the US, about 1,000-1,200 people get meningococcal disease each year and 10-15% die
despite receiving antibiotic treatment. Of those who survive, about 11-19% may lose limbs, become hard of hearing or
deaf, have problems with their nervous system, including long term neurologic problems, or have seizures or strokes.
How is meningococcal disease spread?
These bacteria are passed from person-to-person through saliva (spit). You must be in close contact with an infected
person’s saliva in order for the bacteria to spread. Close contact includes activities such as kissing, sharing water
bottles, sharing eating/drinking utensils or sharing cigarettes with someone who is infected; or being within 3-6 feet of
someone who is infected and is coughing and sneezing.
Who is most at risk for getting meningococcal disease?
People who travel to certain parts of the world where the disease is very common, microbiologists, people with HIV
infection and those exposed to meningococcal disease during an outbreak are at risk for meningococcal disease.
Children and adults with damaged or removed spleens or persistent complement component deficiency (an inherited
immune disorder) are at risk. Adolescents, and people who live in certain settings such as college freshmen living in
dormitories and military recruits are at greater risk of disease from some of the serotypes.
Are camp attendees at increased risk for meningococcal disease?
Children attending day or residential camps are not considered to be at an increased risk for meningococcal disease
because of their participation.
Is there a vaccine against meningococcal disease?
Yes, there are 3 different meningococcal vaccines. Quadrivalent meningococcal conjugate vaccine (Menactra and
Menveo) protects against 4 serotypes (A, C, W and Y) of meningococcal disease. Meningococcal serogroup B vaccine
(Bexsero and Trumenba) protects against serogroup B meningococcal disease, for age 10 and older. Quadrivalent
meningococcal polysaccharide vaccine (Menomune) is recommended for people age 56 and older with certain high-
risk conditions.
Should my child or adolescent receive meningococcal vaccine?
Meningococcal vaccine is not recommended for attendance at camps. However, these vaccines may be
recommended for children with certain high-risk health conditions, such as those described above. MDPH strongly
recommends two doses of quadrivalent meningococcal conjugate vaccine: a first dose at age 11 through 12
years, with a second dose at 16 years.
Meningococcal serogroup B vaccine (Bexsero and Trumenba) is recommended for people with certain relatively rare
high-risk health conditions age 10 or older (examples: persons with a damaged spleen or whose spleen has been
removed, those with persistent complement component deficiency, and people who may have been exposed during an
outbreak). Adolescents and young adults (16 through 23 years of age) may be vaccinated with a serogroup B
meningococcal vaccine, preferably at 16 through 18 years of age, to provide short term protection for most strains of
serogroup B meningococcal disease. Parents of adolescents and children who are at higher risk of infection, because
of certain medical conditions or other circumstances, should discuss vaccination with their child’s healthcare provider.
How can I protect my child or adolescent from getting meningococcal disease?
The best protection against meningococcal disease and many other infectious diseases is thorough and frequent
handwashing, respiratory hygiene and cough etiquette. Individuals should:
1. wash their hands often, especially after using the toilet and before eating or preparing food (hands should be washed
with soap and water or an alcohol-based hand gel or rub may be used if hands are not visibly dirty);
2. cover their nose and mouth with a tissue when coughing or sneezing and discard the tissue in a trash can; or if they
don’t have a tissue, cough or sneeze into their upper sleeve.
3. not share food, drinks or eating utensils with other people, especially if they are ill.
If your child is exposed to someone with meningococcal disease, antibiotics may be recommended to keep your child
from getting sick.
You can obtain more information about meningococcal disease or vaccination from your healthcare provider, your local
Board of Health (listed in the phone book under government), or the Massachusetts Department of Public Health Division of
Epidemiology and Immunization at (617) 983-6800 or on the MDPH website at www.mass.gov/dph.
BCYF CAMP JOY 2021
COMPLETED APPLICATION CHECKLIST
Before returning this Camp Joy Camper Application,
Please check (√) to see that the following sections are FULLY completed:
CAMPER INFORMATION COMPLETED including HOME ADDRESS (you will get a transportation assignment)
PARENT/GUARDIAN INFORMATION COMPLETED
EMERGENCY CONTACT LISTED (AT LEAST ONE)— Must be different from home telephone number.
EMERGENCY CONSENT SIGNED (parent/guardian signature)
ACKNOWLEDGEMENT SIGNED (parent/guardian signature)
PHOTO RELEASE SIGNED (parent/guardian signature)
GENERAL CAMPER INFORMATION PAGE COMPLETED
CAMPER MEDICAL SECTION
CAMPER IMMUNIZATION PRINTOUT
WITHOUT MEDICAL & IMMUNIZATION PRINTOUT COMPLETED BY A PHYSICIAN YOUR
APPLICATION WILL BE RETURNED. PLEASE DOUBLE CHECK
COMPLETE AN AUTHORIZATION TO ADMINISTER MEDICATION TO A CAMPER FORM BY A
PARENT/GUARDIAN IF NECESSARY.
NON-REFUNDABLE FEE: Personal Checks and Cash are not accepted. Please make money orders
payable to the Foundation for BCYF-Camp Joy. FULL payment is due with the completed application.
If you are a parent paying the entire Camp Joy fee, you will pay $250 for your first child
and an additional $75 for each additional sibling. Siblings without special needs can
attend Camp Joy between the ages of 3-5. Siblings with special needs can attend Camp
Joy between the ages of 3-15.
If you are a parent receiving a scholarship from another agency or organization that will go towards
covering a portion of the Camp Joy fee, you are responsible for paying the remaining balance of the
$300.00 fee. Your application must include the payment or a letter stating intent to pay from the
organization, as well as a money order from the parent for the remaining balance. (For example, if
you receive an agency scholarship for $100, you are required to pay the remaining balance of $200.)
If you are an agency supporting in registering a child and covering the ENTIRE Camp Joy fee you are
required to pay $300. Documentation stating the agency’s intention to pay and/or complete
payment needs to accompany any application. ***Please DO NOT send a check that does not
include information about whose fee the payment is intended to cover.
CAMPER PHOTO: Please include a photo of camper along with Camper application!
CURRENT IEP (Individual Education Plan): Please send copies of the goals pages of your child’s most
current IEP. A letter from your child’s doctor will be accepted if you do not have an IEP.
PERSONAL CHECKS AND CASH ARE NOT ACCEPTED. NO EXCEPTIONS!
ONLY COMPLETED APPLICATIONS WILL BE PROCESSED!
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May 2021 Boston Centers for Youth & Families (City of Boston)

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Completed 2 June 2021

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