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Register for the Roxbury Youth Initiative 2009! An affordable six-week summer camp providing academic & personal enrichment for the youth of Academy Homes, Orchard Gardens and greater Roxbury since 1980


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Register for the

Roxbury Youth Initiative 2009!

An affordable six-week summer camp providing academic & personal enrichment for the youth of Academy Homes, Orchard Gardens and greater Roxbury since 1980.
Thank you for considering the Roxbury Youth Initiative (RYI) as an option for your child this summer! As directors of Roxbury Youth Initiative 2009, Jon and I are excited to meet all your children and welcome them to the camp this summer. Last summer Jon and I bcamperoth worked as senior counselors—I taught our class of six-year-olds while Jon worked with our oldest boys. Jon is a resident of Allston, and heard about RYI through his community organizing work around CORI reform. Jon has been a private tutor for two boys for the past three years. I am a rising senior in college, studying to be a history teacher & youth worker, who has gotten to know Roxbury first through an after-school program and now through RYI. We work closely with David Dance, a Boston community organizer and employee of Phillips Brooks House Association with three decades of experience.

Jon and I have been working since January to fundraise, organize, and plan for the best summer possible for your children. We have been guided by a vision of a camp that connects our campers to Roxbury history and community organizations, supports their academic achievement, and gives them concrete tools to enrich their community and world. This summer, camp will run from June 29th to August 7th. These dates may change if the Boston Public School calendar changes. The camp day goes from 8:30 to 4, Monday through Friday (please note the change to full-day Fridays from last summer.) Breakfast and lunch are provided. The camp fee is $100 for the first child, $90 for the second, and $80 for each child after that. Feel free to contact us with any questions at (857) 233-8892. We look forward to hearing from you!
Mary Cate Curley Jon Barry
Application Instructions

Returning Camper Priority Deadline: MAY 8, 2009

Returning campers who submit applications postmarked by this date will have a spot in RYI 2009. Payment should be included.



New Camper Priority Deadline: MAY 20, 2009

First-time RYI campers who submit applications postmarked by this date will have a spot in RYI 2009 as long as there is room in our classrooms. Payment should be included. Checks will be returned if there is no space.


Please return all completed applications to:

Roxbury Youth Initiative

Phillips Brooks House

Harvard Yard

Cambridge, MA 02138
You will hear from us a week after your application is submitted.
Included are two recommendation forms to be filled out by your child’s math & English teachers (if this is the same teacher, you need only submit one form.) If necessary, the teachers may send these forms in separately. These forms are invaluable to our senior and junior counselors, as they allow them to create the most helpful and appropriate lesson plans suited to your child.
RYI At A Glance
Camp Dates: June 29th to August 6th

Camp Hours: Monday – Friday, 8:30 – 4

Camp Fee: $100 for first child, $90 for sibling, $80 thereafter

The complete fee is due with the application. We can work with you on payment plans, but we cannot hold spots for campers who have not at least made arrangements to pay.


Transportation:

RYI will run shuttles each morning and afternoon with pick-up and drop-off points at Academy Homes I, Academy Homes II, and Orchard Gardens Community Center.


Breakfast and lunch are provided.
About RYI: RYI is an academic enrichment summer camp that has been working with the families of Roxbury for over 25 years. The goals of RYI go beyond promoting academic achievement. We strive to cultivate an excitement about learning in our campers, to expose Roxbury children to a world not yet discovered by them, to build character and confidence in our campers, and to give the children concrete tools that they can use to enrich their community and world.
We strive to accomplish these goals by exploring a unique curriculum covering topics in the following areas:

  • Roxbury History

  • Math, Science and Literacy

  • Health

  • Media Curriculum

Other features of the program include:

  • Field trips to educational and recreational sites around Boston

  • Collaboration with other neighborhood youth organizations

  • Swimming once a week or more

  • Activities with Mission Hill and South End summer camps

  • Health workshops & cooking classes

  • Overnight camping trip

  • Overnight final trip for oldest campers




Camper Information

Name of child/ Nombre del nino: __________________ Gender (Male or Female)__________


Date of Birth/ Fecha de nacimiento: _____________________Age/ Edad_________________
Grade camper will be beginning in September, 2009: __________
Is there a computer at home?/ Tiene computadora en su casa? Y / N
Does the student have a library card?/ Su nino tiene una tarjeta para usar la biblioteca? Y / N

Address/ Direccion: _____________________________________________________________

Street/ Calle Apt #

________________________________________________________________________

City/ Ciudad State/ Zip


Home phone/ Telefono de casa: ___________ Work phone/ Telefono de trabajo:___________
Email address / dirección correo electrónico: _________________
If there is no phone, how can the parent/ child be contacted?

Si no hay telefono, como se puede comunicar los directores con los padres/ nino?
Mother’s Name/ Nombre de mama __________________________________________________
Occupation/ ______________________________________ Day Phone: _________________
Address if different from above: ____________________________________________________
Father’s Name/ Nombre de papa ___________________________________________________
Occupation/ ______________________________________ Day Phone: _________________
Address if different from above/: _________________________________________

I authorize the following people to take my child from camp or act in the event of an emergency/ La gente siguiente tiene permiso para tomar mi niño del RYI o actuar en evento de una emergencia:



Name/ Nombre

Relation/ Relacion

Phone number/ Telefono

Address/ Direccion






























*PLEASE NOTE: We will not release your child to anyone other than who appears on this list, unless you give any of the directors advance notice.

Release Form
I am the parent and/or legal guardian of________________________. I understand that the Phillips Brooks House Association professional staff and the staff of PBHA youth program will maintain files containing academic, behavioral, and health related information about my child. I also understand that the aforementioned people may establish both written and verbal correspondence with my child’s teacher and/ or guidance counselors in regard to my child’s progress and well-being. This correspondence may involve the sharing of behavioral reports and academic report cards. I grant the staff of PBHA youth program permission to share with each other any information collected in my child’s file. Upon withdrawing my child from the program or upon my child’s completion of the program, I retain any right I may have to gain possession of copies of my child’s file, including any and all copies of the documents in that file which are in the possession of Phillips Brooks House professional staff or the staff of PBHA Youth Program.

I also grant permission for my son/daughter/ward to be included in the documentation of the program including photographs, video recordings, audio recordings, reproductions of academic work, and written quotations or descriptions of academic activities. I am aware that this documentation material may be edited as necessary. I also understand that the resulting material may be exhibited before the community, school, fundraisers, or other groups or individuals in video, audio, print, or other media formats.

I, as the legal guardian, release, hold harmless and agree to indemnify the Phillips Brooks House Association (PBHA), Harvard University, and all Board of Trustees, officers, directors, faculty, staff, representatives, employees and agents, from and against any present or future claim, loss or liability for injury to person or property, related to my child's participation in this program (including periods of transit).

Yo soy el padre o el custadio legal de _______________________. Yo entiendo que la administracion de Phillips Brooks House Association, los directores, y los consejeros de PBHA Youth Program tendran un archivo con informacion sobre el comportamiento, la salud y el progreso escolar de mi nino. Yo tambien entiendo que la adminstracion de PBHA Youth Program podra estalecer correspondencia verbal y escrita con los maestros o con el conserjero de la escuela con repecto al progreso del nino y de su bien-estar. Esta correspondencia puede envolver compartiendo information escolar y del comportamiento del nino. Yo le doy permiso a la administracion PBHA Youth Program para compartir esta informacion entre ellos mismos. Cuando mi hijo/hija deja el programa, tengo el derecho a demandar el archive sobre mi hijo y todas las copias.

Tambien le doy permiso a mi hijo/hija para participar en fotagrafias, grabaciones de video o de cintas de escuchar, y para que su trabajo escolar o citactiones sean publicada. Yo se que estas publicaciones podran ser redactidas si es necesario. Tambien entiendo que el material podra ser exhibido adalante de grupos de comunidades, de escuelas, y de contribuidores o otros grupos de individuales en formas audio visual, audial, escritas o otros metados.

Yo, por este medio hago público, de liberar, y de comprometerme a no demandar y estoy de acuerdo a indemnizar y a no hacer responsible, a la Phillips Brooks House Association (PBHA), Harvard University, la Junta Directiva, los oficiales, los directores, la facultad, el personal, los representantes, los empleados y los agentes, de y en contra cualquier demanda en el presente o en el futuro, de demandas y reclamación de daños de cualquier clase, incluyendo lesiones y daños a propiedad, relacionada con la participación de mi niño(a) en este programa (incluyendo períodos de tránsito).

Parent Name/ Nombre de padre (printed): __________________________________________


Parent’s signature/ Firma del padre: ____________________________Date/ Fecha: ________

Additional Information

Is there any activity in which you do NOT want your child to participate?



Hay una actividad en que NO quiere que su nino participa?

Would either parent be willing to participate in camp events over the summer? Please describe (opportunities include chaperoning field trips, being present in the classroom, helping organize community events like barbecues, planning or supervising community service events, etc.).


Is there anything we should know about the child, for example, temper tantrums or hyperactivity?



Hay alguna cosa en particular, por ejemplo, un problema de conducta or hiperactividad, que tiene su nino que usted cree que los directores deben de saber?

I give my child permission to participate in this program and all its activities, and to ride in PBHA vehicles.



Yo le doy permiso a mi hijo para participar en este programa, en todas sus actividades, y ser transportado en los vehiculos de PBHA.

Signature/ Firma Date/ Fecha




Roxbury Youth Initiative

Health Form/ Formas de Salud

Name of Child/ Nombre del nino: __________________________________________________


Do you have medical insurance?/ Tiene usted seguro medico?: Y / N
Name of insurance company/ Nombre del seguro: ______________________________________
Policy number/ Numero de la poliza: ________________________________________________
Hospital or health clinic/ Hospital o clinica de salud: ___________________________________
Address/ Direccion: ________________________________________________

Telephone number/ Numero de telefono: ________________________________


Does your child have any allergies? / Tiene su nino alguna alergia(s)? (please specify)

Is your child on medication? Medicine name, reason for use, dosage per day.



Toma su nino medicina? Nombre de la medicina, razon de uso, dose diaria.

If your child needs to take medicine during program hours, please fill out the attached form.



Si su nino necesita tomar esta medicina mientras esta en el programa, por favor de llenar la proxima pagina.
Is your child being treated for any other condition we should know about?

Haga una lista de otros problemas de salud que nosotros debemos saber.
In case of emergency, I authorize PBHA Youth Program staff to seek any medical assistance that the above named child may require.

En caso de emergencia, yo le doy permiso a los directores de este programa para buscar cualquier tratamiento que sea necesario para mi nino.

Signature/ Firma Date/ Fecha

Medication/ Medicina: ________________________ Prescription/ non-prescription (circle one)


Dosage/ Dose: _______________________________

When to be given (time): ____________________________ and for __________________ days.



Caundo de deber ser dispensada (tiempo): ___________________ y por _______________ dias.
I give permission to the counselors, directors and volunteers of PBHA Youth Program to dispense the medication listed above to the child named on this form.

Yo le doy permiso a los consejeros, directores, y voluntaries del programa para dispensar le arriba mencionada medicina a mi nino.
Parent Signature / Firma del pariente: _______________________ Date/ Fecha: _____________
Doctor Signature/ Firma del doctor: _________________________ Date/ Fecha: ____________

For staff use only*:







Date

Dosage

Time

Signature of staff

1.













2.













3.













4.













5.













6.













7.













8.













9.













10.












*This form must be filed in the child’s records after the course of medication has been completed.



In addition to this health form, please include an updated immunization record for your child. If you do not include one and/or it is not up to date, your child will not be able to attend camp.

Input


  1. What do you feel RYI has done well in previous years?/ ¿Que piensa que RYI hecho bien en los años pasados?




  1. What do you feel we could do better?/ ¿Cómo podría mejorar?



  1. What sort of activities would you like to see your child take part in during classroom time?/ ¿Qué actividades usted quisiera que sus niños participaran durante clase?


  1. What sort of field trips would you like your child to go on?/ ¿Qué actividades usted quisiera que sus niños participaran afuera del clase?


  1. Do you have any specific field trip location recommendations?/ ¿Tiene recomendaciones para los viajes afuera del clase?


Thanks for all of your help!

Teacher Input for Roxbury Youth Initiative 2009: English

The Roxbury Youth Initiative is a low-cost, six-week summer program that has been working with Roxbury residents since 1980. Our campers take part in 3 hours of classroom activities each morning, followed by field trips in the afternoon. Your input on this child’s academic strengths and weaknesses are of enormous value to our senior counselors in planning customized lessons and academic support. Thank you!
Student’s Name: _______________________________________
Teacher’s Name: _______________________________________
Teacher’s Phone Number: ________________________________
Is there a time you may be free to talk about the student’s progress? _________________
Please rank the student’s proficiency in the following areas (1 poor – 5 excellent):
Overall literacy: _____

Spelling: _____

Grammar: _____

Reading – Comprehension: _____

Reading – Mechanics: _____

Writing – Structure: _____

Writing – Expression: _____

Overall test-taking skills: _____

Test time management: _____

Understanding the questions: _____

Presentation of responses: _____

Free-answer questions: _____



Multiple choice questions: _____
What books has the student read this year? _____________________________________
________________________________________________________________________
________________________________________________________________________
What strengths have you observed in this student that our counselors might be able to build on this summer? _____________________________________________________________
________________________________________________________________________
________________________________________________________________________
In what ways might the student be unprepared for the upcoming year’s curriculum?
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
For students entering the fourth or eighth grades, did this student struggle with any MCAS skills?
________________________________________________________________________
________________________________________________________________________
Please describe any disciplinary issues that you have observed in the student.
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Are there any other comments about the student that you would like to share?
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Are you available/interested in helping (volunteering) over the summer? (opportunities might involve observing/mentoring/critiquing the senior counselors, helping refine curriculum, chaperoning field trips, providing MCAS preparation to junior counselors – high-school-aged students, etc.)
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Thank you for taking the time to fill out this form. If you have additional questions/comments about the student, the program, or how you can get involved over the summer, please feel free to contact Mary Catherine Curley or Jonathan Barry, co-directors of the Roxbury Youth Initiative, at ryicamp@gmail.com, or by phone at (857) 233-8892.

Teacher Input for Roxbury Youth Initiative 2009: Math

The Roxbury Youth Initiative is a low-cost, six-week summer program that has been working with Roxbury residents since 1980. Our campers take part in 3 hours of classroom activities each morning, followed by field trips in the afternoon. Your input on this child’s academic strengths and weaknesses are of enormous value to our senior counselors in planning customized lessons and academic support. Thank you!
Student’s Name: _______________________________________
Teacher’s Name: _______________________________________
Teacher’s Phone Number: ________________________________
Is there a time you may be free to talk about the student’s progress? _________________
Please rank the student’s proficiency in the following areas (1 poor – 5 excellent, or n/a):
Overall Math: _____

Arithmetic: _____

Formulas/Equations: _____

Applications/Problem Solving: _____

Mathematical Intuition/Deduction/Logic: _____

Algebra: _____

Geometry: _____

Overall test-taking skills: _____

Test time management: _____

Understanding the questions: _____

Presentation of responses: _____

Free-answer questions: _____

Multiple choice questions: _____
Are there other math areas in which the student is particularly advanced or deficient?
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Please describe briefly the topics covered in the past school year.
________________________________________________________________________
________________________________________________________________________
_______________________________________________________________________
In what ways might the student be unprepared for the upcoming year’s curriculum?
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
For students entering the fourth or eighth grades, did this student struggle with any MCAS skills?

________________________________________________________________________


________________________________________________________________________

Please describe any disciplinary issues that you have observed in the student.


________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Are there any other comments about the student that you would like to share?
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Are you available/interested in helping (volunteering) over the summer? (opportunities might involve observing/mentoring/critiquing the senior counselors, helping refine curriculum, chaperoning field trips, providing MCAS preparation to junior counselors – high-school-aged students, etc.)
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Thank you for taking the time to fill out this form. If you have additional questions/comments about the student, the program, or how you can get involved over the summer, , please feel free to contact Mary Catherine Curley or Jonathan Barry, co-directors of the Roxbury Youth Initiative, at ryicamp@gmail.com, or by phone at (857) 233-8892.


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