HomeMy WebLinkAboutNewsletter 1994 summerEnfield Community CurrentsJessla Connors, Editor ; 273-9268
Community
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ur+_ I`D WAY u / / e / is Summer 199i1
of Tar"eimi Cawmr �'ii✓:did%l///,-,i.."---
Community Council News
This years summer camp will run
Wed. July 6- August 5. The camp will
operate Monday thru Friday mornings
8:30-1:00, at the Enfield School, 20
Enfield Main Rd..
Arts and Crafts, Sports, Drama
activities, and Science/Nature projects
are some of the programs planned. A
free lunch program is scheduled from
11:30-12:00, registration forms are
enclosed for both programs.
Linda Hubbell will be the camp
director this summer. Linda Has done
an excellent job running the afterschool
program the past year, we look forward
to her working this summer.
Many staff are returning this year
to the camp and there has been
tremendous intrest on the part of the
youth in the community to volunteer.
Due to the increase of Jr./Sr. high youth
attending camp, we have created a
fourth age group 6th-up. All youth
wishing to volunteer will be assigned to
this group and will get opportunities to
volunteer and participate in the camps
activities.
Bus transportation will be
provided again this year in cooperation
with the Chapter I program. To secure a
place on the bus for your child, return
camp forms as soon as possible to
Enfield School sun: L. Hubbell, ECC,
or Mamie Kirchgessner,
Get into the Sun!!
Swim lessons will be offered again
this summer at the fireman's pond 180
Enfield Main Road. (Approximately 314 of
a mile from the Enfield school).
Testing for assignment will take
place Wednesday July 6, and Thursday
the7th, 1994, Lessons will be scheduled
for afternoons 1:30-5pm.
Bobbie Jo Dekay is returning as the
swim instructor, assisted by MaryEllen
Jackson. Please bring the registration (on
the next page) along with any swim cards
you may have earned. The fee for lessons
is $10.00 but no one will be turned away
for inability to pay.
Preschool news
The preschool held it's last class
May 27, 1994. It was a very successful
year with enrollment up seven students.
This is the highest it has been in two
tears. The preschool is held in the
Enfield Community Building, MWF
mornings. Cathy DelSignore is the
director and is assisted by Laura Owens.
The only mqu:;rernent is t: a your child
must be potty trained If you have any ?
you can contact Cathy at 387-6756.
The Enfield Youth Group
If anyone is interested in meeting
over the summer please contact Carol
Barriere at 277-3843.
**Save October 21 &22 for the
Harvest Festival The seniors have
completed a quilt called "A Tripp
Around the World" tickets will be
available from local outlets and
community council volunteers
shortly.
Editor's Note
I want to thank everyone who
contributed to this edition. For the
next issue I would really like to
include more about local people. If
you, your children, friends or family
receive an award , or celebrate an
anniversary, recently retuned from
an overseas trip or anything that
might be of interest to the community,
please don't hesitate to write a piece
for Community Currents. The
deadline for the next issue is August
15, 1994. Thanks again!
c
SWIM REGISTUATION
• Child's Name PH#
Address
Parents Name
Emergency Contact: Name PH#
I give my child Permission to participate in the Enfield
Community Council Swim Program. I understand that that the Community
Council is not responsible for any accedents or injuries, unless it is
negligents on their part
Signature of Parent or Guardian Date
A Note from the Boy Scouts
Looking for Enfield boy Scout history for the upcoming book
about our town that will be coming out in about a year or 6o- just in time
for the 1996 celebration marking the 175th year since Enfield was
• incorporated. We'd like personal write ups, pictures, memorabilia, or
whatever you have that will help us tell the story of boy Scouts in Enfield.
If you're a former (or present) scout master, can you send u6
the names of the boys who were in your Troop --plus the Troop number. If
you are a former (or present) scout, will you send us the name of your scout
master and the other 6cout6 in your Troop.
If you have some history on the scouts in Enfield but don't
want to write it down, Lanny and Pat will come to your place with a tape
recorder and chat with vou. Your comments will be typed im and tient to
you for checking to be sure that we don't write down the wrong thing.
We'll even come and take pictures of any scout troops now in
existence. Arid last, but not least, any pictures or memorabilia that you
give us will be returned to you if you so wish. Otherwise, the material will be
stored in the Historian's vault --safe and sound for.hlstorical purposes over
the next 175 year, in Enfield.
We thank you in advance, and hope to hear from you. Pat',
number is 272-7095 and Lanny's is 273-6355.
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A PARENT'S CHECKUST FOR BABYSITTER!
AGE:
Age 12 should be the absolute
minimum. Younger children do
not have the emotional or
physical maturity to deal with
many of the problems that
could arise. A good rule of
thumb is, the younger the
children being watched, the
older the babysitter should be.
REFERENCES:
Sitters should provide references
that indicate a proven track
record for showing good
common sense, maturity and
following instructions.
FIRST AID:
Sitters should have first aid
training and know the Heimlich
maneuver for aiding choking
victims. A knowledge of CPR
techniques for infants and
children is also important. Make
sure the sitter knows where your
first aid kit is located.
NO SURPRISES:
There should be no surprises on
either side. Before a sitter is left
alone with the children, fees,
house rules. discipline. etc.
should be clearly discussed.
EMERGENCIES:
Sitters should always err on the
side of caution. If a babysmer
suspects a child in their care
needs professional medical help,
they should get it, even if it
turns out later that it was an
unwarranted precaution.
Source: American college of
Emergency Pliysiaarn. 1993.
HOUSE Rul-Es:
Make sure everyone
understands the "house rules"
in terms of what is permissible.
for both the sitter and the
children. Examples include
whether or not guests are
allowed, telephone use,
allowable snacks, etc.
CHECKLIST:
Keep a list of qualified
babysitters. In case your
regular sitter is busy, you
won't have to take "just
anyone" at the last minute.
41�% Tell the sitter where you will
be and how to reach you by
phone. Leave the number
by the phone.
® Make sure the sitter knows
how to access emergency
medical services such as the
ambulance or the local
hospital. If you have the
9-1.1 emergency number in
your area, explain how it
works and how to use it.
Also, put the number of the
poison control center by the
phone.
q. Give the sitter the shortest
route to the nearest hospital
emergency department in
case he or she must drive
there. If the sitter does not
drive,
make arrangements
with a neighbor who could
be contacted in the event of
an emergency. Explain that
they should use the
hospital's "Emergency
Department" entrance and
make sure they know where
It Is.
L Leave the sitter a list of
current health problems any
of the children have and
what medications or other
treatments are prescribed.
® If the sitter has to give
medication, either measure
it in advance or have him/
her practice measuring It
until you're confident it can
be done properly.
Give the name and number
of a nearby friend or
neighbor who can be called
on quickly for assistance.
® Explain the significance of
the "consent -to -treat" form
(see reverse), sign it in the
setter's presence and Instruct
him/her to take it to the
emergency department if
the need arises. (This form
may not be legally binding
in every state. Check with
your local emergency
department.)
EMERGENCY
MEDICAL
SERVICES
if
DO NOT WRITE ON THIS FORM. USE IT TO MAKE COPIES.
• CONSENT FOR:
MEDICAL/SURGICAL CARE/EMERGENCY TREATMENT
AND CHILD'S MEDICAL INFORMATION
In presenting my sort/daughter for diagnosis and treatment
Name(s):
— Mother _ Father _ Legal Guardian
for
_ Son — Dauahrer
of years of age; hereby voluntarily consent to the
rendering of such care, Including diagnostic procedures, surgical
and medical treatment, and blood transfusions, by authorized
members of the hospital staff or their designees, as may in their
professional judgement be necessary.
I hereby acknowledge that no guarantees have been made to me
as to the effect of such examinations or treatment on child's
condition.
I have read this form and I certify that I understand its contents.
• We/I hereby give our (my) consent to:
(Name of PeaoNAoenty)
who will be caring for our (my) child
(Name of Child)
for the period to
to arrange for routine or emergency medlcaVdental care and
treatment necessary to preserve the health of our (my) child.
W e/I acknowledge that we are (I am) responsible for all reasonable
charges in connection with care and treatment rendered during
this period.
Name:
Address:
Telephone:
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Family Physician:
Pediatrician:
Surgeon:
Orthopedist:
Child's Allergies, if any:
Date of last tetanus booster
Medicines child is taking:
Name of Insurance Carrier:
Group #
Agreement #
Signature
Mother, Farther or Legal Guardian
Date:
Witness
Date:
In case of emergency I can be reached at:
J
NCTSS FROM THE TOWN SUPEI?ISOR - JEAN OWENS
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- JON HUBBEi.L RETIRES FROM TOWN OF ErIFIE?,f, HIGHWAY DEPARTMENT AFTER 34 YEARS OF SERVICE.
Thanks Jon for the many years of service and dedication. We wish you much happiness.
- 24 ENFIELD HOPES RECEIVE MAJOR REPAIR 14ORK THIS SMIER. The renovations are being
paid for by the $40G,000.00 grant Enfield was awarded through the Snal: Cities Block
Grant administered by HUD. Homeowners are low income and must remain in the4r homes
for j years after the work is done. Repairs include such things as major structurl,
water, septic type of work.
- 'GI-N BOARD SEES SECGIqD HOME REPAIR GWtT FROM SMAit CITIES BLOCK G.--R '. Low i^.Come
homeowners interested in being a part of the grant application - please send the
form in to Better Housing found in this newsletter.
- ENFIELD COMY11 ITY BUILDING RENOVATIONS - The Town Board continues to wove oc, e;ans to
replace the roof and create Murdcipal Office space for Town Officers as well as
studying how best to develop the existing space to best serve vouth pro;ra,..dnr
and all other groups presently using the building. The money needed .'or the
proposed work comes from savings made over the past few years throu-;i careful
fiscal manaeement.
- EiFI�ZD GEARS UP FOR UPCOMING 911 EP RGENCY SYSTE,'1. The Town Board and
other Town Officials, and the Fire Company continue to work on providing inforation
for the emergency response system to help auick emergency response.
- TOWN BOARD TG rim WITH BE^ = HOUSI`:, S-KING IZI', ItICOM , SFIIICSHC'jljj:G. In June
exploratory discussions will be takin_; place to determine what the possibilities
might be for an Enfield Senior housins unit.
- i✓.OBILE HO?E PARR CPDIhANJE became e_^ective "lay 1, 1994. lnforution is available
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through the Town Clerk's office.
- JUN:; CAR. / JJNh^YAPD REGUI.A-IONC nav not beer. finalized. This is a difficult issue
for a rural corrmunity to work. on wit- ::an;: di^^grin` needyto consider-.
You probally did not know this, but according to The Town of
Enfield's Local Law No. 1 of Uniform Fire Prevention and Building code
Administration and Enforcment, you must obtain a building permit to erect,
improve, enlarge(additions), even to tear down any structure on your
property. below is the policy on building permits;
SEC:I021 III - ADMINISTRATION AND ENFORCEMENT
A. Buildinc. Permits
1. No person, firm, corporation, association or other organization shall
co=ence the erection, construction, enlargement, alteration, improvement, removal
.or demolition of any building or structure or any part thereof when such activity is
an activity subject to the New York State Uniform Fire Prevention and Building Code
in the Town of Enfield or the use of any building, structure, property, site or
part thereof in the Town of Enfield, without having first obtained a Building
Permit therefor from the Town of Enfield.
2. Application for a Building Permit shall be made to the Town Clerk..
Applicants shall provide such information as shall be required by the application
form together with such other and further information as the authorized inspector
shall reasonably require from time to time. Applicants shall be the owner(s) of
the premises or any other person, firm, corporation, association or organizaticr
authorized to apply by the owner(s) of thv subject premises.
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ATTENTION - TOWN OF ENFIELD RESIDENTS - IMPORTANT NOTICE
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ENFIELD HOUSING REHABILITATION PROGRAM
The Town of Enfield is planning to submit a second application to the Federal government for a grant to
continue to implement a Small Cities Housing Rehabilitation Program in the Town. Last year, the Town
received a S400,000 grant to implement a Town -wide program. This program is available to intone
qualified residents with serious housing needs but funds awarded are not sufficient to meet all Town needs.
If we receive a second grant, assistance in the form of 100% direct grants (no payback) will be continued.
The application will be submitted later this Sumpter, but planning must begin now.
Eligible improvements include: septic, electrical, plumbing, heating, roofing, windows and doors, and
insulation. Exterior improvements that eliminate blight are also eligible. If you are interested in being
considered for participation In the second program, please complete this Preapplication/Survey and
return it in the enclosed envelope. Please return this Preappl►cation even if you submitted one last
year.
PREAPPLICATION/SURVEY FOR HOUSING REHABILITATION ASSISTANCE
Name:
Street Address:
Mailing Address:
Phone: (Home) (Work)
I want to participate in the program if I meet income eligibility and other program requirements.
Signature
Number of Persons in Your Household:
Age of the Head of Household:
Current Annual Income (Check Category):
Under $14,750
23,601 - 24 400
33,701 - 36.350
14,751 - 16.850
24,401 - 26.100
36,351 - 39,050
16,851 - 18.950
26.101 - 26.950
39.051 - 41.750
18,951 - 21,050
26,951 - 27,900
41,751 - 44,450
21,051 - 22,750
27,801 - 30.300
Over $44,450 _
22,751 - 23.600
30,301 - 33,700
_
Color of House:
(Please mark the location of your house on the Map on the back side of this Survey.)
Most Critical Improvement Needs Are (check applicable):
Water Electric Insulation Roof _
Septic Plumbing Foundation Exterior _
Heat Windows/Doors Chimney Other:
Comments:
Thank you from Supervisor Jean Owens and Members of the Enfield Town Board.
FOCUS ON FAITH
F'RST BAPTIST CHHM7H OF E!FIaD CENTER - 174 Enfield Main Rd.
277-6301
• Pastor - Rev. `fdchael Krembs
14ORSHIP SERVICE Sunday 1G:45 a.m. SUNRAY SCHOOL Sunday 9:45 a.m.
BIBLE STUDY Wednesday 6:30 p.m. CHOIR PRACTICE Thursday 6:30 p.m.
PRAISE S=--E announced Sunday eve. YOUTH GRGUtT�� Saturdays call for
SOFTBALL Tuesdays 6:03 p.m. (info. 277-38G4J info. 273-8268, 273-6699
The church continues to grow. There is so much going on that a weekly newsletter
gets handed out each Sunday to keen everyone informed. If you'd like a copy of the
newsletter please tali.
The church family is active in community and world mission work and have ongoing
oroiects to help those in need. Vie tr;., to be aware and responsive to moral and political
issues that are facing all of us. We are working to put sound moral beliefs back into
America, in our schools, and in the workplace.
_OYE JOIN US!
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E171ELD FOOD DISTRIBUTION
ve Care! Don't Go Hungry! If you are out of food,
eo to the Enfield Comminity Building Saturday's between 9:00 a.m. and 3:0G p.m.
Our reeular hours are the first and third Mondays at the Enfield Comminity
Building between 3:3G and 5:C3 p.m. Bring proof of address if possible.
'.'s Call 273-5682.
ENFIELD METHODIST CHURCH
• The Enfield Methodist Church is featuring a chicken barbeque at
the Enfield Firemen's Field, Route 79, on July 2nd. Serving from
lls00 am until sold out, with take outs available. Adults - $5.00,
children under 12 - $3.50. Also featured will be a flea market and
yard sale from 10,00-4:00. Interested vendors may reserve a space
by contacting Florence Laue at 273-7453•
The church has had a bake sale at Willowood this spring and we are
planning others for August 20t:n and September 3rd.
Also, we are sponsoring an ENFIELD COMMUNITY BIRTHDAY CALENDAR.
(Enfield hasn't had one in a long time!) Calendars are $3.50 each
with 1 listing, $5.00 for a family with up to 5 listings, $.50 for
each additional listing. If you'd like to purchase one with or without
a listing, please contact either Florence Laue at 273-7453 or Diane
Sherman at 273-2715• If you have a business and would like to place
an' advertisement, please contact Roger Laue at 272-8035.
All of the above activities are to benefit the elevator fund of
the church. The installation is nearly completed!!
Don't forget our annual combined Methodist/Baptist church service
and dish -to -pass picnic to be held at Newhart's Lodge on June 26th
with services starting at 11:00 am. Everyone is welcome. Come and
enjoy the good fellowship (and good food!).
Our regular services are at 11:00 am with Pastor Earl Andrews. If
you have need of his services he is always available at 273-3919.
• My memory is a little hazy as to what happened its been a few years and
days... perhaps its in my diary or my neighbor can remember better than I. To
pass my memories on to my children and their children is one of the greatest
gifts I can give to them.
"Your children, grandchildren, and mine will live to see a Day
After Tomorrow as different from today as today is from Day
Before Yesterday" Eastman '63
DONATE YOUR MEMORY TO ENFIELD'S HISTORY BOOK
The ENFIELD COMMEMORATIVE COMMITTEE is still working hard on trying to put
together a grand birthday celebration for the town in 1996. We still need lots of
volunteers to head committees for the celebration. We lost a close friend and
member of the Committee this past year - Helen Smith. We will miss Helen and
work hard to carry through her projects and ideas within the Committee.
We have welcomed in two new members Alice Laue and Bertha Hubbell.
Alice Laue has taken over collecting for the Commemorative Cookbook so ... if you
have any recipes please contact Alice. Some of the other projects the Committee
has been working on are: Hot Plate Trivet. Gary Fisher has been making
arrangements to have a beautifully drawn map of Enfield and the Old Mill to be
placed on the trivet. This will be sold in 1996. Wall Hanoinq. Wilma Fisher has
been diligently looking for help in sewing a Commemorative Map Wall Hanging to
be used at different events in 1996. If you know how to sew give Wilma a call.
Nina Linton had initiated a group of sewers for a Commemorative Quilt to be
raffled off in 1996. The Quilt is finished and waiting for those raffle tickets to be
sold. Commemorative Logo. Christine Finnigan, Art Teacher at Enfield
• Elementary School, has been working with the children at the school to submit
designs for a logo to be used during the Birthday Celebration. All designs will be
used in displays during 1996.
The Enfield History Book is slowly coming together. We have had some
wonderful contributions from the Fire Company, Women's Auxiliary, and a few
businesses in Enfield. One author submitted a wonderful history on the Post
Offices which were once in Enfield. If you have any writings you would like to see
in our Enfield History book let us know now. WE DESPERATELY COULD USE THE
HELP IN WRITING AND RESEARCHING ENFIELD - we need information of
involvement in the military, local schools, businesses. doctors, anything and
everything that involves Enfield and the people who live and lived there. IF YOU
ARE SIGNED UP AS AN AUTHOR FOR ONE OF THE SECTIONS IN THE HISTORY_
BOOK WE NEED YOUR SECTION WRITTEN BY SEPTEMBER 1996.
At the March 16, 1996 Birthday Event we hope to have guest speakers,
rededicate the town and ring all the bells and horns in Enfield on March 16... are
you ready!1!!
The Commemorative Committee meets the 4th Wednesday of each month at
the Town Hall - 7:30 p.m. everyone is welcome to come and join in.
Thanks for reading this - Enfield Commemorative Committee - Sue
Thompson (272-6412)
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TOMPKINS COUNTY PUBLIC WORKS
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• SOLID WASTE DIVISION
122 Commercial Avenue
Ithaca, NY 14850
BARBARA A. ECKSTROM Telephone (607) 273.6632 SOLID WASTE MANAGER
FOR IMMEDIATE RELEASE
Contact person:
Bill Seavey, Financial Analyst
273-6632
The Tompkins County Solid Waste Management Division has received
many requests for information on tenant's responsibility for paying the Solid
Waste Annual Fee, and there have been many misunderstandings. The Solid
Waste Annual Fee is not charged by the County to tenants, and the County does
not require tenants to pay this fee. Anyone who has been told that the County
has forced landlords to collect the fee from tenants has been misinformed. The
County will not pursue claims against tenants for the fee. The fee is charged to
property owners, and failure to pay could result in a lien on the property.
• Tenants must pay the fee to a landlord only it their lease requires tenants
to make such payments. If tenants have been told by their landlord that they are
required to pay the fee, or if a landlord has withheld money for the fee from a
tenant's security deposit, the tenants should consult their lease. If their lease
does not require the tenants to make such payments, the tenants need not pay
the fee.
Ss^ e^ tow clerk' hours fro- Ju e '_Et. until September 20th will be Tuesday's
a/.rt.., and _ M., tsednesday's 4:00 - 7:GG p.m. arxi
The Enfield Fire Department's Ladies Auxillary
is looking for any information or pictures related to
thief past activities. the Auxillary wants to document
the history of the organization. Anyone having
information should contact Annabelle Seamon 273-4938 or
Fern Ferris 533-4938.
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TRAVELERS' F[RsT AID Krr
'he American College of
emergency Physicians has
ompiled the following list of
terns for a Travel First Aid Kit.
his list will provide you with
he necessary "tools" to handle
nany medical emergencies.
Prior to any foreign or
iomesm travel, check with your
foctor and travel clinic or public
)ealth department for specific
�egmred immunization/
Jocumentation for you and the
area you are traveling.
For the kit itself, a tote bag
is recommended because it can
hold all the items listed and is
easy to carry. Never store your
kit in your luggage: put it in
your carry -on bag — always keep
it with you.
Follow the same
precautions with your first aid
kit as you would with any
medicine. Store out of reach of
children and only use products
with child safety caps.
BEFo1E You LE:AvE
+ Visit your doctor prior to
traveling. Have your
doctor prepare a medical
summary listing medical
problems, operations,
allergies and a copy of your
most recent EKG. If you
wear corrective lenses. take
an extra parr on your tnp
and carry your lens
Prescription with you. Have
TB skin test results recorded
by your donor.
+ Ask your doctor to list
any medications you are
taking, using both generic
and brand names. Be sure
to pack enough medication
for your trip.
+ Check your medical
insurance policy and
health plan for coverage of
illnesses or accidents
outside the U.S.
+ Assemble Travelers' First
Aid Kit.
SUGGESTED
CONTENTS:
+ Aspirin, acetaminophen,
or ibuprofen: For
headaches, pain, fever, and
simple sprains or strains of
the body. (Aspirin should
nor be used for relief of flu
symptoms or given to
children.)
+ Antihistamine/
decongestant cough
medicine.
+
Antinausea/motion
sickness medication
+
Bandages of assorted
sizes, including adhesive
bandages: (i.e., Bandaids)
+
Adhesive tape and 2"
gauze: For dressing
wounds.
+
Elastic wraps: For
wrapping wrist, ankle, knee.
and elbow injuries.
+
Triangular bandage: For
wrapping injuries and
making an arm sling.
+
Scissors with rounded
tips.
+
Rubber gloves: To reduce
the risk of infection.
+ Disposable, instant -
activating ice lugs: For
icing injuries and treatino
high fevers.
+ Ani ifungal cream
(tolnaftate 1 % or
dotrimazole 10l6): good
for athletes' foot or
ringworm.
+ Antibacterial ointment.
+ Antibiotic ointment: For
burns, cuts. and scrapes.
+ Thermometer with case.
+ Sunscreen: Number 15 or
higher.
+
Insect Repellent: Those
that contain 35-559/o DEET
with stabilizer.
+
Anti-Diarrheal
Medications: (i.e. Pepto-
Bismol, Imodium A-D)
tablets or liquid. follow
directions carefully
+
Anti -malaria medications
(if indicated)
+
Water purifying pills or
liquid (Tincture of Iodine or
Halazone tablets), or
mechanical filtration
devices, such as Katadvne
water punher.
+
Steroidal Cream, such as
hydrochordizone cream:
for insect bites.
+
Tweezers: To remove small
splinters and ticks.
+
Safety Pins: To fasten
splints and bandages.
CHILD' S NNM FS AFLC QISE no. CSIID' S JVm TS—AFMOld no.
PART 2 - CQ'M=-- THIS PART FOR ANY CAIIDREN !Dr DIIDDED IN A FS/AFDC CASE.
r-u • r r:u • . r-n • - r r-u
PART 3 - IF YOU LISTED ANY CAIIDREN IN PART 2, YCU MUST CCl.TL= THIS PART.
LIST HVE3UCHE rN YOUR HWSFMZ. LIST GROSS DCUM RECEIVED Hy EACH PERSON
By 9XTCZ LAST MDNIA (before deductions).
Welfare/ Pensions/
Naae Wages Support SOC.Sec. Other
1VD(L IN TOM
BCDSImn mcmmr D'ime —
In sane cases 1umm CminFEN are eligible for free or reduced seals regardless
of household incoae. If you wish to app1Y for a foster gild, please contact us.
• PART / - PLEASE r= YOUR CR=IS RAC /LmaC IDER'ITY. YCII ARE NOT RFI==
TO AN317ER 'IRIS. BUT MUS DO''DRIATICN ENSUtff'S E.VEWCM ==VFS BESffE M FA13SS,
FD CUME NnZ BE DLL AGAINST DUE TO RACL, SIX, CM3L MT'L Ci=IH,
ArE OR BAMrMp. _.RSTE or _JUAa (not of Hispanic origin)
__MSPANIC _/SIAN/PA=C M. _AME3.DDLAN/AIJ%mW
PMV1LTIPS FOR PUSREPREMnXTION' I certify that the anove inforsation is true
and correct i all incoae is reported. I understand this is being given for the
receipt of Federal bads, the sponsor say verify it and that deliberate misrep-
resentation say subject me to prosecution under applicable State/Federal lawn.
ADULT
s>r� a RAZZ
SCCIAL
SHCUlU.TS
HUOimm-
�
r rr
CmCE USE Qd.Y( /_/ ELICDII.E /_/ IL=Gmx Sessiont
(reason)
Signature of Elicibility Cfficial
E
Date
ENFIELD COMMUNITY COUNCIL WEER DAY CAMP PROGRAM REGISTRATION
Child
Grade Completed
Parents Names
Address
•
Me Birthdate
Interests
Hone Phone
Emergency Phone
Person to contact if Camp is closed early Phone
Confidential Medical History. (as recuired by Public Health Law Part 225)
Doctor b Phone t
Immunization Dates for:
Diptheria
Poliomyelitis
Measles
Rubella
Mumps
Tentanus
Has your child ever had or currently
suffers from: (If yes, please give date and
any pertainent information needed to
provide adequately for your child)
Amebiasls
Meningitis
Anthrax
Aseptic
Babeslosis
Hesophilus
Botulism
Men ingococol
Brucellosis
other (specify type)
Ca pylotactenosis
meningoc9Renia
Chancrold
LWe
Chicxenpox
Pertussis Ivtpoping tough)
Cholera
Plague
Diptheris
Poliomyelitis
encephalitis
Psittac is
Disrdiasis
Rabies
conococcal infection
Rare" syndrome
Dranuiome ingulnale
Pat1T M tzin spotted fever
He,ophilus Influenne (invasive diseasel
Rubella
Hepatitis IAr B: non A. Mon BI
Ccrtyntul motile syndrome
Histonlasaxals. nev cams
salaonellosis
Aauasast Sy. rome
snlgellosis
Legionellosis
Syphilis, specify stage
prosy
Teunua
•
Le
I<De osptrosls
Ttnle 5hoee synf come
Lyme disease
Trlchinosts
Lyeprogranuior,a veneream
Tuberculosis
Malaris
Tularemia
Measles
Typhoid
TyMus
Yellm raver
yeralnlosis
Is your child currently under treatment for any medical condition or require any
medication: If yes, please provide details:
List any allergies, etc.
The Enfield Community Council Summer Program is partially funded by the New
York State Division for Youth, matched by money from the Town of Enfield and the
United Nay. The balance of the cost of this program must be raised but no child
will be turned away for inability to pay. I am including a donation of
to maintain quality activities for my child.
I give my child permission to participate in the Enfield Community Council
Program. I understand that the Enfield Community Council is not responsible for
any accidents or injuries, unless there is negligence on their part!
Signature of Parent or Guardian
Date
Return to: M. Kirchgessner, 191 Enfield Main Road. Ithaca, NY 15850
•
In Hev York Stele Aaaer raopa [prat Mve ..tat.. city a r,wn'Ybe to cr e d"Ite,t
pernlI to opera" /gdly, There- Perri[. Are %a+ued only 1t tie coop
with the et.t., health cgwbtlarce. Tho petit to operate rust hedi epl sYW In a con-
aplcwm plan on the prenleoa.
The rip east he Inspected twice Yearly by A Health Wfartab't repreear"t lv.. At
the
IrMeked of 1mie sure that the Phloiearat two await c.lnlac{liti~ s� c� 1- 1. operation. fjwh and that 10 tvialw I.c� 1.
.dqw".
W. ctooe5N . Aware[ can, for their children. parents W guacdi.n. fI",eot Ly
ant the follr,lcag "at'":
SLII Otritivirms
Mat Aar the pullticatl ao of the cap dlrecta}
fhe Haw took Stara IrAlth Cab raPwlo. that the director of An overnight cup W
at I.AAt }S at. old a hold A ocMlor'. Ogres: a day cap directorr.wt b At Iwet }l.
all diractore ant Nv...pedaar. In cooing sdrinlatIetlon or o aloe. CAo dilac[oo.
bckgrornh or. ecr..ned by the Stan Cart'.I Ifglstry fa 011d Musa And Mltnst~t
for reported Incident. of child ahoaa read "it...taawt. Tn.ir b.ctgrorrd. At..%an
acr.aeal by two 1Nslth Departsant for crinlcul conrictlons. thlY inllrtduals ea
erar. con-
.IdW to pas ro Ilse to cAo.rs are AcceptW by the Haelth Depatteent Me Carp dlrertora
Nat are the pallflcatiau of the carp coucTdael
At de, c+ia• coaarlae wet b 16 yn.. oo older. Mv. One Yere'• ..Pi.. as e
)arnloo corrals a caaa.loo-Ir�t"Inl1q .Wow far. Attended A pr.-c.o neia n"tlon
progrr. The rtaff-to-ron,el let" aust b 1:12. In .dlltlen, eprclal "pica and toucrla
pal{flt.[fam I. eadated to owperw\.low of Niniry. Arcto,. riflery and ort-of-care
trip activitlaa.
trAIL"
1e A data a raMee In r.Aldarca or on call to raper. At .11 [IwsT
RayalclN a raralrq eervlcro rust be ...11ahl.. All .renfr CAAps In HN York State
at. ra Jiod to MAncona,w. written A.dlc.l plan. AfpeowW by the "..Ito pep.rTAwent. The written
plen suet Include Ancona, other ChiN., prwl A lore fa aeunu dll, rsing Andfirst aid
aervlpee. In JrrlAA W 111nase" Are rtwlre, to b [Poona, to the H"Ith bpertnnt And
a. Ihooniaghly r.wkr .
Cora the cup raWir. erdlcAl acord, for caap.rs}
In How Yak Stara, crepe of keo currant radical hl.tory repacte on file for all
c..pe". M nor. to detail " Illnae. disability of 0aro enwl-111 kd beto a ad'"r a)
thet Afflict ywr child. Special dial. Are;aatl.ityetr
A,. ", ,ape Mcllrt ien ecd act lrit lea oslet
tree can, opereto A.et develop A written cane "lecy plan to mole o pewlalona for
[ninirg a"I[ seen" red orlen"elco of cede". CanpAlte herald- am natetY pr«eduro
foo prx,ran lctivillt..
.WH SMUT
Arir there periodic fire drill. for both crepes Arai etattl llaa earn Ilwc of Necy
pMi ool IN we fit.
tce)it, in Iwo
� Y frwe.ct lvltyrcen"rerandl kp nuMel lock And I Ley}lice
c,i
ell of the above ere eadatory in rNv Yora State.
N� M PAMCIS Ant) aWmlaili
InvolvTo lrgnyoorf child, joalor,,N as 1. In}orythe ran, director Or ,l III--- or sstwa. of any Incident
To r.vi. in.pactlon And Invwl"tlon report. for a carp. Mich are nit."Ired
of the local health unit Isaoing the carp a pecait to ape"" I".sent And Poor «port.
Aa a .rdleble. )
on fit. atrboth the com And wYt
the. tlthg Unit ("I I" Parnit"plane.
Ara
.6yof;MIt1T}O V M rdw
A '"lows you and the local health —it it youchild Is Involved in Any eeriwa
I.Jury. 111be. Or aers. Incident.
To screen the bckgroud And Palifi"Ilona of .11 tell.
fo provide supervision foo .11 racers - }a hwre A day at ovecnl i't cope. And
dortm fours of cpe"tlon for day I-"
To nintein all can, Nrysicel hcililbe in A sale And a.olcery condition.
to preside safe And sholeavr nala.
b have end "low reWlr d plane for CAW AafotY• health and fire "ety
Tb nobly the parent or g acdkan. with the enrollawnt Application no encollwnt
,contract. that:
.the cane teat Mve A peralt to atM[&ta fcb the Hew, York Stet.
Drpar"rrrt of "Aalth a the b.J"td panit-leaolnq official:
.the cup la 1"1Id to be lnepacted twice y... ly: and.
.eM lnapectton I. and ceylred plane or filed Issdreae of atotal
coe,ty a city health deport rent) red avAila • for theft rNIN.