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MEDICAL PHYSICAL FORMSPursuant to New York State DOH Regulations, eachcamper is required to have on file, a current annualphysical exam, a current PRN sheet (as needed/over the counter medication sheet), the currentyear’s Medical Clearance, which must be signedor stamped by the doctor in order for camper toattend camp, and a current copy of the camper’simmunization record. In the event that vaccines arenot received due to an underlying medical condition,documentation must be submitted from the doctor.Please note that there are no more religiousexemptions for vaccines. Proof of blood level titersfor immunity are accepted and required in theabsence of the vaccine, underlying medical condition,and/or religious beliefs.*If campers have specific MEDICAL GUIDELINES(e.g. seizures, insulin, bowel protocols, etc.) theseguidelines/directions should be included with themedical forms to the Health Center to ensure thehighest level of camper safety. For example, if achild has not had a bowel movement in 5 to 7 days,it is standard that they will be sent out for a medicalevaluation unless otherwise noted by an MD.Annual physical exam, medical clearance,immunization record, PRN form, Diastat letter forcamp transport, prescriptions and adequate supplyof medications are required for camp attendance. Werealize that there are insurance challenges and specialexceptions. We will assist you in facilitating theseitems from your doctor if you require assistance, butfor everyone’s safety, campers will not be permittedto attend camp unless we have each of these medicalforms prior to your camper boarding the bus.A physical exam form is considered current if thedate of the exam was within on year of the camper’sattendance at camp. Example: Joe Smith is attendingSession 1 (June 14, 2020 - June 28, 2020) and thedate of his annual physical was July 11, 2019. Hismedical exam is current. If the date of the examwas June 18, 2018 that would not be consideredcurrent. If the current physical exam will expire whileat camp, a visit to the doctor will be required prior toattending the full session.Contact us immediately at our Nursing Supervisor’soffice if there are any medical changes after yousubmit the physical forms. Every camper attendingour program has a special medical care plan, and wemust update it accordingly. Early notification to ourHealth Center helps to avoid confusion andpossible safety risk.Annual Physical Exam, PRN form, immunizationrecord for all campers and Medical ClearanceDiastat letter (if applicable for transportation tocamp) is due to the PLAINVIEW Camp Office byFEBRUARY 1st or no later than one week after theAnnual Physical Exam, if after February 1st.Any questions should be addresseddirectly to the Nursing Staff atCamp Loyaltown at 518.263.4242 Ext. 125For those campers whose date of annual physical isin the days just prior to their camp stay, the nursingdepartment must be notified directly.For the purpose of camp, all “over the countermedications” are considered the same as prescriptionmedications and require a doctor’s prescription inorder for our camp nursing staff to administer them.This includes vitamins, as needed allergy medications,supplements, etc. Doctors can list the “as neededmedications” (not on the PRN list) on the signedphysical form and that will suffice as a doctor’s order.9

PAYMENTSELF - DIRECTION / MEDICAID WAIVERIf your camper has been enrolled in self-direction or medicaid waiver, we will need thelife plan that is generated by your camper’s care manager. Please be aware that we arelisted in the HCBS waiver services section. The self-direction plan or medicaid waivermust cover the time frame of the 2020 Camp Loyaltown season and be sent before yourcamper’s stay.TYPE OF SERVICE: RESPITESERVICE PROVIDER: CITIZENS/CAMP LOYALTOWNPlease note: we cannot accept documents that read AHRC or only Camp LoyaltownAdditionally, for those enrolled in self-direction, we require a budget for the personbeing supported. Please ensure your broker has contacted our office for the proper rateand units needed. The rate for Camp Loyaltown continually changes as it is set by theCenter for Medicaid Services (CMS). Other factors will also affect this rate, which caninclude behavioral and medical needs of the camper.Please Note: If the required documentation is not submitted in a timely manner, you willjeopardize your camper’s placement.SCHOLARSHIPSPRIVATE PAYTo apply, the scholarship requires awritten letter of need for your camperand a recent W-2 for the household.Please be aware that grantedscholarships are need-based anddependent on available funds.Private pay rates are dependent onthe camper’s county of residence.Please call the Camp Loyaltown officedirectly at 516.626.1075 Ext.1453 foradditional information.ALL PRIVATE PAYMENTS MUST BEMAILED PRIOR TO THE CAMPERATTENDING, AND CAN BEFORWARDED TO:TO LEARN MORE ABOUTCAMP LOYALTOWN SCHOLARSHIPOPPORTUNITIES, VISIT:www.camployaltown.org/scholarshipCitizens Options Unlimited/CampLoyaltownAccounting, #5189 Wheatley Road,Brookville, NY 1154510

BUNK 1Bunk1.com is the source of ouronline application and camper database.PHOTO RELEASEIf you are a returning user, please knowthat each year all medical questionsare cleared so that families can provideupdated information.Only if you select ‘yes’ to the photoagreement at the end of yourapplication, should you expect to viewphotos of your camper on Bunk1.In March 2020, you will receive aprinted copy of your application,please carefully review this documentfor any errors.Hundreds of photos are uploadeddaily throughout the camp season.If you have opted-in to the photoagreement and are still not seeingphotos of your camper during thesummer season, please contact thecamp office at 518.263.4242.We ask that you complete theapplication as thoroughly as possible.It is mandatory to provide anyadditional plans (behavior plans,eating guidelines, ambulation guides,etc.) This is critical in providing thehighest quality of care.Please Note: Photos are throughlyreviewed by our Social Media Counselorsand a representative of the CommunityResources department prior to beingposted to Bunk1. This will occasionallycause a delay in publishing over weekendsand holidays. We appreciate your patience.If you are having difficulty accessingBunk1.com, please call our office at516.626.1075 Ext. 145211

CAMPER HOUSINGThe Camp Loyaltownadministrative team isresponsible for placingcampers in cabins. Whenmaking placements, thisteam’s considerationsmay include, and are notlimited to the camper’swishes, age, gender,ability level, socialpreferences, behavioraland medical issues.Housing requests aretaken into consideration,however these requestsfor specific placementare not guaranteed.Camp Loyaltown has 32 cabins for campers/counselors. Those32 cabins are divided into 5 units, with 3 to 4 cabins in each unit.Each unit has one Unit Head, who oversees the cabins, bothcampers and the staff.The assigned Unit Head will be your contact and will reach out toyou prior to your camper’s stay. Please make all communicationneeds and preferences known at this point.The Unit Head has direct contact with counselor and camper torelay any pertinent information. If you would like to speak directlyto your camper, the best time of day to do so is between 6:00p.m. - 7:00 p.m. This can be arranged through your Unit Head.We ask that you do not exchange phone numbers with thecounselors who work directly with your camper, as we ask that theydo not use a cell phone during their work day so that they canprovide the best possible care and supervision to each camper.12

TYPICAL DAY ATCAMP LOYALTOWN8:00 a.m. - 8:45 a.m. Wake Up And Line Up9:00 a.m. Breakfast10:00 a.m. - 11:10 a.m. 1st Period11:10 a.m. - 12:30 p.m. 2nd Period1 p.m. Lunch2:00 p.m. - 3:00 p.m. Relaxation Time3:00 p.m. - 3:45 p.m. 3rd Period4:00 p.m. - 4:45 p.m. 4th Period5:00 p.m. Dinner6:15 p.m. - 7:30 p.m. Evening Activity8:00 p.m. Cabin TimeOur 1st, 2nd, 3rd, 4th and 5th period activities include swimming, nature, ceramics, cooking,drama, music, athletics, arts & crafts, dance, sensory room and when available, our equineprogram.Our program team works effortlessly to provide creative, person-centered activities. If youor your camper have any ideas to enhance our program, please let us know!Our evening activity, referred to as ‘EA’ includes our dances and spirit nights.13

MEALS/NUTRITIONCAMP LOYALTOWN IS PROUD TO PROVIDEA MEAL PLAN INCLUDING 3 NUTRITIOUS MEALSA DAY SIGNED OFF BY A DIETICIANAll meals are served family-style and eaten inthe Dining Hall. Campers are assisted in whatevercapacity needed, taking into account specificeating guidelines, which are posted to eachtable setting.If a camper has a special diet, including glutenfree or food allergies, please provide thisinformation on the camper’s health form to besubmitted to our Health Center. We prioritizemeeting all dietary needs so that family membersdo not feel the need to send food to camp.If there is a need to send food, please labelany food items DINING HALL along with yourcamper’s name. We request that no food be keptin a camper’s bag for snacking as we require alleating be done in the Dining Hall.14Please Note: Written doctor’s orders arerequired for liquid or anyother type of supplement.These must be sent to theHealth Center or brought tomedication check-in. If you are sending food to begiven with medication, pleaselabel it Health Center. If your camper requiresadaptive equipment, this mustbe noted on the application. As Summer 2020 approaches,we will post the menu onwww.camployaltown.org foryour review.

PACKING LISTSUGGESTIONS FOR A 2 WEEK STAY AT CAMP LOYALTOWNCLOTHINGPERSONAL ITEMS 8 - 10 shorts shampoo & conditioner 10 - 12 shirts liquid body wash 2 long pants diapers 3 sweatshirts swim diapers 2 sweatpants extra pads for bed 12 underwear toothbrush & toothpaste 12 pairs of socks deodorant 2 pairs pajamas brush/comb 1 medium weight jacket sun block (at least 30 spf) 2 - 3 bathing suits sanitary pads (women) 3 washclothsAll campers are given sheets, blankets, pillows, pillowcases, and towels. 2 pairs of sneakers 1 additional footwear for rainy weatherCampers are not permitted to bring alcohol, firearms orweaponry, or fireworks to Camp Loyaltown. 1 pair of heavy-duty covered toe sandals 1 pair of water shoesIf a camper chooses to bring sporting equipment, theseitems must be stored within a locked shed on campgrounds. 1 raincoat , poncho, or waterproof jacket 1 pair of jeans ( if participating inhorseback riding)There can be a delay in returning lost and found items,as our program remains in Hunter, NY until September.We do our best to return items as quickly as we can. 1 pair of heeled shoes (if participating inhorseback riding) 1 dressy out fit for ‘banquet night’We request all items be labeled with the camper’s first& last name with permanent markers or sewn on labels.15

LUGGAGEPlease pack all of your camper’s clothing and otherbelongings in one suitcase or duffel bag. Your campermay also bring 1 carry-on. All luggage must be broughtto the bus with the camper on the day of travel. Pleaseremove all previous travel luggage tags and attach onlythe current 2020 Camp Loyaltown luggage tag. Food ormedication should not be packed in any bag. Pleasekeep in mind, Session 5 & 6 campers only require half ofthe above items.If the camper uses the following, please be sure to sendalong extra: A bsorbent Waterproof Mattress Pad or Disposable Pads W ipes D iapersINSTRUCTIONSFOR SENDING OTHERESSENTIAL ITEMSDiapers: In addition to sending extradiapers, those campers who haveincontinence issues should bring moreclothing than listed, specifically moreundergarments, pants, shorts andpajamas.Glasses, helmets, hearing aids or otheradaptive equipment: These items mustcome to camp with the camper’s namesecurely taped to them or engraved onthem.Please Note:INSTRUCTIONS FORLABELING CLOTHESClothing should be labeled so the full name of thecamper is visible when the article is folded. For example,any item with a neck or waist should have the name onthe inside of the back part of the clothing.Take inventory of every item sent to camp to indicate thequantities on the list as a guide. Send a copy of this list inthe camper’s luggage.16 All adaptive equipment must arrive atcamp in good working order. If you aresending a wheelchair, everything mustbe operational, such as seat belts,brakes, etc. Orthotics must be labeled with a L forleft or R for right so that staff can puton the orthotic correctly

TRANSPORTATIONALL DROP-OFFS AND PICK-UPS TAKE PLACE AT189 WHEATLEY ROAD, BROOKVILLE, NY 11545When you arrive on campus, follow the signs for the Brookville Center/Cissy Birnbaum Building. Our Coachbuses will be arriving & departing directly in front of this facility. Please park only in the parking lot, our busesneed ample room to turn and drive on the property. Buses leave promptly at 2:00 p.m.DROP-OFFYOUR CAMPERPICK-UPYOUR CAMPERSession 1June 14thArrive 1:15 p.m.Bus Departs 2:00 p.m.June 28thBus arrives between11:15 a.m. - 11:30 a.m.Session 2June 28thArrive 1:15 p.m.Bus Departs 2:00 p.m.July 12thBus arrives between11:15 a.m. - 11:30 a.m.Session 3July 12thArrive 1:15 p.m.Bus Departs 2:00 p.m.July 26thBus arrives between11:15 a.m. - 11:30 a.m.Session 4July 26thArrive 1:15 p.m.Bus Departs 2:00 p.m.August 9thBus arrives between11:15 a.m. - 11:30 a.m.Session 5August 9thArrive 1:15 p.m.Bus Departs 2:00 p.m.August 16thBus arrives between11:15 a.m. - 11:30 a.m.Session 6August 16thArrive 1:15 p.m.Bus Departs 2:00 p.m.August 23rdBus arrives between11:15 a.m. - 11:30 a.m.Session 7August 23rdArrive 1:15 p.m.Bus Departs 2:00 p.m.September 6thBus arrives between11:15 a.m. - 11:30 a.m.SESSIONPlease noteBus SafetyNo pets are allowed. Pleaseprovide advanced notice if yourcamper travels with a service dog.No parents can board the busAll campers must be supervisedwhile on the Brookville campusgroundsStaffing on all buses will be at least 1:5All campers must remain seated with seatbelt fastened throughout the bus rideunless they are using the bathroomNo eating is permitted while on the bus. Water is the only allowed beverage.Please ensure that your camper has eaten and taken all appropriate medicationbefore boarding the bus. We will not have nursing staff on the bus.17

TRANSPORTATIONFAY J LINDNER/ADVANTAGE CAREBUS LOADING/ UNLOADINGDO NOT PARK HEREDO NOT PARK HERECISSY BIRNBAUM BUILDING/BCCS CENTER NURSE’S OFFICE:Approved medicationdrop-off onlyDOORTABLE 2TABLE 3TABLE 4A–GH–MN–QR–ZINFOTABLE 1BUSES ONLY — BUSES ONLY — BUSES ONLY — BUSES ONLYPARKING LOTPLEASE PARK ONLY IN THE PARKING LOT. THE COACH BUSES NEED SPACE TO TURNTables for check-in will be set up accordingto the first letter of your camper’s last name.Table 1: A-GTable 2: H-MTable 3: N-QTable 4: R-ZWhen you arrive, please bring your luggageto the appropriate table to check-in.A Camp Representative will provide abracelet for your camper which should beput on at immediately at check-in.Once you are provided with a bracelet, theCamp Representative will provide you witha Bus # and assist you with your luggage.Please Note: Medications, PRN (as needed/over the counter) or otherwise, shouldNOT be transported in the camper’s luggage or on the camper’sperson. Please DO NOT leave notes about your camper’s medications ormedical care inside their luggage; please communicate directly withthe nursing staff prior to busing. Changes in medication should not be brought to busing, pleasecommunicate with the nursing staff prior. No medication will be accepted at busing without our authorization. No medication will be given on the bus with the exception of anemergency Epipen. Please communicate any new health concerns with the NurseManager prior to the day of departure. If your camper comes tobusing with new health concerns, they will not be permitted to ridethe bus to camp.18

TRANSPORTATIONDRIVING TO CAMP LOYALTOWNFOR PICK-UPS OR DROP-OFFSIf you want or need to drop-off yourcamper at camp, then you should planto arrive no earlier than 4:00 p.m. on thefirst day of the session. Unfortunately,we will not have appropriate staffingavailable until that time.To pick up your camper, you shouldarrive between 9:00 a.m. - 10:00 a.m.on the final day of the session.Please note, if you are dropping off yourcamper, this is not the time for meetingswith the nurse or other camp staff. Weneed to have all staff available assist withcamper arrival/departure. All necessaryconversations should take place prior toyour camper’s arrival.If someone other than the parent/guardian is planning on picking up yourcamper, please contact the camp officeand provide written permissions.OUR RETURN TO BROOKVILLEPlease know that we do our absolute best toleave Camp Loyaltown on time and to arriveas close to the scheduled time as possible.Traffic, weather, and other factors may bringus to Brookville earlier or later than stated. Weappreciate your patience and understanding.Bus numbers for your camper will be postedon the BCCS building for you to check. Pleasekeep in mind that your camper may not arriveback on the same bus they left on. Uponarrival, camp staff will unload all luggage,including project bags.Please Note: Any camper who is not met by a parent/guardian upon arrival at Brookville, willstay under the supervision of a camp staffmember until a parent/guardian has arrivedon site. If someone other than the guardian ispicking up your camper, written permissionmust be provided.19

FREQUENTLY ASKED QUESTIONSHelp! I do not see any photos of my camperPlease e-mail the camp office atcamp@citizens-inc.org. We will check to see ifthere is a photo release on file. If there is not,we would ask you to sign one. This is the onlyway you can view photos of your camper onBunk1.com.Will I meet my child’s counselorat busing?Busing is staffed to ensure everyone’s safety,however we cannot have all counselors on thebus. You will have the opportunity to speakwith your child’s Unit Administrator.The camper is independent, can I sendmedication in luggage/can they carry itthemselves?No medication can be placed in a camper’sbag, or carried on the camper’s person. Thisincludes vitamins and supplements or lotionsand creams.Can I talk to my camper’s counselorwhenever I want?Unit Heads will be your point of contact, andwith their support you can schedule phonecalls with your camper and your camper’scounselor. Scheduling calls will ensure theirdaily activities are not interrupted.There are no exceptions.When can I apply for next year?Our application goes out in October. Pleasecheck Bunk1 and www.camployaltown.org formore information.The camper utilizes Self-Directionfunding, my broker said I can add morethan two weeks in the budget, is this true?Camp Loyaltown is a Medicaid WaiverProgram. We are able to bill Medicaid Waiverdirectly. The most we can bill for is 14 calendardays per calendar year. If a camper wants toattend more than 14 calendar days, they wouldhave to privately pay Camp Loyaltown. If youor your broker have any questions, please callthe camp office.My camper will be attending for severalweeks, can the camp staff cut fingernails/toenails?Please ensure that you trim your camper’sfingernails/toenails before they arrive. Ourcamp staff can file nails, but are not permittedto cut nails to avoid potential infections.The camper came home with 1/4 of theclothing/items that they brought withthem. How can I get them back/getreimbursed?Unfortunately, we cannot replace any missingitems. If you are missing an item, please callthe camp office so we can immediately let theUnit Head know. We will try to get it back toyou as soon as possible. Please remember toalways label your items with both first andlast names. Camp Loyaltown will notreimburse for lost items.How can I find out if I sent in myHorseAbility paperwork?As Hors

Camp Loyaltown is a program of Citizens Options Unlimited, providing year round respite opportunities for people of all ages in Hunter, NY. NYS Department of Health (DOH) visits Camp Loyaltown once before the start of the summer season, and once during the season. Copies of DOH reports can be found in the Camp Loyaltown office on request.