Frontiersmen Camping Fellowship

Size: px
Start display at page:

Download "Frontiersmen Camping Fellowship"

Transcription

1 Explorer Territory North Star Chapter Frontiersmen Camping Fellowship Application for Membership (Please Print Legibly) Print Name: Phone: (First) (Middle) (Last) Address: Tee-Shirt Size Age: Birthday: Section: Chartered Outpost Church Name and Address: Non Royal Ranger activities involved in at church: Requirements for Boys Be 11 years old or graduated the 5th Grade Complete the Big Adventure Camp and Fall Trace in the same calendar year Be an active member of Royal Rangers Earned 1 of the following : Discovery Gold Eagle, Adventure Bronze Medal or Expedi on E1 Award Be 18 years old or older Requirements for Leaders Complete the Big Adventure Camp and Fall Trace in the same calendar year Be an active member of Royal Rangers and in good standing with your church Earn the Ready and Safe levels for the Outpost Leader. A end either the NRMC, NEEC or WCO Na onal Training Have a genuine interest in the camping aspect of Royal Rangers Have a genuine interest in the camping aspect of Royal Rangers Submit a 300 word essay Why you want to be in FCF If problem with writing then needs to be able to explain why at camp 3 recommendations need to be completed on the back of this form Submit a 300 word essay Why you want to be in FCF 3 recommendations need to be completed on the back of this form Note: This application and your essay need to be mailed to the FCF President no later than July 8, STATEMENT OF PURPOSE: The goal of the Royal Ranger Ministry is to Evangelize, Equip and Empower the next generation of Christlike men and lifelong servant leaders. Realizing the Frontier Camping Fellowship upholds this purpose in its fullness, I agree to live by the ideals set forth in the above requirements and hereby submit my application. Applicant s Signature: Date: Revised

2 RECOMMENDATION OF BOY S SPONSOR: SPONSORS S SIGNATURE: DATE: RECOMMENDATION OF OUTPOST COORDINATOR: COORDINATOR S SIGNATURE: DATE: RECOMMENDATION OF PASTOR: PASTOR S SIGNATURE: DATE: MAIL COMPLETED APPLICATION FORM TO: TIM BOULDIN FCF PRESIDENT TH AVE NW FARIBAULT MN For Office use only: Received Reviewed Accepted Rejected Notified Revised

3 Minnesota District Royal Ranger Leadership Training Academy The Woods at Lake Placid: Pillager, MN Dear Ranger, Ranger Parent or Ranger Leader: Thank you for your interest in the Minnesota District Royal Ranger Training Camps! Our camps assist boys, young men and adults who are interested in developing leadership and camping skills. If you are interested in advanced training, and encouraging fun and safety in the outdoors please sign up for this event at The Woods at Lake Placid in Pillager, Minnesota. The process begins with this application. Please follow the instructions below. Once the application has been received, you will be sent an information pack about your camp(s). This will include the camp schedule(s), all camp prerequisites and everything you will need to bring. We are excited that you will be joining us at this year s Leaders Training Academy! INSTRUCTIONS: Please fill out the Camp Application 1. Fill in the Applicant Information. 2. Fill in the Church Information. 3. Select the desired camp(s). If a Ranger selects more than one camp, please make sure the dates do not conflict. Also, there will be a $20.00 discount for each additional camp. 4. Please include at least the minimum deposit of $25.00 for each camp. (Note: a deposit is required.) 5. Fill out the Medical Release form. 6. Complete the additional information below if required. 7. Return this application and medical form to the address below. PHYSICAL EXAM: Participation in the following camps may include strenuous outdoor activities: Honor Guard Camp Junior Canoe Expedition Therefore, we require that a Ranger has received at least a Sports Physical within the past year. After he receives the physical exam, please sign the following statement: After consultation with my son s physician, I know of no physical reason that would restrict my son from participation in any camp activities. Parent s signature Date In the event your son receives his exam after this application has been submitted, he must bring a statement from your physician when registering at the camp. Your son will not be able to participate without an exam. For more information about each camp go to the website: Applicant Information Name: Address: City: State: Zip Code: Phone: ( ) Age Date of Birth: T-shirt size: Youth Men s Church Information Name: Address: City: State: Zip Code: Church Phone: ( ) Pastor: Phone: ( ) Junior Camp Information (check the desired camps) Early registration due by July 1 Deposit Amount: Week 1: Aug 4 Aug 7, 2016 Cost: $ ea* Honor Guard Camp $ Week 1: Aug 4 Aug 7, 2016 Cost: $ ea* Discovery Training Camp $ Big Adventure Camp (FCF) $ Week 2: Aug 11-14, 2016 Cost: $ ea* Junior Training Camp $ Junior Shooting Sports Camp $ Junior Canoe Expedition $ Junior Spirit Challenge Camp $ REGISTRATION DUE JUNE 12 Leader s Camp Information Registration due by July 15, 2016 Deposit Amount: Session 1: Aug 12-13, 2016 Cost: $75.00 Ranger Basics, Ranger Essentials $ NO DISCOUNTS Early Registration Discount before July 1st $50.00 Discount $ Registration between July 2 14 $25.00 Discount $ Total Registration Amount $ *Charter Membership Discount ($25 per camp) $ Discounts ($20 for 2 nd )$ Total Camp Fees $ Deposit Enclosed $ Mail all registrations to: Todd Wille Minnesota District Royal Ranger Training Camps 3625 Power Dam Rd NE Bemidji MN For Official use only: Date: Check # Amount: $

4 Minnesota District Assembly of God 1315 Portland Ave S Minneapolis, MN (612) Parent(s): Please completely fill out and sign this form. For your son s protection and safety, he will not be able to participate in any Royal Ranger or Minnesota Boys District event without it. Minnesota District Royal Ranger 2016 PERMISSION / EMERGENCY MEDICAL AUTHORIZATION For all boys and youth (Kindergarten to 12 th grade) under 18 This medical emergency form MUST be signed by a parent or guardian, and accompany the minor who wishes to participate in the Minnesota District Boys/Royal Ranger event. Child s Name: Date of Birth: Street Address: Home phone: ( ) City / State / Zip: Father s Name: Work / Cell phone: ( ) Mother s Name: Work / Cell phone: ( ) Family Doctor: Office phone: ( ) Insurance Company: Policy Number: MEDICAL QUESTIONNAIRE Please answer ALL of the following questions. EXPLAIN any YES answers completely in the space provided below. Does your son have or is currently being treated for: Yes No 1. Any injury/ illness or taking any form of Yes No 12. Has your son ever had any operations? medication? Yes No 2. Asthma? Yes No 13. Is there any family history of any disease? Yes No 3. Allergies to any medication? Yes No 14. Has your son had any Childhood Diseases (i.e. Yes No 4. Hay fever? measles, mumps, chicken pox, etc)? Yes No 5. Other known allergies? Yes No 15. Does your son ever sleepwalk? Yes No 6. His tonsils removed? Tylenol Yes No 7. His appendix removed? What may we give your son for pain or fever? Aspirin Yes No 8. Require a special diet? Ibuprofen Yes No 9. Any chronic medical problems (i.e. cardiac, respiratory, kidney, seizure or other problems)? Yes No 10. Color blindness? Yes No 11. ADD or ADHD? (Is he on medication?) How would you classify your son s swimming ability? In addition to the above explanations, list any other medical considerations not mentioned above? What is the date of your son s last physical? What is the date of your son s last tetanus shot? Beginner Intermediate Advanced Person(s) to contact in the event of an emergency: Name: Phone: ( ) Name: Phone: ( ) I have read and approved the included information. You have my permission for my child to attend the camp and to participate in its activities. I, acting on my own behalf, also release the Minnesota District Boys/Royal Rangers and/or The Woods at Lake Placid, its agents, assigns, staff, employees as well as volunteer workers from any liability whatsoever arising out of property damage or loss as well as any injury, sickness or death which may be sustained by my child as the result of any participation in any camp activity. I am aware of the risks associated with participating in camping activities and accept participant s participation with full awareness of these risks. I give my permission for the camp medical personnel to treat the listed participant in the event of a minor illness or minor injury. In case of emergency, and when I am unable to be contacted, I hereby give permission to the local physician selected by the camp to hospitalize, secure proper treatment for, order injection, anesthesia, or surgery for my child. I authorize the MN District Royal Rangers to use our child s likeness in photographs or video in any and all of its publications and in any and all other media. I will make no monetary or other claims against the District for the use of such photos or videos. I authorize camp personnel to inspect camper s belongings to see that they have not brought any prohibited or illegal items. I understand that if my child misbehaves and violates the camp rules, I may be called to pick him/her up. Signature of parent or legal guardian Date Print name

5 Minnesota District Assembly of God 1315 Portland Ave S Minneapolis, MN (612) Part I: For the Senior Pastor: ADULT VERIFICATION FORM Minnesota District Boys/ Royal Ranger STATEWIDE EVENTS For all person 18 years and older Please completely fill out and sign this form. The purpose of the document is to promote a safe environement for all children attending this event only. He / she will not be able to participate in any Royal Ranger District event without this form. This form MUST be signed by a senior pastor or a staff pastor designated by a senior pastor and accompany the adult who wishes to participate in this Minnesota District Boys/Royal Ranger event. Any person without this document will be asked to leave. NAME PHONE ( ) ADDRESS CITY STATE ZIP CHURCH CITY I am an adult serving the following outpost: Royal Ranger Outpost # or Church Name Pastor s Certification of Adult: I am personally acquainted with the applicant and a background check is on file for this individual. In my opinion, he/she is of appropriate character to be with young people. I know of no facts or allegations that raise any question concerning his/her suitability for participating with minors. Pastor s Signature of Affirmation (No photocopied signatures will be accepted BLUE INK ONLY) Pastor s name and position (please print) Church name (please print) Date of Pastor s Signature An original copy with an original signature, must be submitted at registration when arriving at the event. One application must be submitted for EACH ADULT and is valid for only this event. Part II: For the Applicant: Permission to Use Image or Likeness: I authorize the MN District Royal Rangers to use my likeness in photographs or video in any and all of its publications and in any and all other media. I will make no monetary or other claims against the District for the use of such photos or videos. Signature Date Print name 1315 PORTLAND AVE S MINNEAPOLIS, MN PHONE (612) FAX (612)

6 Minnesota District Assembly of God 1315 Portland Ave S Minneapolis, MN (612) Minnesota District Royal Ranger EMERGENCY MEDICAL AUTHORIZATION For Adults Leaders Ranger s Name Street Address City/State/Zip Spouse Names Family Doctor Insurance Company Date of Birth Phone ( ) Soc Sec # Work Phone ( ) Office Phone ( ) Policy Number MEDICAL QUESTIONNAIRE Please check you have any difficulty with: Asthma Heart Trouble Eyes, ears, nose throat Fainting spells Allergies Lungs Digestion Convulsions Allergies to medication Hernia Diabetes ADHD or similar Describe if checked: Please answer the following questions: Swimming ability (please circle one): Cannot swim / Beginner / Intermediate / Advanced I can take the following (please circle which are applicable): Aspirin / Tylenol / Ibuprofen Family history of disease: Do you require a special diet? Any condition now requiring regular medication? Operations of serious injuries (list injury and date)? Other chronic medical problem or other medical considerations not listed above? Any restrictions of activities for medical reasons? Date of last Tetanus shot: (DATE) Date of last physical: (SIGNATURE)

August 4 -August 7, 2016

August 4 -August 7, 2016 Minnesota District Royal Rangers DISCOVERY LEADERSHIP TRAINING CAMP THE WOODS AT LAKE PLACID PILLAGER, MN August 4 -August 7, 2016 PURPOSE OF THIS CAMP Discovery Training Camp will provide boys with training

More information

2018 SPORTS CAMP REGISTRATION FORM

2018 SPORTS CAMP REGISTRATION FORM 2018 SPORTS CAMP REGISTRATION FORM CHILD NAME: Date of Birth Age T SHIRT SIZE: S M L XL WHAT SESSION(S) ARE YOU REGISTERING FOR (PLEASE CHECK): Jul 9 Jul 13 Jul 16 Jul 20 Jul 23 Jul 27 Aug 13 Aug 17 Aug

More information

U.S. Martial Arts Academy SUMMER CAMP 2015

U.S. Martial Arts Academy SUMMER CAMP 2015 U.S. Martial Arts Academy SUMMER CAMP 2015 3430 Oak Road Vineland, NJ 08361 Hours of operation 7:30am-5:30pm (Monday-Friday) Dates of Operation: Monday June 22nd thru Friday August 28th CLOSED WEEK OF

More information

CANOE EXPLORATION ON THE ELKHORN RIVERS OF LIFE JOHN 7:38

CANOE EXPLORATION ON THE ELKHORN RIVERS OF LIFE JOHN 7:38 CANOE EXPLORATION ON THE ELKHORN RIVERS OF LIFE JOHN 7:38 LOCATION U S HWY 127 N. FRANKFORT KY. AT-- STILL WATERS CAMP GROUND ACTION CAMP MAY 2-3 HIGH SCHOOL AGE & UP Boys Discovery and Adventure Rangers

More information

(8-12 years old) Sponsored by Perry Hall Baptist Church

(8-12 years old) Sponsored by Perry Hall Baptist Church (8-12 years old) Sponsored by Perry Hall Baptist Church Call or e-mail us to request a Registration Form and a Health Form. Forms must be returned with full payment. Space is limited Register soon!! Wo-Me-To

More information

August 19-24, 2014 (Tuesday-Sunday)

August 19-24, 2014 (Tuesday-Sunday) What is EDGE Adventure Camp? A five day Catholic camp with sports & activities including canoeing, kayaking, giant rope swing, water sports and more! Live music, catechesis, Mass, praise & worship and

More information

November 17-19, 2017

November 17-19, 2017 NE District High School Youth Gathering 9th-12th grade vember 17-19, 2017 LaVista Conference Center Omaha, Nebraska $200/person Registration Deadline: October 1st (Scholarships available) Late registration

More information

September Dear RYLA Coordinator: Rotary Youth Leadership Awards Rotary District 6670 Southwest Ohio Fastfacts:

September Dear RYLA Coordinator: Rotary Youth Leadership Awards Rotary District 6670 Southwest Ohio Fastfacts: September 2017 Dear RYLA Coordinator: Each spring, local Rotary Clubs partner with local school districts to select one or more High School sophomores and juniors (Award Winners) to attend a leadership

More information

Counselor Application 2018 July 9 th 13 th

Counselor Application 2018 July 9 th 13 th Counselor Application 2018 July 9 th 13 th Name Address City State & Zip Home Phone Cell Phone E-mail address Male Female Birth Date (mm/dd/yy) Age (at camp) Emergency Contact Name Phone Relation to Camper

More information

ZooCrew Registration Packet Summer ZooCrew

ZooCrew Registration Packet Summer ZooCrew Summer ZooCrew Check the weeks you would like to sign your child(ren) up for ZooCrew: 4 & 5 year olds* Week of 7/18 In My Backyard Week of 8/1 Once Upon a Story Week of 8/15 Where the Wild Things Are 6

More information

SHAWNEE COUNTY SHERIFF S OFFICE WORKING TOGETHER FOR OUR KIDS

SHAWNEE COUNTY SHERIFF S OFFICE WORKING TOGETHER FOR OUR KIDS SHAWNEE COUNTY SHERIFF S OFFICE WORKING TOGETHER FOR OUR KIDS JUNE 4 th - 8 th JUNE 11 th - 15 th JUNE 18 th 22 nd Seaman High School Shawnee Heights High School Washburn Rural High School 8:00am-12:00pm

More information

2016 Health History and Enrollment for Sam Davis Youth Camp for Youth and Adults

2016 Health History and Enrollment for Sam Davis Youth Camp for Youth and Adults 2016 Health History and Enrollment for Sam Davis Youth Camp for Youth and Adults Complete this form in ink answering all questions. Please print legibly The parent/guardian and camper both must sign this

More information

Application. For The. Tyler Police Department Law Enforcement Explorer Program

Application. For The. Tyler Police Department Law Enforcement Explorer Program Application For The Tyler Police Department Law Enforcement Explorer Program Attached are the forms that are required to be completed to be admitted into the Law Enforcement Explorer Program at the Tyler

More information

Adventure Club. Before and After School Care Enrollment Packet. Before and After School Care Mission:

Adventure Club. Before and After School Care Enrollment Packet. Before and After School Care Mission: Adventure Club Before and After School Care Enrollment Packet Before and After School Care Mission: Our before and after school care is designed to provide children with a safe, loving and exciting environment

More information

4-H HEALTHY LIVING RETREAT OCTOBER 13 TH -15 TH. Learn about careers & other opportunities in the healthy living field!

4-H HEALTHY LIVING RETREAT OCTOBER 13 TH -15 TH. Learn about careers & other opportunities in the healthy living field! Learn about careers & other opportunities in the healthy living field! Attend workshops on trending topics in Healthy Living! OCTOBER 13 TH -15 TH 4-H HEALTHY LIVING Take the 500 Mile Challenge, and participate

More information

AGE Is the student age 18 or older? (If YES, please skip to signature section below) p YES p NO

AGE Is the student age 18 or older? (If YES, please skip to signature section below) p YES p NO New York Summer music FeStivaL PERMISSION FORM This form must be emailed or faxed to NYSMF before your arrival. StudentName _ Festival Year AGE Is the student age 18 or older? (If YES, please skip to signature

More information

BACK FOR ANOTHER Come and YEAR celebrate

BACK FOR ANOTHER Come and YEAR celebrate The All Days are Happy Days summer day camp offers a week of fun, learning, and activities for the child with Attention Deficit Hyperactivity Disorder. The University of Tennessee, Boling Center for Developmental

More information

REGISTRATION FORM. Parent Name Relationship to child. Address (if different) . Place of employment Hours - Work phone

REGISTRATION FORM. Parent Name Relationship to child. Address (if different)  . Place of employment Hours - Work phone REGISTRATION FORM FUN FITNESS CAMP All forms can be filled electronically. Please complete forms and submit with original signature and registration fee. Child s name Age Sex Address State City Zip Date

More information

THE AMERICAN LEGION LAW ENFORCEMENT CAREER ACADEMY

THE AMERICAN LEGION LAW ENFORCEMENT CAREER ACADEMY APPLICATION CHECKLIST To be completed by the Applicant and Parents (MUST BE ATTACHED TO APPLICATION) June 3rd to June10 th of 2017 (St. Joseph s Youth Camp-Mormon Lake) CHECK DATE COMPLETED All areas of

More information

Rotary District 5180/5190 RYLA REGISTRATION FORM 2018

Rotary District 5180/5190 RYLA REGISTRATION FORM 2018 Rotary District 5180/5190 RYLA REGISTRATION FORM 2018 ROTARY CLUB OF: ROTARY CLUB CONTACT: This form must be completed in full and signed by the student as well as a parent or legal guardian in multiple

More information

Provincial Opportunities

Provincial Opportunities Provincial Opportunities Agri-Career Quest (ACQ) Target Audience: 16-22 year olds (by midnight Dec 31 st previous yr) Opportunity Date: May 4-9, 2017 Location: Begin and end in Abbotsford Registration

More information

Huntington University Nursing Career Academy Application Process Summer 2015

Huntington University Nursing Career Academy Application Process Summer 2015 Application Process Eligibility Requirements: applicants must be in 10 th, 11 th, or 12 th grade during the 2014-2015 academic school year and be interested in exploring a career in nursing. Program cost:

More information

4-H Shooting Sports Instructor

4-H Shooting Sports Instructor Training 4-H Shooting Sports Instructor Certification Training for 4-H Certified Adult Volunteers in the 4-H Shooting Sports Program Date: May 27-28, 2016 Location: Cost: State 4-H Office and Stillwater

More information

To begin the application process, please complete the enclosed application and bring it with you to one of our weekly meetings.

To begin the application process, please complete the enclosed application and bring it with you to one of our weekly meetings. Dear Explorer Applicant, We are pleased that you have shown interest in the Miramar Police Department Explorer Program. The Explorer program is the best program that young men and women can become involved

More information

August, GA 13. June 10-15

August, GA 13. June 10-15 August, GA 13 June 10-15 Jan. 16, 2013 Dear parents and students 6 th -12 th grade, Our excitement is growing for our missions opportunity this summer for all middle school and high school students. We

More information

State Officer Application - SLC 2016

State Officer Application - SLC 2016 Candidate name: State Officer Application - SLC 2016 Read the following pages of information very carefully. If you have any questions, please call the Florida HOSA State Office at (386) 462-HOSA. Fill

More information

If you have any questions concerning the application process, do not hesitate to contact us soon.

If you have any questions concerning the application process, do not hesitate to contact us soon. Cristo Vive International P.O. Box 527 Big Lake, MN 55309 Dear Applicant: Thank you for expressing an interest in joining the Cristo Vive Team as a participant with the camp ministries for children and

More information

Camp TOV Medical Form

Camp TOV Medical Form Mail: Fax: Please send these forms to us by either: Jewish United Fund/Jewish Federation of Metropolitan Chicago Attn: Camp TOV 30 South Wells Street, Room 5034 Chicago, IL 60606 Attn: Camp TOV 312-444-2086

More information

N.E.O. CAMPMEETING STUDENT MINISTRIES PROGRAM PACKET

N.E.O. CAMPMEETING STUDENT MINISTRIES PROGRAM PACKET N.E.O. CAMPMEETING STUDENT MINISTRIES PROGRAM PACKET - 2016 Dear North East Ohio Church of God families of teens, NEO Camp Meeting (July 24-31) is a family camp experience. Many families bring a camper

More information

**** Medical Information/ Emergency Contacts/ Insurance/ Consent ****

**** Medical Information/ Emergency Contacts/ Insurance/ Consent **** Arrival Departure Certification Level: **** Medical Information/ Emergency Contacts/ Insurance/ Consent **** Camper s Name: Birthdate: Age: Parent/Legal Guardian/Adult Leader Name: Day Time Phone: Evening

More information

YMCA OF GREATER NEW YORK SUMMER DAY CAMP REGISTRATION FORM

YMCA OF GREATER NEW YORK SUMMER DAY CAMP REGISTRATION FORM Branch: Camp Site: Camp Type: PARTICIPANT INFO: Date of Birth: Gender: Grade in September 2018: School: Home Phone: ( ) Email: My child will: Be picked up Walk Home (Only campers 10 years or older. Please

More information

2018 SUMMER DAY CAMP ENROLLMENT PACKET

2018 SUMMER DAY CAMP ENROLLMENT PACKET 2018 SUMMER DAY CAMP ENROLLMENT PACKET Enrollment : Child s Full Name: Mother s Name: AGE: Birth : Home Father s Name: Gender: (Please circle) M F Mother s Father s Mother s Home Father s Home Employer:

More information

Community Life Center

Community Life Center Community Life Center- 2018-2019 Page 2 of 6 MEGA SPORTS CAMP- Waiver & Release Forms Effective Dates: January 1, 2018 January 1, 2019 CHILD S INFORMATION Name Grade Age DOB Male/Female Nickname School:

More information

Kairos Retreat for Teens [SFK13] September 22, 23, 24 & 25 th, 2016

Kairos Retreat for Teens [SFK13] September 22, 23, 24 & 25 th, 2016 For Juniors & Seniors in High School What is Kairos? Kairos, which means Lord s Time, is a Christian experience of prayer and reflection, run by a team of adults and trained peer leaders. St. Francis de

More information

Camp Connect 2018 ENROLLMENT APPLICATION

Camp Connect 2018 ENROLLMENT APPLICATION ENROLLMENT APPLICATION Will a buddy be attending? Yes NO If yes, please complete buddy section Name of Camper: Date of Birth: County: * A separate Enrollment Application and Camper Portfolio must be completed

More information

2016 Multi-Jurisdictional Law Enforcement Explorer Academy

2016 Multi-Jurisdictional Law Enforcement Explorer Academy 2016 Multi-Jurisdictional Law Enforcement Explorer Academy All questions must be answered. If something does not apply please indicate N/A. Note: If there are any un-answered questions on this application

More information

2018 INDIANA COUNTY CAMP CADET APPLICATION

2018 INDIANA COUNTY CAMP CADET APPLICATION 2018 INDIANA COUNTY CAMP CADET APPLICATION CAMP SEPH MACK, BSA SUNDAY, AUGUST 5 TH - SATURDAY, AUGUST 11 TH, 2018 INDIANA COUNTY CAMP CADET, INC. 4221 ROUTE 286 HIGHWAY WEST INDIANA, PA 15701 PHONE: 724-357-1960

More information

Camp Victory Lock-In 2014

Camp Victory Lock-In 2014 Camp Victory Lock-In 2014 Friday June 20th - Saturday, June 21st For youth entering grades 6-12 in the fall of 2014 Please sign and return the following forms along with payment: The Code of Conduct form

More information

APPLICATION PACK BURJ DAYCARE NURSERY

APPLICATION PACK BURJ DAYCARE NURSERY APPLICATION PACK BURJ DAYCARE NURSERY Child s Name: This application form must be fully completed and the necessary documents provided before a child can start at nursery. Child s Details Child s name:

More information

Dear Parent/Guardian,

Dear Parent/Guardian, Dear Parent/Guardian, Thank you for your interest in Nathan Adelson Hospice s Camp Erin. Camp will be held June 1 st 3rd, 2018. We are very excited and looking forward to another great camp experience!

More information

ST. CHARLES BORROMEO FOUNTAIN OF YOUTH YOUTH MINISTRY PROGRAM

ST. CHARLES BORROMEO FOUNTAIN OF YOUTH YOUTH MINISTRY PROGRAM YOUTH MINISTRY PROGRAM The St. Charles Borromeo Fountain of Youth is a unique Youth Ministry Program open to all young people in St. Charles Borromeo Church Parish in grades 5 12. Junior High Program is

More information

Church of St. Raphael - Summer Stretch 2017 PARENTAL CONSENT FORM & INDEMNITY AGREEMENT

Church of St. Raphael - Summer Stretch 2017 PARENTAL CONSENT FORM & INDEMNITY AGREEMENT Church of St. Raphael - Summer Stretch 2017 PARENTAL CONSENT FORM & INDEMNITY AGREEMENT Student/Participant Name: of Birth: / / Sex: M / F Current Grade in School: 6 th / 7 th / 8 th / 9 th / 10 th / 11

More information

2018 Super Summer Student Registration Form

2018 Super Summer Student Registration Form Staple a copy of your insurance card front and back to this paper 2018 Super Summer Student Registration Form Please print legibly (circle the name you normally go by) Student Personal Information Last

More information

4-H Music Education Matters Summit Scholarship Application Open to all youth 8 th -12 th grade Scholarship Deadline: May 1, 2018 by 4:00pm

4-H Music Education Matters Summit Scholarship Application Open to all youth 8 th -12 th grade Scholarship Deadline: May 1, 2018 by 4:00pm 4-H Music Education Matters Summit Scholarship Application Open to all youth 8 th -12 th grade Scholarship Deadline: May 1, 2018 by 4:00pm Please type or print using black ink. Scholarship covers travel

More information

2018 Alexandria 4-H Summer Day Camp- Lights, Camera Cooking Registration Form

2018 Alexandria 4-H Summer Day Camp- Lights, Camera Cooking Registration Form 2018 Alexandria 4-H Summer Day Camp- Lights, Camera Cooking Registration Form First Name: Last Name: Address: City: Birthdate: Parent/Guardian Name: Primary Phone: State: Age as of Sept 30: Email: Alt.

More information

Mindfulness Yoga & Meditation Retreat Registration July 15-21, 2019

Mindfulness Yoga & Meditation Retreat Registration July 15-21, 2019 Mindfulness Yoga & Meditation Retreat Registration July 15-21, 2019 Please fill out a separate registration form for each participant. A $100 non-refundable deposit is required and will be applied to your

More information

CAMP WASTAHI MEDICAL FORM DUE ON OR BEFORE JULY 1, 2018

CAMP WASTAHI MEDICAL FORM DUE ON OR BEFORE JULY 1, 2018 1 CAMP WASTAHI MEDICAL FORM DUE ON OR BEFORE JULY 1, 2018 CHECK LIST & INSTRUCTIONS FOR COMPLETING THIS FORM: This Medical Form is required EACH YEAR for every participant of Camp Wastahi. As a requirement

More information

1) INFORMATION ABOUT THE PARTICIPANT AND ACTIVITY

1) INFORMATION ABOUT THE PARTICIPANT AND ACTIVITY 2016-17 South Carolina 4-H Membership and Event Permission Form for Youth (Updated 08.01.16) ALL elements of this form must be completed by youth participating in clubs, field trips, events requiring group

More information

MISSOURI STATE HIGHWAY PATROL YOUTH ACADEMY PROGRAM June 11 - June 17, 2017 Sunnyhill Adventures - Dittmer, Missouri

MISSOURI STATE HIGHWAY PATROL YOUTH ACADEMY PROGRAM June 11 - June 17, 2017 Sunnyhill Adventures - Dittmer, Missouri MISSOURI STATE HIGHWAY PATROL YOUTH ACADEMY PROGRAM June 11 - June 17, 2017 Sunnyhill Adventures - Dittmer, Missouri APPLICANT NAME: (Last) (First) (Middle) ADDRESS: CITY: STATE: ZIP: EMAIL ADDRESS: AGE:

More information

2018 MARSHALL COUNTY LAW ENFORCEMENT YOUTH CAMP APPLICATION

2018 MARSHALL COUNTY LAW ENFORCEMENT YOUTH CAMP APPLICATION 2018 MARSHALL COUNTY LAW ENFORCEMENT YOUTH CAMP APPLICATION Law Enforcement agencies from across Marshall County will sponsor and provide a Law Enforcement Youth Camp for students this year on the dates

More information

HIGHLAND MEDICAL INFORMATION FORM

HIGHLAND MEDICAL INFORMATION FORM HIGHLAND MEDICAL INFORMATION FORM TODAY S DATE: SESSION NAME SESSION DATE Having adequate information about your child is crucial to our ability to provide a supportive environment. We rely on you to tell

More information

4-H Memorial Camp. Please use a separate registration for each camper or if you are attending multiple camp weeks. Camper Information

4-H Memorial Camp. Please use a separate registration for each camper or if you are attending multiple camp weeks. Camper Information 4-H Memorial Camp 2018 Summer Camp Registration Please use a separate registration for each camper or if you are attending multiple camp weeks. Camper Information Camper s First Name Male Female Camper

More information

Breakaway Teen Counselor/Staff Application **COUNSELOR FEES ARE NON-REFUNDABLE **

Breakaway Teen Counselor/Staff Application **COUNSELOR FEES ARE NON-REFUNDABLE ** Breakaway Teen Counselor/Staff Application **COUNSELOR FEES ARE NON-REFUNDABLE ** Please Mail by June 1, 2016 Counselor/Staff Administrative Fee: $35 Please contact ISM at ilsmonline.com or 217-854-4631

More information

Naturopathic Wellness Center

Naturopathic Wellness Center Naturopathic Wellness Center Ashley G. Lewin, N.D. Erica Waters, ND Mychael Seubert, ND Pediatric Intake Birth to 3 years Name Sex Date of Birth / / Age Parent(s)/Guardian(s) Address City/State/Zip Telephone

More information

Palmetto Health Tuomey Student Volunteer Application Application to be completed by the student, NOT the parent. Full Name: Phone: (

Palmetto Health Tuomey Student Volunteer Application Application to be completed by the student, NOT the parent. Full Name: Phone: ( 1 Palmetto Health Tuomey Student Volunteer Application Application to be completed by the student, NOT the parent. Full Name: Phone: ( ) Email address: Cell Phone: ( ) Address: City: Zip: Social Security

More information

Ambassador Program Application Packet

Ambassador Program Application Packet Ambassador Program Application Packet Thank you for your interest in becoming an Ambassador at Centinela Hospital Medical Center. Please complete the attached forms and then contact the Centinela Hospital

More information

NOTE: WE REQUEST THAT PARISHES AND SCHOOLS DO NOT USE THE RALLY AS A SUBSTITUTE FOR A CONFIRMATION RETREAT.

NOTE: WE REQUEST THAT PARISHES AND SCHOOLS DO NOT USE THE RALLY AS A SUBSTITUTE FOR A CONFIRMATION RETREAT. M E M O TO: FROM: CYMs, DREs and Middle School/Jr. High Principals Clare Kolenda, Middle School Youth Rally Coordinator Brian Flynn, Office of Youth Ministry DATE: January, 2018 RE: Middle School Youth

More information

Watermarks MS/HS Camp Information

Watermarks MS/HS Camp Information Watermarks MS/HS Camp Information When: Friday, November 13 - Sunday, November 15 Where: Watermarks Camp in Scottsville, VA (just south of Charlottesville) Cost: $110 Register by November 2. We will leave

More information

KANSAS PACKET INSTRUCTIONS

KANSAS PACKET INSTRUCTIONS KANSAS PACKET ALL LOCATIONS EXCEPT HIGHLANDS AND SANTA FE TRAIL All of our programs are licensed by the Kansas Department of Health and Environment. This is a set of documents which is required by state

More information

2018 RA Camp Discount Application

2018 RA Camp Discount Application 2018 RA Camp Discount Application Thank you for choosing Reston Association and placing your child(ren) in our care. The intent of the RA Camp Scholarship Program is to provide financial assistance to

More information

2018 Counselor College

2018 Counselor College OHIO STATE UNIVERSITY EXTENSION 2018 Counselor College Canter s Cave 4-H Camp, Jackson, Ohio March 24 th @ 1:00 p.m. - March 25 th @ 10:30 a.m. Counselor College is open to any teen, 14-18 years of age,

More information

NURSING STUDENT HEALTH & IMMUNIZATION RECORDS

NURSING STUDENT HEALTH & IMMUNIZATION RECORDS NURSING STUDENT HEALTH & IMMUNIZATION RECORDS *********************************** COMPLETE THE ATTACHED HEALTH PACKET AND SUBMIT TO THE NURSING DEPARTMENT NO LATER THAN THE ASN ORIENTATION. **************************************

More information

4-H Youth Development Team Coordinator 4-H Community Educator

4-H Youth Development Team Coordinator 4-H Community Educator Wayne County 1581 Route 88N Newark, NY 14513 p. 315.331.8415 f. 315.331.8411 www.ccewayne.org Dear 4-H Families, Welcome to Wayne County 4-H! It is a very exciting time of the year to join 4-H; new projects

More information

Parent/Guardian Names: Cell Phone: School: Parent/Guardian Signature: Date:

Parent/Guardian Names: Cell Phone: School: Parent/Guardian Signature: Date: SPIRIT OF AMERICA BOATING SAFETY PROGRAM Offered by Sailing Center Chesapeake & St. Mary s College of Maryland Open to students who have completed 6 th, 7 th, or 8 th grades in 2017. Summer 2017 Student

More information

PROGRAM TO COMPLETE YOUR REGISTRATION PLEASE KEEP A COPY OF COMPLETED FORMS FOR YOUR RECORDS

PROGRAM TO COMPLETE YOUR REGISTRATION PLEASE KEEP A COPY OF COMPLETED FORMS FOR YOUR RECORDS GENESEE COUNTY YMCA GENESEO SUMMER REC PROGRAM 2018 PARTICIPANT FORMS MONDAY JULY 2ND FRIDAY AUGUST 10TH 9AM-1PM COMPLETE YOUR REGISTRATION REGISTRATION: MAIL COMPLETED FORMS AND PAYMENT 209 E MAIN ST.

More information

DISTRICT 205 STUDENTS ARE FREE

DISTRICT 205 STUDENTS ARE FREE The Rockford Area Arts Council offers RAAC Camp for students ages 5-13. Students will participate in three classes per day and present a performance and art exhibit for family and friends on Thursday,

More information

NOT SIGNED/INCLUDED as my student does not self-administer medicine

NOT SIGNED/INCLUDED as my student does not self-administer medicine 2017-18 School Year Hello, and welcome to Ridge Point High School Band and Guard! The attached forms help us manage and support the more than 170 members of the Band and Guard. Please sign and return all

More information

St. Joseph Parish Youth Ministry Registration 2018/19

St. Joseph Parish Youth Ministry Registration 2018/19 St. Joseph Parish Youth Ministry Registration 2018/19 Please take a moment to register for this year s Youth Ministry program at St. Joseph, Colbert. St. Joseph Parish s Youth Ministry programs are open

More information

All clubs will receive a confirmation including directions, waiver forms and other pertinent information upon receipt of registration.

All clubs will receive a confirmation  including directions, waiver forms and other pertinent information upon receipt of registration. IDENTITY YMCA of Greater Fort Wayne Teen Service Day WHO: Teens in the Fort Wayne area. Must be in grades 6-12. WHERE: The YMCA of Greater Fort Wayne Central Branch WHEN: December 28 th, 2017 9:00am-9:00pm

More information

Extended Day Registration Packet

Extended Day Registration Packet St. Benedicts School Extended Day Registration Packet 2014 2015 School Year 4811 Wallingford Avenue North Seattle, Washington 98103 206-518.6009 l.wescott@stbens.net A Registration Packet Contents The

More information

BOSTON COLLEGE BOYS BASKETBALL CAMP

BOSTON COLLEGE BOYS BASKETBALL CAMP BOSTON COLLEGE BOYS BASKETBALL CAMP 2015 APPLICATION Conte Forum 224 Camp phone: 617-552-3003 Dan McDermott, Director Chestnut Hill, MA 02467 MBB Office: 617-552-3006 Evan Librizzi, Assistant Director

More information

St. Louise de Marillac Catholic School

St. Louise de Marillac Catholic School St. Louise de Marillac Catholic School REGISTRATION FORM 2018-19 Registration Date: Student Name M F Last First Middle Date and Place of Birth Father s Name Mother s Name Last First Middle Last Maiden

More information

2018 Summer Camp Registration

2018 Summer Camp Registration 2018 Summer Camp Registration Registration is a 3-Step Process. Complete all of the steps listed below to secure your registration and rate. Incomplete forms and a delay in submitting the required documents

More information

NC 4-H Youth Development Health History & Authorization Form

NC 4-H Youth Development Health History & Authorization Form 4-H Group / County: Year: (Must be updated each year) 4-H ers Name: Last Name First Name Middle Initial Birth Date / / Age as of Jan. 1 Gender: Female Male Email: Address: Street City State Zip Code Custodial

More information

FRONTIER DISTRICT CUB SCOUT WEEKEND DAY CAMP June 22,23,24, 2012 Cub Scouts Summer Olympics

FRONTIER DISTRICT CUB SCOUT WEEKEND DAY CAMP June 22,23,24, 2012 Cub Scouts Summer Olympics FRONTIER DISTRICT CUB SCOUT WEEKEND DAY CAMP June 22,23,24, 2012 Cub Scouts Summer Olympics South Gate Park, 4900 Southern Ave, South Gate, Ca. Dear Camp Participants: Welcome to our Frontier District

More information

4-H Enrollment Form. Name of 4-H Group/Unit: Member Name: First Middle Last. Address: Street Address City State Zip Code

4-H Enrollment Form. Name of 4-H Group/Unit: Member Name: First Middle Last. Address: Street Address City State Zip Code 4-H Enrollment Form Name of 4-H Group/Unit: Year: Member Name: First Middle Last Address: Phone:( ) Email: County: Gender*: q Male q Female Date of Birth: Grade: School Attending: If re-enrolling in 4-H,

More information

Come join the Youth Ministry for fun, fellowship and a friendly game of softball with other area Catholic High School teens.

Come join the Youth Ministry for fun, fellowship and a friendly game of softball with other area Catholic High School teens. Come join the Youth Ministry for fun, fellowship and a friendly game of softball with other area Catholic High School teens. Who do we play? Other Youth Ministries from the Dallas Diocese When do we play?

More information

Kids for a Cure Club Day Camp June 18-21, 2018

Kids for a Cure Club Day Camp June 18-21, 2018 1) Requirements: Age 13 or 14 Kids for a Cure Club Day Camp June 18-21, 2018 Junior Counselor Requirements and Application Check List Teacher s written recommendation (if new to the KFCC camp) Documentation

More information

RETURN COMPLETED FORMS AND FEE TO YOUR CHILD S SCIENCE TEACHER by Wednesday, March 4, Camp Parent Meeting, March 3rd, 6:30 pm, Cafeteria

RETURN COMPLETED FORMS AND FEE TO YOUR CHILD S SCIENCE TEACHER by Wednesday, March 4, Camp Parent Meeting, March 3rd, 6:30 pm, Cafeteria RETURN COMPLETED FORMS AND FEE TO YOUR CHILD S SCIENCE TEACHER by Wednesday, March 4, 2015 Camp Parent Meeting, March 3rd, 6:30 pm, Cafeteria February, 2015 Dear Parents: After several years of 7 th graders

More information

FIRST BAPTIST FORNEY JUNE 22 nd TO JUNE 26 th FULL PAYMENT FOR ALL IS DUE BY JUNE 7TH

FIRST BAPTIST FORNEY JUNE 22 nd TO JUNE 26 th FULL PAYMENT FOR ALL IS DUE BY JUNE 7TH CAMP GAP 2015 FIRST BAPTIST FORNEY JUNE 22 nd TO JUNE 26 th EARLY RATE (March 22 nd May 3 rd ) $205 REGULAR RATE (May 4 th May 31 st ) $230 LATE RATE (June 1 st June 7 th ) $255 FULL PAYMENT FOR ALL IS

More information

2 SESSIONS!!! Sign up for one OR both!

2 SESSIONS!!! Sign up for one OR both! ARTS Camp for 5-13 year olds!!! Campers choose THREE classes: Art, Hip-Hop Dance, Modern Dance, Theater, Video, Singing, Rap, Creative Writing, and Guitar (for 10 and up). There is an Art Exhibit & Performance

More information

Cooperative Extension Service Daviess County 4800A New Hartford Road Owensboro KY Fax: extension.ca.uky.

Cooperative Extension Service Daviess County 4800A New Hartford Road Owensboro KY Fax: extension.ca.uky. Cooperative Extension Service Daviess County 4800A New Hartford Road Owensboro KY 42303 270-685-8480 Fax: 270-685-3276 extension.ca.uky.edu Win A Chicken Coop! Girls In Agriculture Leadership Academy

More information

Project C.O.P.E. at Camp Birch for Scouting and non-scouting, Non-Profit Organizations

Project C.O.P.E. at Camp Birch for Scouting and non-scouting, Non-Profit Organizations Project C.O.P.E. at Camp Birch for Scouting and non-scouting, Non-Profit Organizations Issued in January 2009, Tecumseh Council, BSA Welcome to the Challenging Outdoor Personal Experience (C.O.P.E.) program

More information

2018 WEST VIRGINIA SHERIFFS YOUTH LEADERSHIP ACADEMY. Application Packet For Cadets, Senior & Junior Counselors

2018 WEST VIRGINIA SHERIFFS YOUTH LEADERSHIP ACADEMY. Application Packet For Cadets, Senior & Junior Counselors 2018 WEST VIRGINIA SHERIFFS YOUTH LEADERSHIP ACADEMY Application Packet For Cadets, Senior & Junior Counselors The West Virginia Sheriffs Youth Leadership Academy is sponsored by: West Virginia Sheriffs

More information

SPECTACULAR All Camp Policies and Expectations

SPECTACULAR All Camp Policies and Expectations SPECTACULAR All Camp Policies and Expectations Our mission is to provide a safe, Christ centered community that encourages young women and men to discover God, their inherent worth and cultivate and express

More information

Monday through Thursday 9:30am 11:30am And 2pm 4pm

Monday through Thursday 9:30am 11:30am And 2pm 4pm Dear Applicant: Thank you for your interest in the Stony Brook University Hospital Volunteer Program. To expedite the application process, please carefully review the information below. All applicants

More information

Health History and Examination Form for Children, Youth and Adults Attending Camps

Health History and Examination Form for Children, Youth and Adults Attending Camps Health History and Examination Form for Children, Youth and Adults Attending Camps Suggested for resident camp use. Developed and approved by American Camping Association American Academy of Pediatrics

More information

FAMILY CHRISTIAN CENTER SCHOOL BEFORE and AFTERCARE APPLICATION

FAMILY CHRISTIAN CENTER SCHOOL BEFORE and AFTERCARE APPLICATION : FAMILY CHRISTIAN CENTER SCHOOL BEFORE and AFTERCARE APPLICATION Student Please Print Name Grade: Age: Review the following to ensure completion of the application process. Registration fee (due upon

More information

4-H Enrollment Form. Name of 4-H Group/Unit: Member Name: First Middle Last. Address: Street Address City State Zip Code

4-H Enrollment Form. Name of 4-H Group/Unit: Member Name: First Middle Last. Address: Street Address City State Zip Code 4-H Enrollment Form Name of 4-H Group/Unit: Year: Member Name: First Middle Last Address: Phone:( ) Email: County: Gender*: q Male q Female Date of Birth: Grade: School Attending: If re-enrolling in 4-H,

More information

4-H Shooting Sports Instructor Training Certification Training for 4-H Adult Volunteers in the 4-H Shooting Sports Program

4-H Shooting Sports Instructor Training Certification Training for 4-H Adult Volunteers in the 4-H Shooting Sports Program Date: August 6-7, 2016 4-H Shooting Sports Instructor Training Certification Training for 4-H Adult Volunteers in the 4-H Shooting Sports Program Location: Cost: Payne County Fairgrounds Stillwater, OK

More information

Teen Leadership Camp July 25, 2012 July 27, LSU Campus Baton Rouge, LA

Teen Leadership Camp July 25, 2012 July 27, LSU Campus Baton Rouge, LA Teen Leadership Camp July 25, 2012 July 27, 2012 LSU Campus Baton Rouge, LA Come join in the fun at the Louisiana Operation: Military Kids Teen Leadership Camp. You are invited to attend a two night camp

More information

Bodhi Tree Language Center, 5403 SE Center Street, Portland OR (503)

Bodhi Tree Language Center, 5403 SE Center Street, Portland OR (503) Bodhi Tree Language Center 5403 SE Center Street, Portland, OR 97206 503-788-0336 http://www.bodhitreelanguagecenter.org Mandarin Chinese Immersion After School Program Child(ren)'s Information Registration

More information

THE 2014 AMERICAN RED CROSS SUMMER YOUTH VOLUNTEER PROGRAM AT THE EVANS ARMY COMMUNITY HOSPITAL FORT CARSON, COLORADO May 27 July 25

THE 2014 AMERICAN RED CROSS SUMMER YOUTH VOLUNTEER PROGRAM AT THE EVANS ARMY COMMUNITY HOSPITAL FORT CARSON, COLORADO May 27 July 25 THE 2014 AMERICAN RED CROSS SUMMER YOUTH VOLUNTEER PROGRAM AT THE EVANS ARMY COMMUNITY HOSPITAL FORT CARSON, COLORADO May 27 July 25 The American Red Cross (ARC) at Fort Carson s Evans Army Community Hospital

More information

2018 Returning Volunteer Staff Application

2018 Returning Volunteer Staff Application 2018 Returning Volunteer Staff Application Camp is a life-changing experience. Thank you for your interest in volunteering at Camp UKANDU. We are currently looking for uniquely qualified candidates to

More information

Student Application. Student Name Nick Name. Address. City State Zip Code. Address

Student Application. Student Name Nick Name. Address. City State Zip Code.  Address General Information (PLEASE PRINT CLEARLY) Residential Intensive Summer Education (RISE ) Program 2012 Student Application Cal Poly Pomona Office of Admission and Outreach, Building 98-4 th floor Attn:

More information

4-H Countywide Youth Lock-In Friend Registration Form

4-H Countywide Youth Lock-In Friend Registration Form 4-H Countywide Youth Lock-In Friend Registration Form Who?- Youth in Grades 4 th -8 th Where?- Kettle Moraine YMCA 1111 West Washington Street, West Bend When?- 8:00pm Saturday December 2 nd until 6:00am

More information

Kennedy King College-Minority Science and Engineering Improvement Program 2013

Kennedy King College-Minority Science and Engineering Improvement Program 2013 Dear Student & Parent/Guardian: This is the Application Packet for the Minority Science and Engineering Improvement Program at Kennedy King College. All documents within this packet must be completed and

More information

Clermont-Hamilton Cloverbud Day Camp. Sunday, June 7, :00 a.m. 3:00 p.m. What is Cloverbud Day Camp? Activities.

Clermont-Hamilton Cloverbud Day Camp. Sunday, June 7, :00 a.m. 3:00 p.m. What is Cloverbud Day Camp? Activities. Clermont-Hamilton Cloverbud Day Camp Sunday, June 7, 2015 10:00 a.m. 3:00 p.m. 4-H Camp Graham Craft Projects Camp Songs Field Games Story Time And much more! Activities Pool Games Circus Science Making

More information

The Alaska Youth Academy Application

The Alaska Youth Academy Application The Alaska Youth Academy Application Email to katina.charles@tananachiefs.org by June 30 th, 2016 Personal Information Please write in or circle your answer. Name: (First) (Middle) (Last ) Date of Birth

More information

The Alaska Youth Academy Application

The Alaska Youth Academy Application The Alaska Youth Academy Application Email to katina.charles@tananachiefs.org by June 26 th, 2015 Personal Information Please write in or circle your answer. Name: (First) (Middle) (Last ) Date of Birth

More information