August 4 -August 7, 2016
|
|
- Emerald Jones
- 5 years ago
- Views:
Transcription
1 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 using merit skills. This merit-based camp is designed for boys (grades 3-5) AND THEIR LEADERS. Older Ranger boys may attend as junior leaders with approval from the Camp Commander. WHO CAN ATTEND? Royal Rangers who have with written permission from their parents and: 1. Have completed grade 3 or above 2. Should have an outpost leader and or legal guardian attend MEDICAL EXAMINATION Rangers: Please fill out the enclosed Minnesota District Royal Ranger Activity Emergency Medical Information and Authorization Form and bring it to the camp with you. Leaders: please fill out the enclosed Adult Verification Form, have your Pastor sign it and bring it with you to the camp. REGISTRATION FEE A $25 non-refundable fee must accompany this application. The registration cost is $125 if received by July 1 st, and $175 by July 14 and $200 after July 15. This fee includes all meals, the DTC T-shirt. If for any reason you are unable to attend the camp, you must notify Todd Wille District Training Coordinator TWO WEEKS prior to the camp to receive a refund. Discounts include: 1. A $25.00 discount is available for Chartered Outposts. Todd Wille 3625 Power Dam Rd NE Bemidji MN mnrr47@yahoo.com An information packet will be sent to you upon receipt of the camp application.
2 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 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 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: : Check # Amount: $
3 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: 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 Print name
4 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) 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 Print name 1315 PORTLAND AVE S MINNEAPOLIS, MN PHONE (612) FAX (612)
5 Minnesota District Royal Ranger EMERGENCY MEDICAL AUTHORIZATION For Adults Leaders Ranger s Name Street Address City/State/Zip Spouse Names Family Doctor Insurance Company 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? of last Tetanus shot: (DATE) of last physical: (SIGNATURE)
Frontiersmen Camping Fellowship
Explorer Territory North Star Chapter Frontiersmen Camping Fellowship Application for Membership (Please Print Legibly) Print Name: Phone: (First) (Middle) (Last) Address: E-Mail: Tee-Shirt Size Age: Birthday:
More information2018 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 informationU.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 informationCANOE 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 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 informationNovember 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 informationAugust 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 informationCounselor 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 informationAdventure 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 informationSeptember 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 informationSHAWNEE 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 information2016 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 information4-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 informationHuntington 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 information4-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 informationAGE 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 informationZooCrew 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 informationREGISTRATION 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 informationBACK 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 informationAugust, 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 informationRotary 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 informationYMCA 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 informationIf 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 information2018 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 informationTHE 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 informationCamp 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 informationMindfulness 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 informationApplication. 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 information2018 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 informationCamp 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 information2018 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 informationN.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 ****
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 informationKairos 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 informationCAMP 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 informationDear 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 informationTo 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 informationAmbassador 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 informationProvincial 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 informationAPPLICATION 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 information4-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 information4-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 informationHIGHLAND 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 information2018 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 informationNOT 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 informationMISSOURI 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 informationPROGRAM 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 informationState 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 informationAll 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 information2018 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 informationNOTE: 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 informationKANSAS 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 informationMindfulness Yoga & Meditation Retreat Registration July 20-26, 2015
Mindfulness Yoga & Meditation Retreat Registration July 20-26, 2015 Please fill out a separate registration form for each participant. A $100 non-refundable deposit is required and will be applied to your
More informationWatermarks 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 informationPalmetto 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 informationNaturopathic 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 informationDodge. County. Schools
Welcome to the Dodge School Based Health Clinic. Dodge Board of Education and Dodge Connection-Communities In of Dodge, Inc. are continuing to move forward with our goal of serving the children and families
More information2018 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 informationCommunity 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 informationKids 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 information1) 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 informationChurch 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 information2016 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 informationHealth 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 informationExtended 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 informationTHE 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 information4-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 information4-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 informationNC 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 information2018 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 informationHUSTON-TILLOTSON UNIVERSITY ENVIRONMENTAL RESCUE ROBOTICS CAMP REGISTRATION FORM
REGISTRATION FORM 9 th -12 th Grade Girls PROGRAM DATES: July 29-August 2, 2013, 9:00 am-4:00 pm. APPLICATION DEADLINE: June 7, 2013 (May 31 for early decision and scholarship opportunities) PROGRAM COST:
More information4-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 informationDiane Kulas, LSW. Dear Parent/Guardian,
Dear Parent/Guardian, Thank you for your interest in Camp Chimaqua, an overnight bereavement camp, through Hospice & Community Care s Pathways Center for Grief & Loss. The camp will be held on June 9-11,
More informationSt. 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 information2018 SUMMER CAMP NANSEMA REGISTRATION NORTH SUBURBAN YMCA
2018 SUMMER CAMP NANSEMA REGISTRATION NORTH SUBURBAN YMCA CONTACT INFORMATION Camper s Name: Grade entering Fall 2018: Gender: Female Male Not specified DOB: Age as of 1st day of camp: Address: City: Zip
More informationCamp 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 information2018 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 informationKERR COUNTY FAIR ASSOCIATION, INC QUEEN S SCHOLARSHIP PAGEANT APPLICATION
KERR COUNTY FAIR ASSOCIATION, INC. 2018 QUEEN S SCHOLARSHIP PAGEANT APPLICATION Name: Address: (street) (city, state, zip) Mailing address: (if different than above) Phone: (home) (cell) (Email) School
More information4-H Camp Tech. June Nationwide & Ohio Farm Bureau 4-H Center on
4-H Camp Tech June 13-14-15 Nationwide & Ohio Farm Bureau 4-H Center on the OSU campus You ll learn about science, technology, engineering and math through challenges and activities, including: Write code
More informationHanover Township Public Schools Memorial Junior School 61 Highland Avenue Whippany, New Jersey 07981
Dear Future 6 th Grade Parents: Hanover Township Public Schools Memorial Junior School 61 Highland Avenue Whippany, New Jersey 07981 May 9, 2014 I would like to thank you for attending last night s Fifth
More information2018 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 informationNURSING 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 informationST. 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 informationBOSTON 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 informationHigh School Theatre Camp Texas Tech University
High School Theatre Camp Texas Tech University July 8-21, 2018 THEATRE CAMP Audition, rehearse, and perform in a one act play in the Maedgen Theatre at Texas Tech. Work with three outstanding directors
More informationBreakaway 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 informationTeen 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 information4-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 informationMESA COMMUNITY COLLEGE. Information Packet 2018 YOUTH COLLEGE. Workshop I & II - Please fill out the following forms and bring to your Audition Time:
MESA COMMUNITY COLLEGE Information Packet 2018 YOUTH COLLEGE Workshop I & II - Please fill out the following forms and bring to your Audition Time: o 14 years and older Need to provide picture ID for Student
More informationParent/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 information4-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 informationStudent 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 informationJoin us for Spring Break Day Camp, we will have a blast rain, snow, or shine... because lets face it, you never know in Michigan!
Kindergarten - 8th grades Join us for Spring Break Day Camp, we will have a blast rain, snow, or shine... because lets face it, you never know in Michigan! March 27-31, 2017 OVERNIGHT AVAILABLE! March
More informationBodhi 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 informationClermont-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 information2018 APPLICATION / REQUIRED FORM
2018 APPLICATION / REQUIRED FORM All questions must be answered. Please complete and return with all forms. 781-239-5727 / Fax: 781-239-5728 / camps@babson.edu Summer Programs Office, Nichols Hall / Babson
More information*A COPY OF YOUR CHILD S IMMUNIZATION RECORD MUST BE FORWARED TO THE HEALTH OFFICE PRIOR TO ADMITTANCE*
WASHINGTON ACADEMY STUDENT HEALTH INFORMATION PACKET SCHOOL NURSE: PHONE: 973-239-6555 Ext: 204 FAX: 973-239-6335 *A COPY OF YOUR CHILD S IMMUNIZATION RECORD MUST BE FORWARED TO THE HEALTH OFFICE PRIOR
More informationKennedy 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 informationDISTRICT 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 informationThe 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