GATEWAY DISTRICT FALL CAMPOREE INTERNATIONAL GAMES OCT 10-12, 2014 FOR ALL WEBELOS BOY SCOUTS VENTURES VARSITY SCOUTS

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1 GATEWAY DISTRICT FALL CAMPOREE INTERNATIONAL GAMES OCT 10-12, 2014 FOR ALL WEBELOS BOY SCOUTS VENTURES VARSITY SCOUTS CONTACTS: Event Chairperson: Dean Clemons District Activities Chairperson: John Beattie

2 1. INTRODUCTION The Fall Camporee is a special event in our district each year. Units will camp out over the weekend, Friday-Sunday. Webelos are expected to camp with a Troop. During the day, Patrols/Dens will participate in activities that are based upon an International games theme. Though it has not been confirmed at this time, there may be an opportunity to perform some type of conservation work. 2. LOCATION The Camporee will be held at Jackson Lake State Park. See the enclosed map. The estimated drive time from the Arvada area is 1 1/2 hours. 3. REGISTRATION AND FEES There will be registration at the September and October Roundtable and at the Scout office, or on-line until Oct. 9 th. Cost is $15.00 per participant. After Oct. 9th, and on the day of the event, the cost will be $20.00 per participant. Everyone who attends must pay this registration fee. There are no refunds, but the fee can be transferred to another person who is attending. The message here is pre-register!!! Even though Webelos are to camp with troops, the Webelos are to register separately--by pack, but designate on their form which Boy Scout Troop they will be camping with. Please bring your payment receipt when checking-in at the Camporee Headquarters (HQ). If you are going to be at the camporee for Saturday only, the fee is $13.00 per person. This will ensure the Packs receive their patches, ribbons and medical forms upon departure. EACH BOY SCOUT unit is to provide at least one adult to assist in staffing events. 4. PARKING AND UNLOADING PLEASE follow the directions of the traffic control people and be patient! We will be using the designated campsites, so vehicle and trailers will be parked there. Parking is limited so be sure to CAR POOL. No mobile homes or pick-up campers are to be used, unless due to medical conditions. Prior approval must be arranged with District Activities Chairperson, (Mr. John Beattie). 5. CAMP SET UP AND TAKE DOWN Please DO NOT arrive at camp before 3:00 PM Friday. Units should plan to depart by 10:30 AM Sunday. Units that need to leave on Saturday should try to plan on staying through the campfire program, Saturday evening. The campfire program will be over at 8:30 P.M. 6. FIRE AND WATER Campfires are allowed as long as they are in the fire pits that are located at the campsites. No collecting of wood is allowed, so bring your own. Plan to bring extra to be provided for the Saturday night campfire. NO OPEN FLAMES IN TENTS. This includes no cooking in tents. Potable Water and restroom facilities will be available at the park.

3 7. FIRST AID First Aid emergencies should be directed to the Medical Team. Venture Crew Post 911 will be on-site for First Aid situations. Minor first aid situations, should be handled by the individual unit. Medical forms (attached), are required for all participants. You may use the same form that was used for the previous summer 2014 activity. The forms have changed, so last year s form cannot be used. You only need to provide Parts A & B. No doctor s signature is required. Medical forms for all participants are to be turned in at HQ upon check-in, Friday night. Do not turn in medical forms if you register at Roundtable or at the Scout Office. Medical forms will be returned with your patches upon departure or at Sunday's church service, except for those persons who were treated by the medical staff. 8. WEBELOS IN CAMP Each Scout troop is encouraged to invite Webelos to the Camporee. This includes 1st and 2nd year Webelos and a parent. All Webelos will need to check in at registration upon arrival. If your Webelos group is coming up just for Saturday we strongly suggest that you arrive before 8:00 AM Saturday. But if the need arises, you may arrive at any time. The idea here is to come 9. SCHEDULE A draft schedule is included with this packet. It is subject to change, but is our best effort at this time. 10. PROGRAM ACTIVITIES Based upon the theme, we are still finalizing the events, but you can be assured there will be those that are fun as well as challenging. Pioneering activities Canoeing Root beer-everyone MUST BRING a CUP!!! Patch trading Geocaching Search and Rescue Fish/Casting Challenge Bocce Ball Soccer Skill for FIA Wood/Pole Carving Capture the International Flag Archery Branding Orienteering with radio transmitter/receiver Eskimo Ski Race Campfire 11. EQUIPMENT It is STRONGLY encouraged that all Scouts and Webelos have their 10 camping essentials. HINT; refer to your Boy Scout Handbook. No special equipment is required to participate in the events. For conservation, bring old clothes and gloves. Tools required will be specified later.

4 12. LATRINES-(bathrooms) The park restroom facilities will be utilized. Be courteous and be sure they are clean upon departure. Remember bathrooms are for human waste only. 13. TRASH ALL UNITS MUST TAKE THEIR TRASH HOME!!! Remember Leave No Trace. What you pack in, you pack out. 14. CAMPSITES Troops will be able to pick their campsite when registering at the Sept/Oct Roundtables. A campsite map will be provided to you when you register at Roundtable. Make additional copies for your participants. If you register at the Scout office or on-line, be sure to contact John Beattie (see cover page), so a campsite can be reserved. By reserving a campsite the check-in process is so much easier. Remember, all units are to check in at HQ after you get to your campsite. For safety reasons, we need to know that you have arrived at the Camporee and we receive your medical forms, roster and collect any additional fees. 15. DISTRICT If you currently do not subscribe to the District , follow the instructions below; To subscribe: send to the following address: LISTSERV@listserv.besteffort.com with the following 1-line message: SUBSCRIBE GATEWAY-INFO firstname lastname By doing so, you will be sure to receive any updates concerning this event, as well as important district news.

5 GATEWAY DISTRICT 2014 CAMPOREE SCHEDULE Friday Oct. 10 3:00-9:00 PM Arrive at Camporee-Check in - set up Camp 9:00 PM Scoutmaster and SPL meeting and Cracker Barrel - HQ 10:00 PM Lights out-quiet time-respect Others Saturday Oct. 11 7:00 AM Begin day, prepare breakfast 7:30 AM Late registration 8:45 AM Flag Ceremony for all at HQ 9:00 12:00 Activities begin for all 12:00-1:00 PM Lunch for all-sack lunches are recommended but the choice is yours 1:00-4:00 PM Events continue 4:15-5:00 PM Catholic Church Service 5:00-7:00 PM Dinner 7:00-8:30 PM Evening program-campfire Fire Ring 8:30-10:00 PM Troop Activity-star gazing-capture the flag 10:00 PM Lights out-quiet Time-Respect Others Sunday, Oct. 13 7:00 AM Begin day, prepare breakfast Clean camp 9:00 AM Chapel Service-Chapel Turn-in evaluation form Patches and medical forms given to units 10:30 AM Check out of Campsite Have a SAFE trip home

6 HOW TO GET TO JACKSON LAKE STATE PARK Map link: Take I-76 towards FT. Morgan for 64.4 miles Take exit 66A CO-39/CO-52 towards Goodrich/Wiggins 0.2 miles Turn left onto CO-39/CO-52/County Hwy 5. Continue to follow Hwy miles Turn sharp left onto County Rd Y miles County Rd Y.5 becomes County Rd miles Follow signs to Jackson Lake State Park.

7 PARKING PASS DISPLAY ON DASHBOARD GATEWAY DISTRICT UNIT # DRIVER S NAME UNIT # PARKING PASS DISPLAY ON DASHBOARD GATEWAY DISTRICT DRIVER S NAME UNIT # PARKING PASS DISPLAY ON DASHBOARD GATEWAY DISTRICT DRIVER S NAME

8 ROSTER 2014 GATEWAY CAMPOREE TROOP# PACK# LEADER NAME: TELEPHONE #: ADULTS YOUTH

9 Part A: Informed Consent, Release Agreement, and Authorization Full name: DOB: Informed Consent, Release Agreement, and Authorization I understand that participation in Scouting activities involves the risk of personal injury, including death, due to the physical, mental, and emotional challenges in the activities offered. Information about those activities may be obtained from the venue, activity coordinators, or your local council. I also understand that participation in these activities is entirely voluntary and requires participants to follow instructions and abide by all applicable rules and the standards of conduct. In case of an emergency involving me or my child, I understand that efforts will be made to contact the individual listed as the emergency contact person by the medical provider and/or adult leader. In the event that this person cannot be reached, permission is hereby given to the medical provider selected by the adult leader in charge to secure proper treatment, including hospitalization, anesthesia, surgery, or injections of medication for me or my child. Medical providers are authorized to disclose protected health information to the adult in charge, camp medical staff, camp management, and/or any physician or health-care provider involved in providing medical care to the participant. Protected Health Information/ Confidential Health Information (PHI/CHI) under the Standards for Privacy of Individually Identifiable Health Information, 45 C.F.R , , etc. seq., as amended from time to time, includes examination findings, test results, and treatment provided for purposes of medical evaluation of the participant, follow-up and communication with the participant s parents or guardian, and/or determination of the participant s ability to continue in the program activities. (If applicable) I have carefully considered the risk involved and hereby give my informed consent for my child to participate in all activities offered in the program. I further authorize the sharing of the information on this form with any BSA volunteers or professionals who need to know of medical conditions that may require special consideration in conducting Scouting activities. High-adventure base participants: Expedition/crew No.: or staff position: With appreciation of the dangers and risks associated with programs and activities, on my own behalf and/or on behalf of my child, I hereby fully and completely release and waive any and all claims for personal injury, death, or loss that may arise against the Boy Scouts of America, the local council, the activity coordinators, and all employees, volunteers, related parties, or other organizations associated with any program or activity. I also hereby assign and grant to the local council and the Boy Scouts of America, as well as their authorized representatives, the right and permission to use and publish the photographs/film/videotapes/electronic representations and/or sound recordings made of me or my child at all Scouting activities, and I hereby release the Boy Scouts of America, the local council, the activity coordinators, and all employees, volunteers, related parties, or other organizations associated with the activity from any and all liability from such use and publication. I further authorize the reproduction, sale, copyright, exhibit, broadcast, electronic storage, and/or distribution of said photographs/film/videotapes/electronic representations and/or sound recordings without limitation at the discretion of the BSA, and I specifically waive any right to any compensation I may have for any of the foregoing. NOTE: Due to the nature of programs and activities, the Boy Scouts of America and local councils cannot continually monitor compliance of program participants or any limitations imposed upon them by parents or medical providers. However, so that leaders can be as familiar as possible with any limitations, list any restrictions imposed on a child participant in connection with programs or activities below. List participant restrictions, if any: I understand that, if any information I/we have provided is found to be inaccurate, it may limit and/or eliminate the opportunity for participation in any event or activity. If I am participating at Philmont, Philmont Training Center, Northern Tier, Florida Sea Base, or the Summit Bechtel Reserve, I have also read and understand the supplemental risk advisories, including height and weight requirements and restrictions, and understand that the participant will not be allowed to participate in applicable high-adventure programs if those requirements are not met. The participant has permission to engage in all high-adventure activities described, except as specifically noted by me or the health-care provider. If the participant is under the age of 18, a parent or guardian s signature is required. None Participant s signature: Date: Parent/guardian signature for youth: Date: (If participant is under the age of 18) Second parent/guardian signature for youth: Date: (If required; for example, California) Complete this section for youth participants only: Adults Authorized to Take to and From Events: You must designate at least one adult. Please include a telephone number. Name: Telephone: Adults NOT Authorized to Take Youth To and From Events: Name: Telephone: Name: Telephone: Name: Printing

10 Part B: General Information/Health History Full name: DOB: High-adventure base participants: Expedition/crew No.: or staff position: Age: Gender: Height (inches): Weight (lbs.): Address: City: State: ZIP code: Telephone: Unit leader: Mobile phone: Council Name/No.: Unit No.: Health/Accident Insurance Company: Policy No.: Please attach a photocopy of both sides of the insurance card. If you do not have medical insurance, enter none above. In case of emergency, notify the person below: Name: Relationship: Address: Home phone: Other phone: Alternate contact name: Alternate s phone: Health History Do you currently have or have you ever been treated for any of the following? Yes No Condition Diabetes Hypertension (high blood pressure) Last HbA1c percentage and date: Explain Adult or congenital heart disease/heart attack/chest pain (angina)/heart murmur/coronary artery disease. Any heart surgery or procedure. Explain all yes answers. Family history of heart disease or any sudden heartrelated death of a family member before age 50. Stroke/TIA Asthma Last attack date: Lung/respiratory disease COPD Ear/eyes/nose/sinus problems Muscular/skeletal condition/muscle or bone issues Head injury/concussion Altitude sickness Psychiatric/psychological or emotional difficulties Behavioral/neurological disorders Blood disorders/sickle cell disease Fainting spells and dizziness Kidney disease Seizures Last seizure date: Abdominal/stomach/digestive problems Thyroid disease Excessive fatigue Obstructive sleep apnea/sleep disorders CPAP: Yes No List all surgeries and hospitalizations Last surgery date: List any other medical conditions not covered above Printing

11 Part B: General Information/Health History Full name: DOB: High-adventure base participants: Expedition/crew No.: or staff position: Allergies/Medications Are you allergic to or do you have any adverse reaction to any of the following? Yes No Allergies or Reactions Explain Yes No Allergies or Reactions Explain Medication Food Plants Insect bites/stings List all medications currently used, including any over-the-counter medications. CHECK HERE IF NO MEDICATIONS ARE ROUTINELY TAKEN. IF ADDITIONAL SPACE IS NEEDED, PLEASE INDICATE ON A SEPARATE SHEET AND ATTACH. Medication Dose Frequency Reason YES NO Non-prescription medication administration is authorized with these exceptions: Administration of the above medications is approved for youth by: Parent/guardian signature / MD/DO, NP, or PA signature (if your state requires signature) Bring enough medications in sufficient quantities and in the original containers. Make sure that they are NOT expired, including inhalers and EpiPens. You SHOULD NOT STOP taking any maintenance medication unless instructed to do so by your doctor. Immunization The following immunizations are recommended by the BSA. Tetanus immunization is required and must have been received within the last 10 years. If you had the disease, check the disease column and list the date. If immunized, check yes and provide the year received. Yes No Had Disease Immunization Pertussis Diphtheria Tetanus Measles/mumps/rubella Date(s) Please list any additional information about your medical history: Polio Chicken Pox Hepatitis A Hepatitis B Meningitis Influenza Other (i.e., HIB) Exemption to immunizations (form required) DO NOT WRITE IN THIS BOX Review for camp or special activity. Reviewed by: Date: Further approval required: Yes No Reason: Approved by: Date: Printing

12 GATEWAY DISTRICT REGISTRATION 2014 CAMPOREE TROOP # PACK # Troops and Packs are to be REGISTERED SEPARATELY We are Webelos and will be camping with Troop Total # adults X $15.00 Total # youth X $15.00 Saturday Day Visitors-NOT camping Total # adults X $13.00 Total # youth X $13.00 Total Fees Due= Name and telephone # of adult volunteer(s) MINIMUM 1 PER TROOP to help staff an event. Late fee is $20.00 per participant after October 9th. Preregister at Sept. and Oct.. Roundtables or at Scout Service Center or On-line. Do NOT submit medical forms or roster when preregistering. Turn in all medical forms and roster when your unit checks in at Camporee HQ. ALL participants must have a medical form. ALL participants pay the registration fee.