June 22, 2018 June 29, 2018

Transcription

1 Michigan Law Enforcement Youth Advisory Committee Presents the 39 th Annual Michigan Law Enforcement Youth Training Academy Fort Custer, Battle Creek MI June 22, 2018 June 29, 2018 Academy Registration: June 22, :00 pm-4:00 pm Opening Ceremony: June 22, 5:00 pm Graduation: June 29, 11:00 am Cost: $ per Explorer $ per adult $50.00 Post Registration ($100 for late post registration) Registration packets are due by June 1, 2018 Mail Packets to: Jennifer Mansfield Elsinore Redford, MI You may also scan and the packets to mleyac@gmail.com Questions or problems with MLEYTA registration Advisors Only please contact: Jennifer Mansfield Medical questions Advisors please contact the Medical Director: Kevin McKee, kmckee1000@gmail.com This page is for Advisors only!!! Do NOT give to parents! Parents should not be contacting Mansfield or McKee!

2 Registration Information Make copies of all registration forms and have your Explorers and adults fill out the proper paperwork. It is very important that ALL paperwork be completed and turned in prior to the registration deadline. All medical forms must be completed! The MLEYTA physical form (Form B) must be signed by the Explorer s doctor. A deposit of $80.00 per Explorer is required to be turned in with your registration packet. If your packet is not turned in by June 1, 2018 then the Post fee will be $ Only one check for your deposit and one check for registration will be accepted. Payments must be made through Money order, Certified Check, Department Check, or Post Check ONLY. The deposit is non-refundable but may be transferred to another Explorer. Due to fees assessed to MLEYAC by Fort Custer, all cancellations must be made prior to June 15, The Post is responsible for full payment of the number of Explorers that are registered on June 15, Criteria for Explorers Attending MLEYTA: o Must be between YOA o Must be a registered member and in good standing with a Law Enforcement Explorer Post. o The Explorer Post MUST be chartered through BSA and show proof if necessary. Any Explorer with questionable medical or physical conditions may be required to submit a letter from their Doctor assuring their fitness to attend MLEYTA. Any Explorer sent home after the opening ceremony will not receive a refund. Any youth sent home will be responsible for any travel expenses and can only be released to a parent, guardian or their post advisor. ALL Explorers must go through a basic firearm safety course prior to arrival at MLEYTA. If possible this should include a live fire exercise. ALL firearms and ammunition will be provided by MLEYTA. In order to graduate, Explorers must have participated in 70% of the entire academy program. Those not achieving 70% shall receive a certificate of attendance. Remember to FEED YOUR EXPLORERS PRIOR TO OPENING CEREMONY; the kitchen does not open until 7:00am on Saturday. Any Explorer attending the MLEYTA for the third time, or more, will be in First Platoon. They will be required to have at least one pair of woodland camouflage BDU s. We recommend more than one pair as they will be wearing these daily. They also are required to bring a gun belt, handcuffs/case, and police style boots. Award and Scholarship information is available online at

3 Pre-Registration Checklist For the Post: Post Registration Form Check for deposit (Non-Refundable) *Please see previous page for payment options (NO personal checks)* $80.00 per Explorer (for deposit) $50.00 per Post ($ if after June 1, 2018) Post responsible for fees for all Explorers registered on June 15, Additional Explorers may be added, please contact Mansfield ASAP For each Explorer: Explorer Personal Record (FORM A) Explorer Physical Form - (FORM B) ** Doctor must sign this form!!!!! Vaccination Record (Shots) or letter from doctor Limited Power of Attorney / Authorization to Release Explorer (FORM C) For each Adult: Adult Personnel Record Room reservations for upgraded rooms, barracks will be provided Per day fee $35/Twin, $45 Double, $55 Queen Suite *This is for the cost of the Pentagon. Advisors MUST contact Fort Custer themselves for reservations. Please notify me if you are getting your own room please. ed or mailed to Jennifer Mansfield, mleyac@gmail.com, Elsinore, Redford MI Registration Checklist Any missing paperwork Check for Balance Due Turn in at Fort Custer Registration Site

4 Post Registration Form POST NAME: POST #: EXPLORER NAME D.O.B. AGE SEX SHIRT SIZE YEAR ATTENDING OFFICE USE ONLY Adult Staff Name DOB SEX Shirt Size Year Attending Office Use I certify that the information contained within this packet is true to the best of my knowledge and that all explorers listed above have received FIREARMS FAMILIARIZATION and have attained the age of 14 prior to June 24, I also certify that no explorer has attained prior to or will attain the age of 21 during the duration of the Academy and that there is an insurance policy that covers all attending Explorers in place. All Adult staff is expected to assist in training, support, or supervision while at the academy. The assignments will be made by the Academy Commander as needed. Advisor s Name (printed): Phone #: Advisor s (for registration confirmation): Advisor s Signature: Date:

5 Adult Personnel Record Please make copies of the necessary forms and have ALL adult personnel complete the necessary paperwork. All staff needs to fill out the Adult Personnel Record, and optionally the adult health information below. Additionally any first year staff must have a negative TB test from their Doctor s Office. Last Name First Name Years At Academy: Home/Work Address City State Zip Code Work Phone Cell Phone Certified Police Officer YES NO Rank Gender DOB Department Name Dept Street Address City Zip Code Address In case of emergency, Notify: Name Relationship Address City State Home Phone Cell Phone Work Phone Other Phone Numbers Optional health information: Please list any medical conditions, medications, and or allergies that you would like the medical staff to be aware of.

6 Explorer Personal / Medical Record Explorer Contact Information Last Name First Name # Years previous at Academy Address City State Zip Gender DOB Age Shirt Size Home Phone Cell Phone Explorer Post Name Post Advisor Advisor s Phone Number Emergency Contact/Guardian Information Name Relationship Address City State Zip Home Phone Father s Cell Phone Father s Work Phone Mother s Cell Phone Mother s Work Phone Other Medical History Have you had or are you currently being treated for any of the following conditions: Y N Condition Y N Condition Asthma Arthritis Abdominal Pain (chronic) Diabetes Epilepsy/Seizures/Convulsions Chronic Earache / Infections Lung/breathing problems (specify below) Heart Problems (specify below) Fainting Spells Hay Fever / Seasonal Allergies Insect Sting Allergies (specify below) Do you tire easily with exertion/exercise? Kidney Disease / Infections Bowel Problems Psychiatric concerns (specify below) Exercise Restrictions Any current or past infectious / contagious disease or illness? (specify below) Do you have any chronic or acute pain? Have you had any recent illness or injury requiring medical attention? Have you had any major surgeries? Comments / Pre-existing Injuries or medical conditions: Current Medications Name of Medication Dose/route Frequency / special instructions Medication Allergies: Dietary Needs, i.e. vegetarian, vegan, gluten free: (we will make every attempt to accommodate special dietary needs. YOU MUST notify us of any food allergies! Immunizations: Please provide a copy of your immunization (vaccination) record with this form. FORM A

7 Explorer Physical Form Must be completed by a licensed physician, nurse practitioner or physician assistant Last Name First Name Gender Date of Birth Age Address City State Zip Father/Guardian Name Cell Phone Mother/Guardian Name Cell Phone Primary Care Physician Office Phone Parent/Guardian Home Phone Other contact Medical History History Y N History Y N History Y N Have you ever had: Fainting spells Have you ever had: Kidney disease Do you currently have: Painful joints Diphtheria Tuberculosis Backaches Scarlet Fever Jaundice Cardiac problems Rheumatism Sickle Cell Anemia Shortness of Breath Rupture Do you currently have: Frequent Urination Rheumatic Fever Exercise Restrictions Cough Poliomyelitis Blurred vision Nosebleeds Pneumonia Headaches Frequent sore throat Asthma Fainting Stomach pain Diabetes Convulsions / Seizures Infectious or contagious diseases Heart Disease Blackouts Psychiatric concerns Notes/ Pre-existing injuries or medical conditions: Physical Exam SYSTEM NORMAL ABNORMAL SYSTEM NORMAL ABNORMAL Vision Arms Blood pressure Legs Heart rate Lungs Respiratory rate Heart Blood Glucose Level Abdomen Nose Hernia Throat Genitalia/testicular exam Ears Neurological exam Orthopedic Muscular Thyroid Back Recommendations/Restrictions: I certify that I have examined the above student and recommend him/her as being in good physical condition and able to participate in the physical activities encountered in the Michigan Law Enforcement Youth Training Academy. Activities include extensive and rigorous physical activities found at a military style boot camp, to include, but not limited to, running, jumping, push-ups, calisthenics, and climbing. Signature of examiner: MD DO PA NP Printed Name of Examiner: Date: / / FORM B

8 Limited Power of Attorney / Medical Treatment Consent Authorization to Release Explorer This form must be completed for ALL explorers regardless of age. Please print clearly and complete all sections of this form. Explorer Name: Last name First name M.I. Name of Person Giving Consent: Last name First name M.I. Relationship: Insurance Information: Company Policy Number Policy Holder Policy Holder Social Security # The undersigned hereby gives express written consent for the following adult staff members to make medically necessary decisions in the event that the above named explorer becomes ill or injured and requires immediate medical attention. This includes onsite evaluation and treatment as well as transport for evaluation and treatment to the emergency room listed below. Persons allowed to make medical decisions: Medical Director: Kevin McKee, Paramedic Assistant Medical Director: Janet McKee, EMT Post Advisor: Hospital Emergency Department: Bronson Health Care Group This limited power of attorney is valid for the following time period only: through Emergency Treatment Facility: Bronson Health Care Battle Creek 300 North Avenue Battle Creek, MI (269) Authorization is hereby granted for the release of the above named Explorer to individual adult staff members of the Michigan Law Enforcement Youth Training Academy. This authorization also allows for release by staff and removal of the above named Explorer during their period of camping by those individuals listed below. Name Relationship Phone # ( ) Name Relationship Phone # ( ) Name Relationship Phone # ( ) Name Relationship Phone # ( ) Name Relationship Phone # ( ) Note: If both parents are listed above only one parent is required to sign below. The following authorization is required by the Michigan Department of Social Services pursuant to P.A. 116 of 1973 and administrative rule 127 (1). (Signature of parent or guardian) (Relationship to above named explorer) (Date Signed) Form C

9 PARENTS READ CAREFULLY! The requirements of the Academy closely parallel those of a regular police academy or military boot camp. The days consist of morning calisthenics and running. The Explorers march to and from classes, marching drills throughout the day, and evening running. The running is on a variety of surfaces including asphalt, concrete, gravel, and grass. If your child is not accustomed to a regular exercise program this program may come as a shock to them, both physically and mentally. It is extremely important that your child prepare his or her self both physically and mentally. Your child must be examined by a physician prior to attending the Academy. The form included in this packet or a similar school sports physical MUST be completed and returned with the registration packet. Your child must be educated as to the effects of rigorous physical activity to any medical condition they may have. If your child does attend this Academy and has been prescribed medications by a physician it is IMPERITIVE that they be sent with your child and LEFT IN THE ORIGINAL CONTAINER. This will allow the medical staff to appropriately dispense the medications as prescribed by the physician. Proper dosage and frequency are important to your child s health and safety. If your child is taking an over-the-counter (OTC) medication that is not on the list below you may send it with your child, IN THE ORIGINAL PACKAGING, and all manufacturers directions will be followed unless a written direction is provided by a health care provider for your child. If you have any questions regarding medications please contact your Post Advisor with questions. We provide the following OTC medications: Acetaminophen (Tylenol) both capsules and liquid pain reliever/fever reducer Ibuprofen (Motrin) both tablets and liquid pain reliever/fever reducer Pseudoephedrine (Sudafed) tablets Nasal decongestant, sinus decongestant Dyphenhydramine (Benadryl) both capsules and liquid Antihistamine Naproxen Sodium (Naprosyn) NSAID Pain reliever/fever reducer Aspirin tablets pain reliever/fever reducer Bisacodyl (Laxative) tablets PeptoBismol Upset stomach reliever/anti-diarrheal Chloraseptic throat lozenges Tums antacid Dyphenhydramine Cream Calamine Lotion Triple Antibiotic Ointment Claritin antihistamine Instant Glucose MediLyte tablets electrolyte replacement tablets ** If your child has an emergency inhaler prescribed to them, even if they have not recently used it, IT MUST be brought to Academy. If your child is diabetic, a glucometer MUST be brought to Academy. The medical infirmary is staffed 24 hours with licensed medical personnel.

10 Equipment List **Sleeping bags, or bed coverings and pillows must be brought, they will not be provided** Toiletries: Clothing: Soap/shampoo Toothpaste/brush Deodorant Razor/shaving cream Towels / wash cloths (2 each) Shower shoes (flip flops) Any medication (in original bottle) Moleskin / Band Aids for blisters (optional) Anti-chafing stick (optional)** [such as Gold Bond Friction Defense] T-shirts (2 for each day) Sweatshirt / light jacket (2) Shorts (8 days plus a few extra) Pants athletic style (in case of colder weather) Compression shorts for under regular shorts (optional) Socks (2 pair per day) Underwear Running shoes (2 pair) Rain poncho Post Explorer Uniform (for graduation) Explorers going to 1 st Platoon: Camouflage BDU s Black boots Gun Belt w/handcuffs Miscellaneous Equipment: Clothes hangers Sun block / sun screen Insect repellant Notebook, pens, pencils Address/Autograph book Money (we recommend not more than $30.00) Explorers DO NOT BRING: ANY ELECTRONIC DEVICES CELL PHONES FOOD/SNACKS KNIVES OR OTHER WEAPONS Remember the Explorers will need clothes for eight days. Adult Staff Extras: Black BDU s for daily wear Black Work Boots Fans Coolers (no fridge in barracks) Alarm Clock Snacks 800 mhz Radio with charger if possible Paddle holster Badge w/ belt clip Full uniform for graduation Laundry soap (washer/dryer on site)