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: 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, 2016. 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 4 2 2016
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 1424 24TH AVE NW FARIBAULT MN 55021 For Office use only: Received Reviewed Accepted Rejected Notified Revised 4 2 2016
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: www.mnaog.org/ministries/royalrangers.aspx Applicant Information Name: Address: City: State: Zip Code: Phone: ( ) E-mail: Age Date of Birth: T-shirt size: Youth Men s Church Information Name: Address: City: State: Zip Code: Church Phone: ( ) Pastor: Phone: ( ) E-mail: Junior Camp Information (check the desired camps) Early registration due by July 1 Deposit Amount: Week 1: Aug 4 Aug 7, 2016 Cost: $250.00 ea* Honor Guard Camp $ Week 1: Aug 4 Aug 7, 2016 Cost: $200.00 ea* Discovery Training Camp $ Big Adventure Camp (FCF) $ Week 2: Aug 11-14, 2016 Cost: $200.00 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 56601 For Official use only: Date: Check # Amount: $
Minnesota District Assembly of God 1315 Portland Ave S Minneapolis, MN 55404 (612) 332 2400 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
Minnesota District Assembly of God 1315 Portland Ave S Minneapolis, MN 55404 (612) 332 2400 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 55404-1486 PHONE (612) 332-2409 FAX (612) 332-2510
Minnesota District Assembly of God 1315 Portland Ave S Minneapolis, MN 55404 (612) 332 2400 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)