To register and for more information visit us at or contact Freddy Vasquez at (813)

Transcription

1 Southeastern Retreat Center, 6575 NE 96th Ave., Okeechobee, FL To register and for more information visit us at or contact Freddy Vasquez at (813)

2 Southeastern Spanish District JLTA Junior Leadership Training Academy December, 1-4, Southeastern Retreat Center Okeechobee, FL. Be a part of the FIRST JCE in SESD history! Junior Training Camp (JTC) is for boys in seventh grade and above. This camp trains boys in camping techniques and outpost leadership and is conducted in an outdoor setting. Trainees are divided into patrols that camp together, eat together, and function as units throughout the camp. Training emphasizes camp craft techniques, and teambuilding skills, giving boys the opportunity to demonstrate what they have learned. In addition, each trainee receives a workbook at the beginning of the camp to complete while at the camp. Advanced Junior Training Camp (AJTC) is for boys who have completed JTC and have finished eighth grade. Boys are taught skills that build upon what they learned at JTC. Emphasis is on advanced camping and leadership skills. The camp has a similar format to JTC, with the added responsibility of assisting with JTC training. Each trainee is given a workbook to complete and use at the camp. Junior Canoe Expedition (JCE) is for those boys who want to learn more advanced canoeing skills as well as how to conduct canoe trips. Boys must have attended Advanced JTC and have finished the ninth grade. Topics to be studied include water-related first aid, swimming safety, canoe safety, waterproofing of gear, canoe care, portaging, and conducting council fires. After attending classes the first day, trainees and staff will set out on a water expedition. During this time they have the opportunity to complete the requirements for the green Canoeing Merit. Expeditions are divided into groups, because often there is a restriction on the number of campers at each campsite. For applications and information you can contact Freddy Vasques at or freddyfixit3@aol.com

3 Name: Date of Birth: Address: City, State, Zip: Home Phone: Emergency Contact: Church: Contact Phone: Church Phone Size: [ ] ADULT [ ] YOUTH [ ] SM [ ] MD [ ] LG [ ] XL [ ] 2-XL Parent or Guardian: Senior OP Coordinator: Pastor: Total cost for this camp is $ A $50.00 non-refundable application fee must accompany this form. Make all checks payable to: S.E.S.D Royal Rangers. Please mail to: PO BOX 1172 Okeechobee, FL For information call Freddy Vasques at (813) , or freddyfixit3@aol.com All applications must include a completed medical form. Campers arriving without a completed medical form will not be allowed to register or participate. NO EXCEPTIONS! All applications must have all signatures that are required: Parent, Senior OP Coordinator, and Pastor. Campers must be in the 8 th Grade by the starting date of the camp. A $25.00 Late fee will be applied to all applications postmarked after the deadline date of 11/04/2011 POST MARK DEADLINE: November 4, 2011 Incomplete applications and applications not meeting the above requirements WILL NOT BE ACCEPTED. Date Received: Balance Due: Office Use Only

4 ADVANCED JUNIOR TRAINING CAMP PERSONAL EQUIPMENT CHECK LIST CLOTHING One complete official Royal Ranger Utility uniform or the old Class B uniform (long sleeve khaki shirt, khaki trousers, khaki Royal Ranger belt, standard bolo tie, black or navy socks, and black or brown shoes). remove insignia and awards (Pin-on items). Patches and sewn on items may be retained. No cap is needed. A special AJTC beret will be issued and worn during camp. One sweatshirt Pair of fatigues, jeans, or other work-type trousers for casual wear. Two Royal Rangers T-shirts One jacket (Royal Rangers type if available) One pair heavy shoes or boots for camp activities Two pairs of socks (navy or black) to wear with uniform Two pairs of socks (any color) for use when not in uniform One poncho or rain suit with hood Extra socks, underwear, T-shirts, sweatshirts, or long pants for fresh change as desired Underwear and handkerchiefs (Plan on quantities needed for four days and three nights.) GEAR Pocket knife and whetstone Hand axe (with sheath) Matches Towels and washcloths (showers available) Adventures in Camping handbook Discovery or Adventure handbook Silva-style compass Insect repellent Toilet kit (toothbrush, paste, comb, soap, washcloth, hand towel, and mirror) Small personal first aid kit Pen and pencil Small Bible Watch Flashlight with extra batteries OPTIONAL ITEMS Ditty bag to carry small items Small package of facial tissues Nail clippers with fingernail file Sunglasses Suntan lotion Camera Compact sewing kit Electronic Devices ( Ipods, DS, PSP, etc. ) will not be tolerated and will be held for the duration of the camp.

5 Medical Record Applicant s Full Name In case of emergency please notify: Insurance Information Health Insurance Company s Name Policy Number Certificate Number Last Name First Name Effective Date of Coverage ( ) ( ) ( ) Daytime Contact Phone # Evening Contact Phone # Health Insurance Company s Phone # GENERAL INFORMATION: Health History A complete health history must be completed by each applicant for participation at the 2011 JR. Training Camps - Up. To be completed by the applicant (if over age 18) or by a parent/guardian if the applicant is a minor (under age 18). Has the applicant experienced the following? Check either Yes or No. If Yes explain under Remarks and Medical facts. Sinus condition Yes No Shortness of breath Yes No Exposed to infectious: Ear problem Yes No Skin infection Yes No Disease past 3 weeks Yes No Lung problem Yes No Hearing difficulty Yes No Hepatitis past 6 months Yes No Heart Problem Yes No Bad eyesight Yes No Any disorder preventing High Blood pressure Yes No Wear contact lenses? Yes No strenuous activity? Yes No Allergy-Asthma Yes No Any medical care Taking prescription Fainting or dizzy spells Yes No in the past year? Yes No Medicine? Yes No Diabetes Yes No Any surgery within Any reaction to drugs or Appendix removed Yes No past year? Yes No medicine of any type? Yes No Food or drug allergies I am currently taking the following medications Remarks and medical facts: Give latest date of inoculation or vaccination against following: Tetanus / / Small Pox / / Measles / / Typhoid / / Diphtheria / / Polio / / Additional remarks: Birth Date Height Weight / / Parent/Guardian s Name (Please Print) Parent/Guardian s Address ( ) City State Zip Parent/Guardian s Phone Number Parent/Legal Guardian Consent: The signature of a parent or legal guardian is required for a minor to attend the 2011 JR. Training Camps at Okeechobee, FL, December 1-4, The parent s or legal guardian s signature below indicates: Permission to administer medical attention to the minor in the event of a medical emergency. X Print Complete Name of Minor Parent/Legal Guardian Signature Date Adult(18+) Pastor s Certification for Church Worker: I am personally acquainted with the adult applicant, and in my opinion he is a competent and qualified youth worker. I know of no facts or allegations that raise any questions concerning his suitability for working with minors in any Royal Rangers activity. The church has on file the applicant s youth workers screening form. Adult leaders are considered 18 years of age or older. X Pastor s Signature ADULT APPLICANT S SIGNATURE: My signature acknowledges that I have truthfully abided by the requirements as stated on this Application form. My signature verifies I am 18 or older, and that I have received my pastor s signatures as stated on this Application form. My signature also indicates my permission for emergency medical treatment should the need arise while at the JR. Camp or while traveling to or from the JR. Camp site X Applicant s Signature Date Date