8-10, 2017 ALL forms

Transcription

1 , , 2017,, We are busy getting ready for camp and we hope you are as excited about it as we are! Enclosed are your registration packet and all the necessary forms. In order for us to process your application, ALL forms must be filled out completely and returned to Texas NF by mail, or fax. IF applying for campership: Deadline for campership applications plus all registration forms & fee is July 14 th. The deadline for general camp registration and fee is August 4 th. Registration Checklist Registration Form Demographics Form Consent/Release Form Medical Release Form Code of Conduct Acknowledgement Form Copy of your insurance card or information $150 per Camper if you are not applying for campership If Applying for Campership(s) be sure to complete the above forms plus: Campership Application $25 Application Fee per family Gates will open at 6:45 PM for campers. Check in time is from 7:00-8:30 PM on Friday, September 8. Staff will not be at the camp site until 6:45 p.m. Please allow 30 minutes to check-in. Campers are assigned to all male or all female cabins; your family will be divided accordingly. Dinner is not served Friday night, please be sure to eat before you arrive at camp. We will begin at 9:00 PM with our first activity, so don t miss out. Please call Cindy if you are running late or need to cancel the day of at (469) Please read the Code of Conduct (Camp Rules and Regulations) for Camp For All to everyone attending camp. The rules will be strictly enforced for the safety and well-being of all campers. Call or (chahn@texasnf.org) the office if you have more questions or concerns. We try our best to accommodate everyone s needs.! 1

2 REGISTRATION FORM Deadline for General Registration is August 4, Applications must be complete and include camp tuition if not applying for campership. Postmarked by August 4 th. Yes, we would like to come to the NF Family Camp and we have included our completed campership application and registration forms. Yes, we are coming! Enclosed is our check (made out to TNFF) or credit card information. AMEX MC VISA Card # Exp. CID# Name Main Applicant (Parent/Responsible Party): Address City ST Zip Phone Camper Information Have you or anyone in your family been convicted of a crime and/or a registered sex offender? Circle one: No Yes If yes, please provide city and state of conviction and details of conviction. Name of Camper T-Shirt Size NF Type Relationship (Start with Main Age Sex Youth S/M/L NF 1 or 2 to Main Applicant) Adult S/M/L/XL/XXL/XXXL Applicant Main Applicant 2

3 Emergency Contact: Name: Relationship: Telephone (home) (work/cell) Health Insurance (Please attach a copy of insurance card or Medicare /Medicaid coverage) Name of carrier ID# Group# PERSONAL INFORMATION (Please list information for all campers and put their name in parentheses if it applies to them.) Allergies (put name of camper by the allergy) (Please list all drug, food, animal) Type of reaction/remedy Dietary Restrictions (List any special diet or food requirements) Special request or needs or anything we need to be aware of (Please explain in detail as this is used to help in cabin assignments) Medications Because we are a family camp, all medications need to be checked in at the Health Center when you arrive at camp. Please list camper s name and all medication each camper takes. (Attach sheet if needed) Name of Camper Medication 3

4 2017 DEMOGRAPHICS Name of Primary Applicant: The purpose of this form is to provide additional information to the Texas Neurofibromatosis Foundation and Camp For All in order to improve our services. Your accuracy is important and appreciated. Please list the number of campers in your family next to each category that applies to you (Example: If you have 2 children under the age of 5, put a 2 in front of 0-5 years of age.) 1. Age 2. Sex 3. Primary Disability 4. Ethnic Background 5. Family Size (check all that apply) 0-5 yrs. Male Mental African American 1 Person 6-11 Female Physical Native American Emotional Pacific Islander Autism Asian Hearing Impaired Caucasian Visually Impaired Hispanic Non-Disabled Alaskan Native Diagnosis-Specific Other (please list): 8 Please specify below: 9 NF1 NF2 Schwannomatosis 6. Residence 7. Income County: $0 - $9,999 State: $10,000 - $14,999 Zip Code: $15,000 - $24,999 $25,000 - $34,999 $35,000 - $44,999 $45,000 $54,999 $55,000 Plus *Please note that any information you share is strictly confidential and will not be shared with outside parties. 4

5 TEXAS NF FAMILY CAMP SEPTEMBER 8-10, 2017 MEDICAL RELEASE I, hereby give permission for any and all medical attention to be administered in the event of an accident, injury, sickness, etc. to the Texas NF Foundation and Volunteer Nurse or Volunteer Doctor. I give permission to the Texas NF Staff to be transported to the local hospital if the accident, injury or sickness requires transportation. I also assume the responsibility for the payment of any such treatment. Emergency contact: Phone: Relationship: 5

6 CAMP FOR ALL FOUNDATION CAMP RELEASE FORM This agreement must be read and signed for you/your child to be eligible to attend the Texas NF Foundation Family Camp at Camp For All. You/Your Child s Name: PARTICIPATION CONSENT I understand and certify that my/my child s participation in Texas NF Family Camp and its activities at Camp For All is completely voluntary. I have familiarized myself with_texas NF Family Camp_ program and activities at Camp For All in which I/my child will be participating. I recognize that certain hazards and dangers are inherent in these activities, which may include, but not limited to, the activities of horseback riding, high and low elements ropes course, swimming, archery, riflery and canoeing. I acknowledge that although Texas NF Foundation and Camp For All have taken safety measures to minimize the risk of injury to camp participants, _Texas NF Foundation and Camp For All cannot insure or guarantee that the participants, equipment, premises or activities will be free of hazards, accidents or injuries. I recognize and have instructed my child in the importance of knowing and abiding by the rules, regulations, and procedures for _Texas NF Family Camp_at Camp For All. Further, I have received approval from a doctor authorizing me/my child to participate in the _Texas NF Family Camp activities at Camp For All. I also agree to inform _Texas NF Foundation of any activities in which I/my child may not participate. LIABILITY RELEASE I, the undersigned, understand that occasionally accidents occur during camp activities and that participants may sustain serious personal injury and property damages as a consequence thereof. Knowing the risks of camp activities, nevertheless, I agree to assume those risks and by signing this liability release, I intend to legally bind myself, my minor children, my heirs, executors, and administrators. I hereby release and forever discharge Texas NF Foundation and Camp For All, and any of their officers, directors, employees, and agents from all claims, causes of action or damages arising out of any injury, illness, or loss of any kind, known or unknown, including but not limited to injuries to property or person, to me/my child during or related to my/my child s attendance at Texas NF Family Camp at Camp For All. MEDIA RELEASE I hereby give Texas NF Foundation and Camp For All the right to interview and/or to take photographs, audio or audiovisual recordings of me/my child to be used in promotional, educational or fundraising materials including, but not limited to videotapes, pamphlets and brochures. I understand my/my child s name may be used in connection with these materials. By signing this media release, I intend to legally bind myself, my minor children, my heirs, executors and administrators. Texas NF Foundation and Camp For All shall have the right to use photographs or other images of me/my child in promotion, educational or fund-raising materials. I acknowledge that Texas NF Foundation or Camp For All shall have all rights of copyright in and to such photographs and videotapes and may use such copyright fully. I also hereby release _Texas NF Foundation_ and Camp For All and its officers, agents and employees from all liability connected with the taking and use of these materials as is authorized by Texas NF Foundation and Camp For All. In addition, I waive all rights, interest or claims for payment in connection with any exhibition or release of these materials. This consent is voluntary, and I give it in the interest of public information, education, the furtherance of the goals of these institutions, or other lawful purposes. I acknowledge that I have legal authority to sign this form on behalf of the minor whose name is mentioned above. X Parent/Guardian/Self Signature Printed Name Date Address City State Zip 6

7 Texas Neurofibromatosis Foundation ( Camp for All Rules & Regulations) 1. The following are not permitted in any part of Camp For All (CFA): Alcoholic Beverages Knives, Fireworks, Firearms or other weapons Pets (except trained service animals)-no DOGS &/or CATS Drugs (except for prescription drugs). All other drugs of any nature are strictly prohibited on any portion of CFA. Prescriptions and other medications must be checked in with TNFF Staff and/or CFA Staff. 2. Smoking is not permitted inside any building portion of CFA. A smoking area has been designated outside. Cigarette butts should not be deposited on the ground, but in proper receptacles. 3. In order to provide security to our campers and staff, we must know who is in Camp at all times. Visitors are not permitted unless approved by Texas NF Foundation (TNFF) Staff and/or CFA Camp Director. All visitors must check-in at the main office upon arrival. 4. Valuables should be left at home. TNFF and CFA are not responsible for loss or damage to personal property. 5. Camp For All shall conduct fire and emergency drills on first day of camp session. 6. Access to specialized program activity areas, including the Ranch, Archery, Bikes, Pool, Lake, and challenge course, are allowed only when accompanied by a properly trained Camp For All Staff member. 7. Vehicles are not permitted beyond designated parking areas. Vehicles must be parked in designated areas. A maximum limit of 10 mph must be observed on camp property. 8. Only TNFF Staff and/or CFA Staff may use the golf carts. 9. Meals are served according to our schedule of activities. The kitchen will be closed after supper clean-up until breakfast the next day. No one is permitted in the kitchen at anytime. No food, glasses, dishes, or utensils should be taken out of the dining hall facility. Food is not allowed in cabins as it attracts rodents and bugs. Cereals, fruit, juice, and peanut butter and jelly will be available throughout the day in the dining hall. Special dietary needs should be arranged through the Camp For All Camp Director. 10. Pay telephones have been provided for personal use. The main Camp phones are for authorized business use only. Messages can be left at and will be relayed to you by TNFF Staff. 11. The use of personal sports equipment such as skate boards, ripstiks and roller blades is prohibited. 12. Don t mess with Texas! Please throw trash in appropriate containers. Camp For All recycles all paper, cardboard, plastic and cans. 13. All Camp Facilities must be left clean and free from debris at the end of the weekend. 14. Everyone must wear closed toed shoes (i.e., tennis shoes) while out in the camp facility. 15. Gates will be locked during the camp; if you leave you may not be able to come back in unless arrangements have been made with TNFF Staff. 7

8 16. No child or children under the age of 18 should be unattended in any area of the camp without a parent or adult. Please be aware where your child or children are at all times. Please respect others in your cabin. You need to be in your cabin by 11 p.m. and lights out by 12 a.m. TNFF staff will be doing rounds at night to make sure everyone is in their cabin. We want to emphasize that this is a FAMILY Camp. Please refrain from drinking, using inappropriate or abusive language or partaking in any other inappropriate activities. Rules will be enforced! After reading the Code of Conduct and sharing with members of your family/group attending camp, please sign the form below and include with your registration documents. Code of Conduct Acknowledgement Form Campers who violate these rules or otherwise behave poorly may be sent home (on public transportation, if necessary) at their expense and may lose the privilege of attending any future camp. I (please print name), acknowledge that I have read the TNFF Code of Conduct and will abide by them. I have shared the Code of Conduct with every member of my family/group attending camp. I also understand that if I fail to comply with these rules, I may be sent home and denied the opportunity to attend any future camps. Parent/Responsible Party Signature: Date Signature (s) of additional Adult Campers: Camper Signature Date Camper Signature Date Camper Signature Date Camper Signature Date 8

9 ( ) From Houston: Total miles 85; Approx. drive time: 1 hour 45 minutes Take Hwy. 290 West toward Brenham, approximately 85 miles. Hwy. 290 skirts the edge of Brenham. Watch signs for Hwy. 290 West to Austin. Loop to the right on Hwy. 290 and proceed West approximately eight miles to FM (Note: If you miss the 290 West turn and continue straight, the road becomes Hwy. 36 and enters Somerville). Turn right on FM The Nueces Canyon Equestrian Center is on the left on 290 just before the turn onto FM Continue on FM 1948 approximately two miles past Highway 390. DO NOT turn right onto Hwy 390 but continue on FM 1948 toward Lake Somerville. FM 1948 curves near St. Paul s Lutheran Church. Approximately 1/4 mile past the church, turn right on Rehburg Road. Proceed for 8/10 mile on paved road. Turn right at CFA gate. From San Antonio: Total Miles: 150; Approx. drive time: 2 hours and 30 minutes Take Interstate 35 to San Marcos. Turn right on Highway 21 toward Bastrop. When you reach 290 turn right and go toward Giddings. Burton is approximately 18 miles from Giddings. You will also go through Ledbetter and Carmine then Burton. After you pass through the outskirts of Burton approximately 3-4 miles you will see a sign for FM 1948 on your left. Underneath the road sign it also says "Camp For All." If you go past the Nueces Canyon Equestrian Center, on your right, you have missed the turn. You will turn left onto You can only turn left onto 1948 from Hwy 290. Continue on FM 1948 approximately 2 miles, to a stop sign, which is Hwy 390. DO NOT turn right onto 390, but continue on FM 1948 toward Lake Somerville. You will cross another intersection on 390 which veers left, it will take you into the city of Burton. Do not go to the City of Burton, but continue around on 1948 to the right about 2 more miles curving right around St. Paul's Lutheran Church. Approximately 1/4 mile past the church is Rehburg Rd. - turn right and proceed 8/10 mile on this gravel road. The entrance gate for Camp For ALL will be on your right. From Austin: Total miles 85; Approx. drive time: 1 hour 45 minutes Take Hwy. 290 East through the towns of Giddings, Ledbetter and Carmine. Approximately 18 miles from Giddings is the outskirts of Burton. After passing the outskirts of Burton, proceed approximately eight miles and turn left at FM Proceed approximately two miles on FM 1948 past Highway 390. DO NOT turn right onto 390, but continue on FM 1948 toward Somerville. FM 1948 curves near St. Paul s Lutheran Church. Approximately 1/4 mile past the church, turn right on Rehburg Road. Proceed for 8/10 mile on paved road. Turn right at CFA gate. From College Station: Total miles: 45; Approx. drive time: 1 hour Take University Drive West to Hwy. 60. Proceed on Hwy. 60 through Snook to the intersection at Hwy. 36 at Lyons. Turn left and proceed on Hwy. 36 to Somerville. Go through Somerville and continue on Hwy. 36 for several miles to FM Turn right on FM 1948 and go over the railroad tracks. You will travel several miles- DO NOT Turn onto Rehburg Rd. from this road, but continue to the stop sign and intersection of FM 547 right and FM 1948 left. Turn left on FM 1948 and proceed to Rehburg Rd. Turn left and go 8/10 of a mile and you will see the entrance gate and sign for Camp For All. From Galveston: Take I-45 North to Houston. Proceed on 1-45 North to 6-10 East. Take 6-10 East to 290 West toward Brenham, approximately 85 miles. Hwy. 290 skirts the edge of Brenham. Continue on Hwy 290 West toward Austin. Proceed approximately 11 miles to FM Turn right on FM The Nueces Canyon Equestrian Center is on the left on 290 just before the turn onto FM Continue on FM 1948 past Highway 390. FM 1948 curves around a church. Approximately 1/4 mile past the church, turn right on Rehburg Road. Proceed for 8/10 mile on paved road. Turn right at CFA gate. From Beaumont: Take I-10 West to 6-10 North. Proceed from 6-10 North to 290 West toward Brenham, approximately 85 miles. Hwy. 290 skirts the edge of Brenham. Continue on Hwy 290 West toward Austin. Proceed approximately 11 miles to FM Turn right on FM The Nueces Canyon Equestrian Center is on the left on 290 just before the turn onto FM Continue on FM 1948 past Highway 390. FM 1948 curves around a church. Approximately 1/4 mile past the church, turn right on Rehburg Road. Proceed for 8/10 mile on paved road. Turn right at CFA gate. From Dallas: Total miles: 195; Approx. drive time: 3 hours Take I-35 South to Waco and from Waco, take Highway 77 through Robinson and Rosebud to Cameron. From Cameron, turn left on Highway 36 through Caldwell and Somerville. Go through Somerville and stay on Hwy 36 for several miles until you come to the flashing light on Highway This will also say "Rocky Creek Park" and 9

10 "Yegua Park." Turn right on FM 1948 and go over the railroad tracks. You will travel several miles-do NOT Turn onto Rehburg Rd. from this road, but continue until you come to a "Stop Sign"- "T-Intersection" - FM 547 right and FM 1948 left, turn left to continue on FM The next road to your left will be Rehurg Rd. and it will have a sign which is labeled "Camp For All and Rehburg Rd." Turn left and go 8/10 of a mile and you will see the entrance gate and sign for Camp For All. 10

11 ! The talent show will be on Saturday evening. Whether it s dancing, comedy, singing, or playing a musical instrument come prepared for the big talent show. Pick a favorite song, dance or lines from your favorite movie. So start practicing and don t forget to bring the necessities to do your talent (musical instrument, etc.). LIMIT: ONE ACT PER PERSON 11

12 CAMP GEAR (WHAT TO BRING TO CAMP) PLEASE KEEP VALUABLE ITEMS AT HOME OR LOCKED UP, TEXAS NF IS NOT RESPONSIBLE FOR LOST OR STOLEN ITEMS. LABEL ALL BELONGINGS WITH YOUR NAME. Pillow; Sleeping bag OR sheets & blanket for twin bed Bath Towel and wash cloth; Towel for the pool and lake Shower shoes Swimsuit (please remember it is a family camp and appropriate swimsuit is appreciated) Shorts Long pants for horseback riding T-shirts Shoes and socks (close-toed shoes required at all times) Rain coat/poncho (just in case) Hat Toiletries Sunscreen Insect Repellent Flashlight Camera and film Change for sodas-there is a soda machine at camp Games, cards, etc. Journal for your camp memories Talent show items (musical instruments, etc.) Sports equipment: tennis racket, fishing pole, frisbee, etc. (they have this equipment at camp - only bring yours if you want your special equipment ) 12