2018 AHG Summer Camp GTR

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1 2018 AHG Summer Camp GTR Forms Check List - EXPLORER GIRL Camper Last Name: **ALL FORMS TO BE TURNED IN ON OR BEFORE May 1st** 2018 AHG Camp GTR Permission Slip (Page 2) Woodland Lakes Christian Camp and Retreat Center Consent and Liability Release (Page 3) Dress and Behavior Code with signatures (Page 4) Element of Danger Form (Page 5) AHG High Adventure Medical Form, healthcare provider signature required (Form on website) Completed Health and Medical History Form or copy* (Form on website, if needed) *Forms completed on or after 7/29/2017 are acceptable. This is a required form when registering with AHG. Please print the following documents as needed: Medication Administration Form (if applicable) *Please note: American Heritage Girls Health and Medical History Form, Request for Administration of Medication Form, and High Adventure Medical Form are located ALL together on the camp website. Download and print what is necessary for your situation. Helpful Hints: Parents make a copy of all forms to file at home. Troop Camp Coordinators make a copy of all forms to bring with you to camp as a backup Page 1

2 2018 AHG Summer Camp GTR Permission Slip Camper's Name: is going to AHG Summer Camp GTR hosted by Woodland Lakes Christian Camp and Retreat Center on Sunday, July 29th through Friday, August 3rd, Activities may include swimming in a lake or pool, archery, nature hikes, climbing, zip lining, team building activities, games, badge work, canoeing/kayaking, fishing, BB guns and/or campfires; if applicable, an off-site geocaching/hiking experience. In addition, those participating in the off-site geocaching/hiking experience will be transported to and from their experience in private vehicles approved for AHG transportation. Two-deep leadership will be maintained in each vehicle unless extenuating circumstances prevent such behavior. In those cases, cars will caravan together and travel directly to the designated meeting place. Place: Woodland Lakes Christian Camp and Retreat Center Emergency Phone #: Address: 3054 Lindale Mt. Holly Road, Amelia, OH Camp begins at 1:00 pm on Sunday, July 29th and ends on Friday, August 3rd, 3 pm. Leaders/Adults accompanying girls: Emergency Contact Person: Emergency Contact Phone #: Leader s Signature: (Cut here and keep the above for your records) My daughter,, has my permission to participate in AHG s Summer Camp GTR, July 29 h Aug 3 rd, If my daughter is participating in the on off-site "geocaching" experience, I am aware that she will be transported to and from the experience in private vehicles approved for AHG transportation. To the best of my knowledge, she is in good physical condition with no serious illness or operation since her last health exam. YES NO. If no, explain on back. Is she currently taking any medications? YES NO Specify: If yes, *Request for Medication Form completed? All medications should be given to her Troop Adult Volunteer at Camp. During this activity, I can be reached at: Phone #: Address: If I cannot be reached, please contact: Phone #: Relationship to girl: In the event that I cannot be reached in an EMERGENCY, I hereby give my permission to the physician selected by the person in charge to secure emergency treatment for my child as named above. Parent Signature: Page 2

3 2018 AHG Summer Camp GTR - Consent and Liability Release Camper's Full Name: I give consent for the above named camper to engage in the activities of AHG Summer Camp GTR and Woodland Lakes Christian Camp and Retreat Center. Included in those activities are (not limited to): lake swimming, pool swimming, archery, climbing wall (indoor/outdoor), ropes/challenge course, play areas, canoeing/kayaking, BB guns, and/or zip lining. I will not hold Woodland Lakes Christian Camp and Retreat Center, AHG Camp GTR Committee Members/Volunteers, Camp Staff or any other individual, responsible for injuries up to death incurred while participating in AHG Summer Camp GTR's and Woodland Lakes Christian Camp and Retreat Center's summer camp program. Additionally, if applicable, I am aware that participants in the off-site "geocaching/hiking" experience (East Fork State Park) will be transported in private vehicles approved for AHG transportation. I will not hold the driver, adult leadership, Woodland Lakes Christian Camp and Retreat Center staff, AHG Camp GTR committee members/volunteers, or any other individual, responsible for injuries up to death incurred while participating in AHG Summer Camp GTR's "geocaching/hiking" experience. My signature below is evidence of my understanding of all above information. Parent/Guardian Signature Date Page 3

4 2018 AHG Summer Camp GTR - Dress and Behavior Code The following Dress Code and Behavior Guidelines have been established for camp. Because we value purity, we will be mindful of our clothing. We will do our best to honor God with our words and actions. These guidelines are for youth and adult campers. Parents please be sure to read and discuss this dress and behavior code with your daughters. Please pack appropriately. If your daughter is in need of proper clothing, you will be phoned. Parents, please talk with your girls about being respectful and responsible with her words and actions. If your daughter is not following the AHG Creed (being Compassionate, Helpful, Honest, Loyal, Perseverant, Pure, Resourceful, Respectful, Responsible, and Reverent) she may be asked to leave camp. You will be contacted to arrange her transportation. Review BEFORE packing: One-piece bathing suits ONLY (NO EXCEPTIONS due to safety). No bikinis, no tankinis, no two piece swim suits. Shirt and/or shorts may be worn over a one-piece suit if desired. No tight shirts, sleeveless shirts (like spaghetti straps, low cut tops, razorback shirts), bare midriffs, or any clothing with inappropriate or offensive messages. Shorts must be at least fingertip length (i.e., end when arms hang at natural sides). No short shorts. Sneakers or hiking shoes are perfect for daily wear. Open-toed shoes are not a safe choice. Flip-flops or crocs may only be used in the shower house or inside the pool area. NO flip-flops or crocs to be used outside those areas. Do not bring any cell phones, CD players, ipods, electronic readers (Kindle, nook), hand held games, MP3 players, DVD players, or any other electronics. These items are not used at camp. No form of tobacco, alcohol or non-prescription medication is acceptable. No fireworks, guns, or sheath knives will be at camp. BB guns may be at camp, but Woodland Lakes and/or Camp GTR staff will organize and lead, no outside BB guns permitted. Pocket knives are allowed, but will be collected if used without care. Every camper will follow the buddy system throughout camp. Inappropriate language is unacceptable. Disrespectful behavior, to campers or adults, is unacceptable. Each girl is expected to follow her daily activity schedule. Issues and conflicts will be addressed following the biblical model for conflict resolution. Grace will be extended when mistakes occur and campers will right the wrong. Repeat issues are unacceptable and campers may be asked to leave camp. I have read and understand these guidelines. I will honor these guidelines for AHG Summer Camp GTR Camper Name: Camper Signature: Parent Name: Parent Signature: Page 4

5 2018 AHG Summer Camp GTR - Element of Danger Form (To be completed by all campers) Element of Danger Statement: As in any physical activity, there is an element of risk during the event. I understand there are inherent risks that cannot be eliminated from these activities. I have full knowledge of the nature and extent of the risks including, but not limited to: 1. Injuries resulting from falling from a height up to 60, collision with the Tower structure, high course events, low course events, or other obstacles. 2. Injuries resulting from rope abrasion, entanglement, and other injuries that may result from activities or other persons, including but not limited to slipping, trip and fall, climbing, rappelling, belaying, lowering on a rope, rescue or emergency activities, as well as injuries, abrasions, and cuts resulting from contact with the ground, equipment, and components of the program elements. 3. Failure of the ropes, harnesses, course hardware, anchor points, or any other part of the challenge course structure or equipment. 4. Injuries from falling participants or equipment or injuries resulting from the negligence of other course participants, belayers, spotters, spectators or staff members. Certification of Fitness: All material, pre-existing health conditions and physical limitations of the participant will be disclosed by the participant or the participant s parent or guardian in writing before beginning any activity. I have listed below any medical conditions, which may hinder my abilities in the selected activities. 1. Do you have any limiting physical disability, or conditions (temporary or permanent)? YES NO If yes, identify and explain: 2. Are you currently taking medication (prescribed or otherwise)? YES NO If yes, identify and explain: 3. Please list any allergies to food, medicine, plant, animal, insect, other: 4. Have or subject to: (Check if yes) Asthma Fainting Spells Convulsions Diabetes Angina Epilepsy Drug Reactions Bleeding Disorders Heart Trouble Prosthesis Explain any checked boxes: Medical Permission: This health information is correct so far as I know, and the person herein described has permission to engage in all prescribed activities, except as noted by a physician or myself. In the event of an emergency, I understand a reasonable attempt will be made to reach my emergency contact. If unable to reach that contact, I hereby give permission to the physician, selected by the adult leaders in charge, to secure proper treatment, including hospitalization, anesthesia, surgery, or injections of medication. Participant s Signature Printed Name Date Parent or Guardian (If under 18 years old) Printed Name Date Page 5

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