2015 Catholic Scout Retreat The Diocese of Birmingham September 25-27, 2015 at Beautiful Camp Tekakwitha

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1 2015 Catholic Scout Retreat The Diocese of Birmingham September 25-27, 2015 at Beautiful Camp Tekakwitha Registration Deadline: September 15 Check-in on Friday begins at 5:00 PM. The program will conclude at about 11:30 AM Sunday. There will be a cracker barrel (snacks) Friday night but no dinner. Eat before you arrive or bring sack lunch. Where Camp Tekakwitha, near Clay Alabama. This is a tent camping retreat, inside accommodations will not be available. Camping trailers and RVs will not be permitted. Bring your tent! Leave No Trace Camp Tekakwitha is a Leave No Trace facility. We ask that you be prepared to take home all trash you and your Scouts generate during weekend. Who Catholic Scouts (boys and girls within the appropriate age group) and Catholic adult leaders. Age Group 9 through 15. Please do not bring or send younger children. Participants do not need to be registered in a Catholic sponsored unit to attend. Everyone (youth and adult) must be registered in a recognized Scouting association. Adults must be up to date on appropriate youth protection training. Pets are not permitted at Camp Tekakwitha. Please leave fluffy at home. What A weekend dedicated to prayer, worship and fun. Those who enjoyed past retreats will find a new program but the same great attitude. Cost - $15 per person (youth and adults). Fee includes weekend of fun, food, and a special embroidered patch. A registration form to be used by youth and adults along with program updates and other information can be found at Follow the links to Catholic Scout Retreat. Use smart phone for quick link to Scout Retreat Info What to Bring Meals will be served in the hall so there is no need to bring cooking equipment. Other things you will want to bring: Tent and flashlight Folding chair (most sessions will be outside) Sleeping bag and pad or cot Bug spray Scout uniform Rain gear Personal care items Pen Bible (if you have one) Other equipment as desired Meals Served Snacks late Friday night, Breakfast, Lunch and Dinner Saturday. Breakfast on Sunday Cell phones - do not work at Camp Tekakwitha. There is a landline for emergency calls Lost If you get lost finding Camp you can call us at for help The Diocese of Birmingham in Alabama Office for Youth PO Box 12047, Birmingham AL or YouthMinistry@Bhmdiocese.org

2 2015 Catholic Boy Scout Retreat - Parental/Guardian Consent Form and Waiver Child Sex Date of Birth Parent(s)/Guardian(s) Home Address City State Zip Home phone ( ) Other phone ( ) I, (name of parent or guardian), grant permission for my child (name of child) to participate in the Catholic Scout Retreat. This activity will take place under the guidance and direction of personnel from The Diocesan Catholic Committee on Scouting. Specific details are located in the event flier. September 25-27, 2015 Check-in begins at 5:00 PM on Friday evening - Program concludes on Sunday at approximately 11:30 AM Overnight Retreat for Catholic Scouts age 9-15 and their adult leaders Camp Tekakwitha, Springville Alabama Specify who will be picking this Scout up from the retreat I grant permission for my child herein named to participate in the event described above. I agree on behalf of myself, my child (named herein), our heirs, successors, and assigns to hold harmless and defend the Diocese of Birmingham in Alabama, its Bishop, Parishes, Employees Volunteers and Camp Tekakwitha from any liability for illness, injury or death arising from or in connection to my child s attendance at the event described above. To the best of my knowledge, my child (named herein) is in good health, I assume all responsibility for the health of my child. In the event of an emergency, I give permission to transport my child for emergency treatment. I wish to be advised prior to any treatment by a hospital, clinic or doctor. I have noted any and all health/diet concerns on the reverse side (second page) of this form. As parent/legal guardian, I remain legally responsible for any actions taken by my child (named herein). My child will conduct himself/herself in a proper and respectful manner. I understand that failure to abide by standard codes of conduct will cause my child to be dismissed from the above named event. I agree that if my child is dismissed from the event I will travel (or send an adult designee) at my expense to the event location and retrieve my child. Yes No Media Permission I give my permission for my child (named herein) to be photographed and/or recorded at the event described herein and understand that media produced may be used to advertise or promote future events: Alternate Emergency Contact: Relationship: Phone number(s) of Alternate: Print Parent Name Signature of Parent/Guardian: Date: Mail to: The Office for Youth, PO Box 12047, Birmingham AL Checks payable to the Office for Youth. Please complete the Medical Information section of this form

3 Name HEALTH INFORMATION Physician: Phone: Family Health Plan Carrier: Policy/Contract Number: Phone: Name of Policy Holder: Optional: My child is taking medication at present. My child will bring all such medications necessary, and such medications will be well labeled. Names of medications and concise directions for seeing that the child takes such medications, including dosage, and frequency of dosage are as follows: Signature: Date: Optional Instruction: Do not give non-prescription medication of any kind to my child without my express permission. Exceptions: Signature: Date: Allergic Reactions (medications, foods, plants, insects, etc.) The retreat is unable to provide food for special diets, please send any special foods with your child. Date of last tetanus shot: Special Dietary Considerations: Physical Limitations: Medical or psychological conditions retreat leadership should be aware of: CODE OF CONDUCT I hold that my child will conduct himself/herself in a proper manner and failure to abide by standard codes of conduct will cause my child to be dismissed from the above named event. I understand that if my child is dismissed from the event I will be expected to travel (or send an over age 21 adult designee) at my expense to the event location to retrieve my child. Signature: Date:

4 Directions to Camp Tekakwitha Please note: Except when an event or activity is in progress, the camp gates are kept locked and the property is posted No Trespassing, No Fishing and No Hunting. Please contact the Youth Office at the Diocese if you would like to arrange a visit. There is no cell phone service within the camp. If you are participating in an outdoor activity you should bring insect repellant - the bugs are very active and we do have a chigger problem! ### By way of I-59 (from the North) Take Springville Exit 154 from I-59 (there is a McDonalds at this exit) 2. Go past the McDonalds and continue through a four- way stop You will travel a bit less than one mile before the turn onto Village Spring Rd 4. Turn Left onto Village Spring Rd (you will see a large church on the Right at this turn). Village Spring Rd becomes Clayton Rd when you enter Jefferson County. 5. Travel about 5 miles 6. Turn Right onto Zuber Rd. (This turn comes up rather quickly after a very large home on the right side and just before a small bridge). If you get to Lowe Rd. You have gone too far on Clayton Rd. 7. Travel about 1.7 miles (until Zuber Rd ends) 8. Turn Right onto Deer Haven Rd 9. Deer Haven Rd. dead ends at the camp gate. ============================================================================ ### By Way of I-59 (From the South) Note: I-59 Exit 143 is between Trussville and Springville I-59 to DEERFOOT PKWY exit, EXIT Take the ramp toward CLAY. Turn West on Deerfoot Parkway toward Clay. 3. Merge onto DEERFOOT PKWY. 2.0 mi 4. Turn RIGHT onto TRUSSVILLE CLAY RD/CR mi 5. Turn RIGHT onto OLD SPRINGVILLE RD/CR-30. Continue to follow OLD SPRINGVILLE RD. 2.1 mi 6. Turn LEFT onto CLAYTON RD. (There is a very large rock house at this turn) 2.0 mi 7. Turn LEFT onto ZUBER RD. 1.7 mi (This turn comes up right at the end of a small bridge it s easy to miss!) 8. Turn RIGHT onto DEER HAVEN RD. 0.8 mi 9. Deer Haven Rd dead ends at Camp Tekakwitha.

5 ======================================================= From AL Hwy 75 to Camp Tekakwitha. From: near AL-75 & Ware Dr & Clay Palmerdale Rd, AL Take Clay Palmerdale Rd / CR-153 East about 2 mi 2. Turn left onto Cedar Mountain Rd / CR mi 4. Keep left onto Deer Haven Rd 2.7 mi Deer Haven Rd dead-ends at Camp Tekakwitha. The last intersection before camp is Zuber Rd ======================================================================================== As you approach the camp you will see several No Trespassing signs. IF you are on Deer Haven Road and IF you have permission to be on the camp property or are attending a scheduled event Come on in. As you approach the camp you will see several No Trespassing signs. IF you are on Deer Haven Road and IF you have permission to be on the camp property or are attending a scheduled event Come on in. Using a GPS? The camp address is 8500 Deer Haven Rd, Springville AL However Mapping software is not always reliable when giving directions to the camp. Please ignore any directions that mention Canoe Creek Rd. The only way into camp is from the South by way of Deer Haven Rd.