A Few Practical Items

Transcription

1 Dear Parent, Congratulations! Your child has been accepted to attend Camp Wojtyla this summer! My name is Annie Powell, one of your Camp Wojtyla directors. Along with my husband Scott, I want to begin by thanking you for enrolling your child/children for this incredible week of self-discovery and outdoor exploration. This Catholic adventure program will teach your child about themselves, others, our Lord and His creation through things like awesome hikes, trips to waterfalls and up mountain peaks. They ll experience overnights in the forest, night games, star gazing and daily Mass in the beautiful Rocky Mountains. We believe it is the most incredible and extraordinary way to learn about Christ and His Church! Be assured that caring for your child s safety is at the foundation of Camp Wojtyla s mission. We have highly trained staff and detailed risk management procedures in place that will keep your child as safe as possible. Many of our staff members have EMT or Wilderness First Responder training and every staff member is CPR and first-aid trained. The activities are meant to be enjoyable, exciting and enriching to your child s personal, social, and spiritual development. What they learn at Camp Wojtyla, they will remember for a lifetime. Thank you for letting your child take part in this incredible Catholic adventure! A Few Practical Items Forms Please take note of all camper documents on the registration page of the Camp Wojtyla website ( please turn in the waivers and photo release as soon as possible. Please send the remainder of your camp fee and all forms to Camp Wojtyla, PO Box 18452, Golden, CO by May 1, We will accept the 2012 Camper Medical Release form later than May 1 st in the event your doctor's visit is past the May 1 st deadline. Please mail it in as soon as your doctor has signed it. If you have any questions about the status of your registration please Registration@camp-w.com Thank you!!! Arrival and Departure Arrival: Camp Registration begins at 2pm on the first day of Camp (June 16, June 23, July 7, or July 21, respectively). Please arrive no earlier than 2pm and no later than 3:30pm*. Departure: Please arrive at 10am for the Camp Wojtyla Closing Ceremonies. *If your child is flying to Colorado for camp AND you would like to use our shuttle service to Camp Wojtyla: Please include their flight information with your waivers if possible. Please schedule your flight to arrive at the Denver International Airport on the first day of Camp by 12:30pm and schedule your departing flight for after 3pm on the last day of camp. Send a confirmation to flights@camp-w.com the week before the flight to assure shuttle service to Camp Wojtyla. Please include an additional $50 to pay for the shuttle fee. Again, thank you so much for registering your child in Camp Wojtyla. We are excited and look forward to seeing you and your children this summer at Camp! Blessed JPII, pray for us! God Bless, Annie Powell, Director

2 CAMPER REGISTRATION FORM SUMMER 2013 QUESTIONS FOR THE CAMPER Are you involved in any school, home school group or church activities? If yes, what are they? What are your hobbies? What are you most excited to do at Camp Wojtyla? In order to best serve your needs, we would like to know if you have any worries about your Camp Wojtyla experience (for instance, are you nervous to try archery for the first time, or to be with a new group of people in a small group, etc)? Would you like us to know anything else about yourself?

3 FEES AND DEADLINES There is a $100 non-refundable deposit due at registration. Middle School Camp: $435 if registration is received before March 1 st and $455 if registration is received March 1 st or later. High School Camp: $675 if registration is received before March 1 st and $695 if registration is received March 1 st or later. PAYMENT OPTIONS: How to pay your remaining balance after the $100 deposit Option 1: Immediate Full Payment Pay all of remaining balance when you turn in your forms. Option 2: Delayed Full Payment Pay all of remaining balance by May 1, NOTE: If your child s Registration Form and deposit are received after Camp Wojtyla is full, we will keep but not cash your check and will put your child on our waiting list. In the event that they cannot be registered, we will return your check. FREQUENTLY ASKED QUESTIONS When is the Registration Form due? As spots are extremely limited, it is best to register as soon as possible. If spots are not already filled, Camp Wojtyla accepts registration forms until May 1st. Forms should be sent to the Camp Wojtyla office located at: Camp Wojtyla, Camper Registration, PO Box 18452, Golden, CO with a $100 non-refundable deposit to hold your child s spot. Note: the cost for Camp increases on March 1 st. If Camp Wojtyla is full before I turn in the Registration Form, will there be a waiting list? Yes! If you send your child s Registration Form and deposit after Camp Wojtyla has filled up, we will place your child s name on the waiting list. We will keep, but not cash your check until we know for sure if he or she can be registered for camp. How do I get the information and other documents needed for my camper? You will find all the documents needed from the Camp Wojtyla website under the Programs tab on the Camper Documents page. The website address is When is the rest of the payment due? The remaining balance can be paid with your registration or by May 1st, What if I register my child for camp, but after May 1st I have to cancel do I get my money back? Before May 1 st all but your $100 registration fee is refundable. After May 1 st the policy is this: While camper fees are non-refundable, they are transferable. If your child cannot attend, but you are able to inform the Camp Wojtyla office of this in enough time for a wait-listed camper to successfully register or you can find your own replacement, you will be refunded all but your $100 non-refundable registration deposit. The replacement must be a new camper of the same gender for the same program and week who is not yet enrolled. A $25 reprocessing fee will be charged in order to transfer registration.

4 CAMPER LIABILITY RELEASE FORM SUMMER 2013 Please submit this form with your Registration form and deposit by May 1st. Please any questions to Brianna Lawson at RELEASE and WAIVER OF LIABILITY and ASSUMPTION OF RISK AGREEMENT In consideration of my child s being permitted to observe, attend, or participate in the activities of Camp Wojytla, a division of the JPII Adventure Institute, a Colorado nonprofit corporation, and on behalf of my child, named below, myself, my spouse, and my child s personal representatives, assigns, heirs, and next of kin: 1. I hereby release, waive, discharge and covenant not to sue the Camp, its officers, directors, board of directors, employees, affiliates, agents, representatives, successors, and assigns, or any customers, participants, sponsors, advertisers, rescue personnel, or other persons or entities involved in any capacity whatsoever with the Camp (for all purposes herein collectively referred to as the Releasees ) from all liability to my child, me, my spouse, and my child s personal representatives, assigns, heirs, and next of kin for any and all loss or damage, and any claim or demands therefore, on account of injury to the person or property or resulting in my child s death, however caused, arising out of or related to activities of the Camp, including, without limitation, observing or participating in any way, including as a driver or passenger in any vehicle, or working on or with any equipment (the Camp Activities ), whether caused by the negligence of any of the Releasees or otherwise (collectively referred to as the Released Claims ). On behalf of my child, I hereby assume full responsibility for any risk of bodily injury, death, or property damage arising out of or relating to the Camp Activities, whether caused by the negligence of any of the Releasees or otherwise. On behalf of my child, I hereby acknowledge that the Camp Activities may involve indoor and outdoor activities that are inherently dangerous and involve the risk of serious injury and/or death and/or property damage. On behalf of my child, I also expressly acknowledge that injuries received may be compounded or increased by negligent rescue operations or procedures of the Releasees or others. On behalf of my child, I hereby agree that this Release and Waiver of Liability, and Assumption of Risk Agreement extend to all acts of negligence by the Releasees, including negligent rescue operations. On behalf of my child, I further hereby agree that this Release and Waiver of Liability and Assumption of Risk Agreement is intended to be as broad and inclusive as is permitted by applicable laws and that if any portion hereof is held to be invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect and the portion held to be invalid shall be deemed to be modified and enforced to the fullest extent permitted by applicable laws. On behalf of my child, I hereby agree that this Agreement shall be binding upon and enforceable against my child, me, my spouse, my child s personal representatives, assigns, heirs, and next of kin without limitation and shall be in full force and effect for all Camp Activities. 2. The undersigned do hereby release, forever discharge and agree to hold the JPII Adventure Institute staff, director, and board members harmless from and against any and all liability, claims, demands, lawsuits, and expenses arising from personal injury, sickness, death, or property damage of any nature whatsoever which may be incurred or suffered by the undersigned and or the participant (If participant is under 18, or 18 and older) while attending the above activity. Furthermore, the undersigned hereby assume all risk of personal injury, sickness, death, damage and expense arising from the undersigned s or participant s (if participant is under 18, or 18 and older) participation in all activities, including recreation and work activities involved in the above activity. In addition, authorization and permission is hereby given to furnish all necessary transportation, food, and lodging for the undersigned or participant (if participant is under 18, or 18 and older). The undersigned further hereby agree to indemnify and hold all staff, director, and board of directors for JPII Adventure Institute, the above

5 named Parish, and their respective members, directors, employees, and agents (collectively, the Indemnitees ), harmless from and against any and all claims, demands, actions, lawsuits and liabilities, including attorney s fee and expenses sustained by the Indemnities as the result of the negligent, willful, or intentional acts of the undersigned and/or participant (if participant is under 18, or 18 and older). If participant is under 18 years of age: We (1) are the parent(s) or legal guardian(s) of the participant, and hereby grant permission for to participate fully in the above activity and all of its undertakings, and hereby give our permission to take said participant to doctor or hospital and hereby authorize medical treatment, including but not limited to emergency surgery; and, we fully and completely assume responsibility for all medical bills. Furthermore, should it be necessary for the participant to return home due to medical reasons, disciplinary action or otherwise, I (we) assume all responsibility and transportation costs. 3. I hereby allow my child to leave Camp Wojtyla for the following outings away from Camp: a. Hiking and camping in Rocky Mountain National Park and Roosevelt National Forest b. Rock Climbing with Kent Mountain Adventure Center (KMAC) c. Whitewater Rafting with Rapid Transit Rafting 4. On behalf of my child, I have read this release, waiver of liability, and assumption of risk, fully understand its terms, understand that I have given up substantial rights of my child and myself by signing it, and have signed it freely and voluntarily without any inducement, assurance or guarantee being made to me or my child. I intend my signature to be a complete and unconditional release of all liability to the greatest extent allowed by law. 5. This Release and Waiver of Liability and Assumption of Risk Agreement shall be governed by and construed and enforced in accordance with the internal laws of the State of Colorado, without regard to conflicts of law rules. Camper s Name: Parent s Signature: Date: READ CAREFULLY BEFORE SIGNING Parent s Printed Name: Parent s Signature: Date: READ CAREFULLY BEFORE SIGNING Parent s Printed Name: PARTICIPATION WITHDRAWAL At Camp Wojtyla, the children and teens hike, *rock climb (with ropes, required safety gear and guided instruction), **whitewater raft, shoot archery, have campfires, cook over a camp fire, sleep in teepees, sleep under the stars, have relay races, participate in a challenge course, all camp relay race, candle making and other crafts, play night games around the property, and other camp games common to summer camps. Please state below any activity in which you DO NOT want your child to participate: *Denotes High School Adventure Program only **Denotes High School Adventure Program and Backcountry Adventure Program only TRANSPORTATION WAIVER The following people are authorized to pick my child up from Camp Wojtyla: These people are NOT authorized to pick up my child:

6 CAMPER MEDICAL INFORMATION FORM SUMMER 2013 Participation in Camp Wojtyla requires the activity level of a person in good health. There will be a considerable amount of walking, climbing and other various physical demands. All of these factors may aggravate certain health conditions. Please submit this form with your Registration Form and deposit to Camp Wojtyla, PO Box 18452, Golden, CO by May 1 st, any questions to Brianna Lawson at registration@camp-w.com. You may use the reverse side of this form if necessary to offer more information. CAMPER INFORMATION Camper Name Camper Phone Number Age Height Weight Street Address City, State, Zip Code Primary Physician s Name Primary Physician s Phone Number Health Insurance Company Policy Number Name of Policy Holder PARENT INFORMATION Father s Name Phone Number Home Street Address City, State, Zip Code Work Street Address City, State, Zip Code Mother s Name Phone Number

7 Home Street Address City, State, Zip Code Work Street Address City, State, Zip Code NON PARENT EMERGENCY CONTACT INFORMATION Emergency Contact Name Home Phone Number Work Phone Number Cell Phone Number Relationship to Camper Street Address City, State, Zip Code HEALTH INFORMATION General Fitness level: circle one (1 = inactive/poor fitness, 5 = very active/fit) Experience hiking: circle one (1 = never hiked, 3 = have hiked occasionally, 5 = hiked a lot) Experience camping: circle one (1 = never camped, 3 = camped occasionally, 5 = camped a lot) Is your child currently seeing a doctor? If so, please state the reason. Please list any physical conditions that may limit your child s ability to participate in activities.

8 Please list any surgeries or major health problems your child has experienced in the past 10 years: Please list any medications or foods your child is allergic to: Does your child have any special dietary needs? If so, please explain. Please indicate the date of your child s last tetanus shot Please circle if your child has ever suffered from any of the following: Please explain any answers that have been circled. Allergic to Insect Bites: Epilepsy: HIV/AIDS: Hypothermia: Frostbite: High Blood Pressure: AMS (AltitudeSickness): Back Problems: Recent Injuries: Diabetes: (treated with diet or insulin?) Asthma: Needs an inhaler? Heart Problems: Does your child have a medical condition, injury or illness not listed above?

9 CONSENT AND RELEASE In consideration of my child s attendance at Camp Wojtyla and the services provided to him (her) by Camp Wojtyla, Ltd. (the Camp ) and the members of its staff, I hereby declare that my child has my permission to attend Camp. Further, in the event of a medical emergency or an incident requiring medical attention, as reasonably determined by the Camp or a medical services provider, I hereby consent to the administration of first aid, the transfer of the child to a medical facility, and/or the administration of emergency treatment deemed necessary or proper by such facility. I understand that the Camp will make every reasonable effort to contact me in the event of an emergency at the telephone number(s) listed below. I hereby release the Camp, including all of its staff members and any individuals, Board of Directors or organizations partnered with or who provide services to the Camp, from liability related to actions taken as a result of this consent and release. Further, I hereby declare that my child has health and medical insurance coverage which will be active and in force during the provision of services by the Camp. Information relating to this coverage is included below, and I agree to provide a copy of the insurance card giving evidence of this coverage. PARENT/GUARDIAN SIGNATURE Your signature below certifies that the above information is a true representation of your child s current health status and that Camp Wojtyla, a division of the JPII Adventure Institute, may use the above information to represent your child s medical needs to a doctor in the event of an emergency. Your signature also gives your medical consent and release, as stated in the above section, to Camp Wojtyla. Signature of Parent/Guardian of Camper: Print Name: Date:

10 CAMPER MEDICAL RELEASE FORM SUMMER 2013 Thank you for your registration for Camp Wojtyla! We are very excited to have you on board and want to make sure that we have a safe and injury free summer. Please fill out the form below, have it signed at the bottom by a medical professional, and return it to Camp Wojtyla, PO Box 18452, Golden, CO by May 1 st, Below is a checklist of items that need to be submitted with this form to Camp Wojtyla by the 1 st day of Camp. Proof of physical in the last 24 months. This can be fulfilled by your doctor signing the release below. Vaccination record. Permission from you doctor permitting us to give your child Ibuprofen, Tylenol, and /or Benerdryl at its suggested dose in case of swelling, fever, bug bites, or other illnesses while at Camp Wojtyla by signing below. Permission from your doctor permitting us to give your child their prescription medications by signing below. Note: If you do not seek medical attention or immunize yourself for religious reasons, please include a note stating your situation, and that you are in good health. Please any questions to Brianna Lawson at registration@camp-w.com. CAMPER INFORMATION Camper Name Camper Phone Number Age Height Weight Primary Physician s Name Primary Physician s Phone Number Please list any medications or foods your child is allergic to: Please list below any prescription and non-prescription medications your child will be taking at the time of Camp, including dosage and frequency. ***Please note: Any prescription drugs need to be in original bottle from the Pharmacy with instructions on dose and frequency given. Any drugs listed below also need a doctor's note saying that your child can take these drugs. For instance, if Ibuprofen is listed and brought with the camper, a note is required from the doctor stating that they can take this medication at a specific frequency and dose. Furthermore, if you would like us to be able to give your child over-the-counter Ibuprofen, allergy medicine or tylenol for swelling, a bug bite, fever or other common camp illnesses, please include a doctor's note saying the child can have this medications and at what dose/frequency. The State of Colorado is very careful when it comes to medications. This is in order to protect children from reactions to unknown allergies and overdose. We thank you for your attention to detail in this matter! Medication and Reason Dosage When to Take

11 MEDICAL RELEASE (To Be Filled Out by a Medical Professional) I, (Name of Medical Professional), consider (Name of Camper) to be in good health, free of any communicable diseases and able to participate in summer camp related activities including but not limited to high altitude hiking, rock climbing, camping, field games, etc. I also hereby swear that (Name of Camper) has had a medical Physical in the last 24 months. Signature Date (Name of Camper) has medical permission to receive the prescription medications listed in the Camper Information section of this form while at Camp Wojtyla and to receive: Tylenol at suggested dose if necessary Ibuprofen at suggested dose if necessary Benadryl at suggested dose if necessary Signature Date

12 CAMPER PHOTOGRAPH RELEASE FORM SUMMER 2013 Please submit this form with your Medical Release form by May 1st. In consideration of my participation at Camp Wojtyla and the services provided to me by Camp Wojtyla, a division of the JPII Adventure Institute (the Camp ), I hereby grant permission to use my image, whether photographic or video footage, taken while participating in Camp activities, including, but not limited to, Rock Climbing, Hiking, Archery, etc. Usage of such images will be limited to a Camp DVD or other publicity pieces produced by or for the Camp, or one or more of the organizations providing services to the Camp. Publicity pieces include (but are not limited to) news releases, newspaper and journal articles, or promotional articles and videos, whether in printed form or posted on a related website. I also give Camp Wojtyla, Ltd. permission to use my first name, age and state of residence in connection with the use of any such image. Name Age Date of Birth / / Phone: Street Address City, State, Zip Code Signature Date

13 Camp Wojtyla Packing List Please bring old but durable clothes; non-cotton clothing options are always preferred. You will need at least six changes of clothes with extra socks and a couple of towels. Durable footwear that fits is absolutely necessary and required (if you are buying new boots, wear them a few hours a day for the weeks prior to camp to help prevent blisters and twisted ankles.) Make sure to initial/label all of your valuable gear. The staff of Camp Wojtlya are not responsible for any lost or left behind items. Sleeping (tents or open air teepee s so think warm) Bedtime PJ s Pillow Bottom fitted sheet Warm sleeping bag (around 15 degree bag It can get VERY cold in the mountains at night If bag is not very warm, simply pack an extra few blankets) Sleeping pad (for the overnight and/or in addition to the cots we provide if your child is tall, wanting more padding or if they choose not to use the cot) Toiletries Laundry Bag Towel Daily activities (i.e. hiking and climbing) 2 Water bottles (Durable and at least one liter each) Whistle Camping bowl Camping silverware Camping cup Socks (around 6 8 pairs; all activity wool socks, like Smartwool are great for the demands of Camp) Under garments Tennis Shoes Shoes (all-terrain) Sandals to ONLY shower in (flip flops, Crocs) Shorts Short Sleeved Shirts Long Sleeve Shirts Long underwear top (non-cotton) Long underwear bottom (non-cotton) Jeans or other sturdy long pants Sweatshirt or Hoodie Wind / Rain Poncho Wind pants or sweatpants Rain Pants (optional) Bug repellent Swimming Suit (please remember modesty when choosing) Sunglasses Sunscreen SPF 15 or above Lip Balm Sturdy Work Gloves

14 Flashlight or headlamp Hat / Bandana Camera Extra Batteries Bible and/or devotional book Journal Pen and/or pencils Backpack You will use this throughout the day to carry belongings from activity to activity and on day hikes. Extra money for the Trading Post (candy, juice, water bottles, souvenirs, etc.) DO NOT bring: (Campers will not be permitted to have these items on their person) Cell phones (there is no reception, so they won t work here anyway) IPod, MP3 players, Boom Box, or similar devices. It s time to listen to God. If you want to sing, we can sing together. DVD players, Laptop etc. The idea is to withdraw from the noise of the world and our daily life. The mountains and nature are an excellent setting to be in contact with ourselves and our Creator. You will see that is possible to survive and have a great experience also. Food (unless noted with special dietary needs). Since we are sleeping outside in teepee s we do not want to attract any of God s creatures with our human food! Drugs, alcohol, tobacco of any variety!