golden eagle district camp-o-ree 2009 firestone scout reservation

GOLDEN EAGLE DISTRICT
CAMP-O-REE 2009
FIRESTONE SCOUT RESERVATION
“CELEBRATING 99 YEARS OF SCOUTING”
APRIL 24
—
26, 2009
FIRESTONE SCOUT RESERVATION
19001 TONNER CANYON ROAD
BREA, CA 92821
(GREEN ISLAND, ARTHUR LEITS & RINCONCITO)
1
CONTACT:
CAMP-O-REE CHAIRMAN
BILl. DUARTE 626-960-1644
GOLDEN EAGLE DISTRICT 2009 CAMP-O-REE
CAMP-O-REE CHAIRMAN
BILL DUARTE, KIOWA TROOP 433
ORDER OF THE ARROW
DAVID WALKER, KIOWA CHAPTER ADVISOR
CAMP-O-REE COMMI1TEE/STAFF
BEGG, NANCY
KIOWA
MEMBER AT LARGE
BONGOLAN, HUBER
KIOWA
TROOP 710
BRAWLEY, RICHARD
CAMACHO, PETER
TROOP 8888
KIOWA
TROOP 620
CUELLAR, CONNIE
TROOP 102
FREEMAN, CLAIRE
TROOP 701
GALLAHGER, JOHN
TROOP 737
KUNZLER, RICK
KIOWA
TROOP 620
MATTHEWS, DENNIS
KIOWA
TROOP 724/CREW 724
MINUTOLI, DEBBIE
TROOP 701
MINUTOLI, JOHN
KIOWA
TROOP 701
MIRABILE, RICK
KIOWA
TROOP 433
PAW, MIKE
KIOWA
TROOP 755/CREW 755
SCHMIDT, STEVE
KIOWA
TROOP 701
SIMONIAN, CLARK
KIOWA
TROOP 620
2
WEBELOS CHAIRMAN
KEN HIRSCHT, KIOWA TROOP 710
WEBELOS COMMITIEE/STAFF
HUNG, RICHARD
PACK 8888
SHELLENBERGAR, scan
PACK 710
TERRIQUEZ, ALEX
PACK 710
DISTRICT PROFESSIONAL STAFF MEMBERS
SHIELLS, SUSAN
SR. DISTRICT EXECUTIVE
BERNAL, LORENA
DISTRICT EXECUTIVE
ZALL-RIN I, APRIL
DISTRICT EXECUTIVE
3
STAFF ASSIGNMENTS
LOGISTICS AND SECURITY
JOHN MINUTOLI AND MIKE PAW
BOY SCOUT EVENTS STAFF LEADERS
STEVE SCHMIDT, RICHARD MIRABILE, RICHARD BRAWLEY
WEBELOS
KEN HIRSCHT
REGISTRATION
APRIL ZALL-RINI, LORENA BERNAL
SAFETY
PETER CAMACHO, MIKE PAVY, CONNIE CAELLAR
CAMPSITE INSPECTION
JOHN MINUTOLI AND CAMP STAFF
CEREMONIES
CLARK SIMON IAN AND KIOWA
AWARDS PRESENTATION
BILL DUARTE AND CAMP STAFF
4
CALL OUT
ORDER OF THE ARROW
KIOWA
SCORING/AWARDS
STEVE SCHMIDT AND RICK MIRABILE AND CLAIRE FREEMAN
CAMP GAMES COORDINATOR
DEBBIE MINUTOLI
SCOUTS OWN
HUBER BONGOLAN
SIGNS
NANCY BEGG
EVENTS STAFF PERSONNEL
GOLDEN EAGLE ADULTS
GENERAL ASSEMBLIES
STAFF MEMBERS
5
CAMP-O-REE SCHEDULE
FRIDAY, APRIL 24,2009
4:00 PM Golden Eagle District Camp-O-Ree Check in Begins
5:00 PM Patrol Flag, Uniform & 10 Essentials Check Begins
7:00 PM Check In Ends
8:00 PM Patrol Flags, Uniform & 10 Essentials Check Ends
8:30 PM Scoutmaster, SPL, & Staff Meeting Begins
9:30 PM Scoutmaster, SPL, & Staff Meeting Ends
10:00 PM Camp-O-Ree Staff Meeting Ends-LIGHTS OUT
SATURDAY, APRIL 25, 2009
6:00 AM Reveille, Breakfast & Prepare Lunch to Go
8:00 AM General Assembly, Flag Raising & Final Instruction
NOTE: CLASS B UNIFORM IS RECOMMENDED WEAR
9:00 AM Skill Events Begin
10:00 AM Campsite and Gateway Inspection Begin
12:00 PM Lunch Begins
12:30 PM Lunch ends, Skill Events Continue
1:30 PM Campsite Inspection Ends
2:30 PM Skill Events Ends
3:00 PM Camp Wide Games Begins
4:30 PM Camp Wide Games End, Dinner Begins
6:00 PM Order of the Arrow, Call Outs Begins
7:00 PM Campfire Begins
9:30 PM Campfire Ends
9:30 PM Order of the Arrow Candidate Meeting Begins
10:00 PM Order of the Arrow Candidate Meeting Ends
SUNDAY, APRIL 26, 2009
6:00 AM Reveille, Breakfast & Camp Break Down Begins
8:00 AM Scouts Own Begins
8:45 AM Scouts Own Ends
9:00 AM General Assembly: Flag & Troop Award Presentation Begins
NOTE: CLASS A UNIFORM REQUIRED WEAR
10:00AM Camp Site Inspection to Leave Begins
NOTE: UNIT PACKET & PATCH DISTRIBUTION BEGINS (IF APPROVED)
12:00 PM Golden Eagle District Camp-O-Ree 2009 Ends
6
GOLDEN EAGLE DISTRI~
CAMP-O-REE
APRIL 24-26 2009
FRIDAY NIGHT
PATROL FLAG
—
UNIFORM INSPECTION —10 ESSENTIALS
(FOR ALL SCOUTS)
SATURDAY
SKILL EVENTS BEGIN —CAMP SITE INSPECTION WITH GATEWAY
(ALL SCOUTING UNITS)
CAMP WIDE GAMES
(ALL UNITS)
SATURDAY NIGHT
SKITS & CAMP FIRE CREMONY
(ONE SKIT PER UNIT ONLY, PACK AND TROOP)
SUNDAY
SCOUTS OWN
AWARD PRESENTATION
WEBELOS SCOUT EVENT:
BOY SCOUT EVENTS:
CAMPING
CITIZENSHIP
CAMPSITE INSPECTION
KNIFE AND SAFETY
FIRE SKILLS
KNOTS
FIRST AID
MAP AND COMPASS
FLAG ETIQU ETTE
READYMAN
KNOTS AND LASHING
NEED: CLASS “A” AND CLASS “B” UNIFORM
MAP AND COMPASS
COMPASS
UNIFORM INSPECTION
FOUR TO FIVE FOOT ROPE
KNIFE, TO BE USED ONLY IN EVENTS
ALL EVENTS WILL COME DIRECTLY FROM
(PARENTS WILL HOLD OTHERWISE)
THE BSA HANDBOOK
7
LOCATION:
FIRESTONE SCOUT RESERVATION
19001 TONNER CANYON ROAD
BREA, CA 92821
(LOCATED OFF THE 57 FREEWAY
DRIVING INSTRUCTIONS:
SOUTH FROM FREEWAY 210, 10, OR 60
EXIT BREA CANYON ROAD AND HEAD SOUTH TO TONNER CANYON ROAD, TURN LEFT (EAST) UNDER THE
FREEWAY AND PROCEED 2MILESTO CAMP ENTRANCE.
NORTH FROM FREEWAY 91 OR 5
EXIT TONNER CANYON ROAD, TURN LEFT AT THE END OF THE OFF RAMP AND PROCEED 2 MILES TO
CAMP ENTRANCE.
FEES AND DEADLINES:
CAMP-O-REE/WEBELOS-REE
EARLY
BIRD
REGISTRATION
FEE
IS
14.00 THRU
FEB
20w.
NEXT
REGISTRATION FEE PERIOD IS 16.00 FEB 21~THRU MARCH ~ FINAL REGISTRATION FEE IS 20.00 APRIL
TH RU APRIL 24TH
1ST
LATE REGISTRATION MAY RESULT IN SMALL THAN EXPECTED CAMPING AREAS OR SPLIT CAMPING
AREAS FOR LARGER UNITS
HEALTH AND MEDICAL RECORDS:
All scouts attending the Camp-o-ree must have a current, completed Boy Scout of America Health and
Medical Record Class 1. Each unit is to have three (3) copies of the medical form. 1 is for youths and
adults to have in their possession at all times. 1 is for the unit and 1 to be turned in at registration which
will be returned upon checking out.
POLICIES AND REGUlATIONS
All units are required to have a current copy of the “GUIDE TO SAFE SCOUTING”. If your unit does not
have a copy, they are available at the scout store.
8
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All units will be required to show a validated B.S.A. Tour Permit, parental permission slips, receipt of
payment, medical forms, and final Troop/Patrol Roster. Upon arrival, all scouts are to remain in the
vehicle. The Scoutmaster is the only person needed to register.
CHECK IN TIME:: 4 PM -7 PM Friday, and 7AM— 8AM on Saturday.
Items needed for check-in:
•
•
•
•
•
•
Copy of Troop! Patrol RQster.
Receipt of Cam p-o-ree fees paid. (Must be paid in full at time of Check-in.)
Copy of local Tour Permit.
Medical Forms.
Parental permission slips.
Are you checking out on Saturday? If so, notify Camp-o-ree Headquarters.
Campsite assignment will be given at time of check-in.
CHECK-OUT PROCEDURES
Every unit should stay until Sunday morning. However, we understand that some units may need to
depart earlier. In all cases, we encourage units to stay through the Saturday night campfire. Any unit
staying through Sunday must depart by 11:00 AM Sunday.
•
•
Your unit campsite will be inspected before checkout whether you are leaving on Saturday or
Sunday.
When your site has passed inspection, your check-in package will be given back to you at that
time.
9
PARTICIPATION
All youth participants are required to be registered members of the BOY SCOUTS of AMERICA before
arriving at the Camp-o-ree. Patrols may have up to 8 scouts and not less than 3 scouts. All patrol
members must participate in the skill events. Any registered scout with the rank of Eagle Scout or lower
(must be age 17 prior to Monday, April 27th 2009) may participate in the skill events.
LEADERSHIP
ADULTS: Each unit is responsible for their own 2 Deep leadership. The “GUIDE TO SAFE SCOUTING”
lists all the leadership requirements. Leaders must be available and present in camp 24 hours a day.
NO EXCEPTIONS!
YOUTH: Youth leaders are expected to set the example by living the Scout Oath and obeying the
Scout Law.
CAMP UNIFORM
The official B.S.A. field uniform (Class “A” Minimum from the belt up, but Scout Pants are strongly
encouraged) will be worn during check-in, Saturday campfire and Sunday. Flag teams will be iii full
uniform. The activity uniform (BSA or Troop Polo or Tee Shirt and Scout hat) is preferred for daytime
activities. Each “Patrol” should be easily recognized. Civilian attire is not permitted. A uniform
inspection will be conducted at morning flag ceremony and evening campfire. Points will be
awarded toward TOP TROOP. NO OPEN TOED SHOES WILL BE ALLOWED.
—
CAMGROUNDS
Firestone Scout Reservation is to be kept neat at all times. Your cooperation is needed to keep it
neat and clean.
FIRES: Absolutely no ground fires, barrels on stands or bricks and Bar-B-Q’s.
TRASH: Each unit should pack out their trash. Pleases dispose of trash properly and keep area clean.
CAMPSITES: Campsite assignments will be determined by the Camp-o-ree staff. And will be given to
you at the time of check-in. Please use the patrol Method in your campsite layout. Units are
encouraged to provide their own shade.
PORTABLE TOILETS: Please respect the use of all sanitation facilities. The unit will pay for damages
or replacement.
WATER: Units are encouraged to bring plenty of water however; water is provided through the
camp but may not be close to your campsite. Units are encouraged to bring their own water
containers to fill in order to limit the number of trips to the water faucets. Dispose of wastewater in
gray water containers away from campsites and the streams.
10
LOW IMPAcT: This camp-o-ree is encouraging the use of low-impact camping skills. Please plan
accordingly with sleeping quarters, meals, etc.
OFF LIMIT AREAS: The following areas are off limits to Scouts: parking lot after check-in, camp staff
area, and all buildings, and the stream. We appreciate your support in enforcing this rule in order to
prevent injuries, theft and unexpected problems.
LIGHTS OUT: All Scouts are to be in their unit area after dark, or following any Camp-o-ree event.
Quiet hours are 10 pm to 6 am. Scout Leaders are responsible for maintaining quiet.
TRANSPORTATION: All units are required to provide their own transportation to and from the
Camp-o-ree. Under no circumstances are Scouts or Leaders to ride in the backs of trucks, trailers or
campers.
PARKING: All motor vehicles will be parked in the designated parking areas. Unattached trailers will
be allowed to park in the campsite area. Wheel blocks must be in use while the trailer is unattached
from the vehicle. An area for parking trailers will be available. NO VEHICLES WILL BE ALLOWED TO
BE PARKED IN THE CAMPSITE.
Drivers are expected to follow the directions of the Parking Staff for the safety of everyone. Failure
to follow directions and other actions that could endanger others will result in the offender being
told to leave immediately.
Please place a card on the dash of each vehicle, identifying driver’s name and unit, in case the Camp
o-ree staff needs to contact them.
ALL MOTOR VEHICLES MUST BE REMOVED FROM THE CAMP-O-REE AREA AFTER UNLOADING
EQUIPMENT AND RETURNED TO THE DESIGNATED PARKING AREA.
CAMP RULES:
•
•
•
•
Do not enter any campsite other than your own without permission
No cell phones, MP3 players, electronic devices, radios, TV’s, electronic games, alcohol,
firearms, tape players, walkmans, fixed blades sheath knives, or personal bow and arrows
allowed.
~~~running or throwing anything at anytime except during games or events requiring it.
NO profanity, racial comments or other language or actions deemed inappropriate will be
tolerated at anytime.
—
Units not following the Camp-o-ree rules WILL be asked to leave the camp-o-ree and WILL FORFIT ANY
FEES PAID AND SCORES WILL BE DISQUALIFIED.
11
B.S.A. SMOKING POUCY
Smoking is discouraged among adult leaders as a rule. Smoking is prohibited in all program areas.
Camp buildings, campsites when boys are present Smoking is not permitted in the presence of boys
anywhere on the camp property.
MEDICAL AND EMERGENCY PROCEDURES
MEDICAL:
Camp~o-ree Medical Staff will be available to handle minor injuries and illnesses. Accidents, injuries and
illnesses must be reported and treated at the Camp Medical area. The Camp-o-ree Medical Officer is
available day and night at Camp-o-ree Headquarters. If you have an emergency, please notify ant Camp
o-ree staff member.
FIRE:
FIRE SAFETY IS EVERYONE’S RESPONSIBILTY
Fire prevention is the key to any fire plan and should be upmost in the minds of every Camp-o-ree staff
member (Leader and Scout). A healthy awareness of the potential for injury from a forest fire, down to
the touching of a hot ember should drive home the need for fire safety.
NO tent material is fireproof and it can burn when exposed to heat or fire. If using tents. Please follow
these rules:
1.
Only flashlights and electric lanterns are permitted in tents. No flames in tents is a rule
which must be enforced.
12
~.
~
~ ~
should never be used in or near tents.
3. DO NOT pitch tents near open fires.
4. DO NOT use flammable chemicals near tents.
Camp fires will NOT be allowed in the individual campsites
CAMP-O-REE PROGRAM
PATROLS
Boy Scouts / Webelos will participate in the Camp-o-ree as Patrols. Scout leaders are reminded that the
patrols/dens are to compete and participate in other activities without direct supervision.
CAM PWIDE GAMES
It is recommended that each troop / pack participate. Points will be added to total scores.
STAFF
It is necessary that all adults from each unit help to organize and staff the events. Notify the registration
area when you arrive of who the staff members are.
ORDER-OF-THE-ARROW
O.A. will perform a call out ceremony at the campfire to identify new candidates.
CAMPFIRE PROGRAM
It is recommended that each Troop / Pack have at least one skit to participate in the campfire. Troop /
Pack wishing to perform a skit and I or song in the program must be pre-approved. Please note NO
vulgar, offensive, or off-color skits, and / or songs are permitted. This will be included as participation
when scoring.
—
13
RELIGIOUS SERVICES
A non-denominational Scout’s Own service will be held Sunday morning to help Scouts reflect reverently
on their duty to GOD and the twelfth point of the Scout Law. Quiet time must be observed by ~1i during
Scouts Own.
CAMP / GATEWAY COMPETITION
Campsites will be judged against correct camp standards. Gateways will be judged for creativity. Judging
will take place during the Inter Patrol Competitions on Saturday.
GATEWAY COMPETITION RULES:
All units are encouraged to construct a Gateway. The Gateway should demonstrate scouting spirit,
utilize pioneering skills, employ planning and show evidence of scout teamwork during the construction.
Adults are expected to observe the construction of the Gateway for safety of the Scouts and to prevent
injury. Construction may start any time after arrival, but must stop by 9:30 pm on Friday night, and may
resume again Saturday morning after 6:00 am and continue until 8:30 am. The Gateway should be free
standing. The only support allowed will be guide wires, pegged to the ground. ABSOLUTELY no holes are
to be dug in the ground. The Gateway should indicate the unit number and be constructed 100% by
Scouts at the cam p-o-ree sites.
CAMP-O-REE AWARDS
TROOPS:
Camp-o-ree Participation Ribbons will be awarded to each patrol.
15t,
~
3rd
place ribbons will be awarded for each individual skill event.
Presidential, 2~, &
3rd
place ribbons will be awarded in the patrol with the highest overall score.
Large axe / 1~ place ribbon will be awarded to the troop with the highest average score.
Medium axe / 2~ place ribbon will be awarded to the troop with the 2’~ highest average score.
Small axe / ~ place ribbon will be awarded to the troop with the
3~d
highest average score.
PACKS:
Webelos participation ribbons will be awarded to each patrol.
Judges will be members of the Camp-o-ree staff. The judges will handle all scoring materials and their
decisions are final.
14
~iuvir~i I i ii~r~i..a turi
The Camp-o-ree Staff will inspect campsites during the Camp-o-ree. Inspections will focus on safety,
sanitation, cleanliness, use of scout skills, unit and patrol identification and general campsite
organization.
EVENT SCORING
Materials that must be provided by patrols:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Compass
Scout handbook
FirstAid Kit
Pen / Pencil and note Book
Pocket Knife
Patrol Fag
Water Bottles
Day Pack
Totin and Fire Man Chits cards
Sack Lunch to eat on the trail
The event scoring will be completed at the event by the judges in charge. It is solely up to the judge as to
how many points a patrol should receive. Their decision is final.
Teamwork & Sportsmanship play an integral part of the competition. These are two qualities that are
stressed throughout scouting. The following guidelines will be given to each judge:
1.
2.
3.
4.
S.
Are all members included in the decision making process?
Does the patrol display good sportsmanship?
Dose the patrol display a positive attitude?
Do all members (up to the event maximum) participate?
Is the patrol dressed uniformly (all in unit t-shirts, uniform shirts or other BSA scout program
shirt)?
Dose the patrol have a patrol flag and a patrol yell?
15
Annual Health and Medical Record
(Valid for 12 calendar months)
Medical Information
The Boy Scouts of America recommends that all youth and adult members have annual medical evaluations
by a certified and licensed health-care provider. In an effort to provide better care to those who may become
ill or injured and to provide youth members and adult leaders a better understanding of their own physical
capabilities, the Boy Scouts of America has established minimum standards for providing medical information
prior to participating in various activities. Those standards are offered below in one three-part medical form.
Note that unit leaders must always protect the privacy of unit participants by protecting their medical information.
-
Parts A and C are to be completed annually by all BSA unit members. Both parts are required for all events
that do not exceed 72 consecutive hours, where the level of activity is similar to that normally expended at home
or at school, such as day camp, day hikes, swimming parties, or an overnight camp, and where medical care is
readily available. Medical information required includes a current health history and list of medications. Part C
also includes the parental informed consent and hold harmless/release agreement (with an area for notarization if
required by your state) as well as a talent release statement. Adult unit leaders should review participants’ health
histories and become knowledgeable about the medical needs of the youth members in their unit. This form is to
be filled out by participants and parents or guardians and kept on file for easy reference.
Part B is required with parts A and C for any event that exceeds 72 consecutive hours, a resident camp
setting, or when the nature of the activity is strenuous and demanding, such as service projects, work
weekends, or high-adventure treks. It is to be completed and signed by a certified and licensed health-care
provider—physician (MD, DO), nurse practitioner, or physician’s assistant as appropriate for your state. The
level of activity ranges from what is normally expended at home or at school to strenuous activity such as
hiking and backpacking. Other examples include tour camping, jamborees, and Wood Badge training courses.
It is important to note that the height/weight chart must be strictly adhered to if the event will take the unit
beyond a radius wherein emergency evacuation is more than 30 minutes by ground transportation, such as
backpacking trips, high-adventure activities, and conservation projects in remote areas.
Risk Factors
Based on the vast experience of the medical community, the BSA has identified that the following risk factors
may define your participation in various outdoor adventures.
•
•
•
•
•
•
Excessive body weight
Heart disease
Hypertension (high blood pressure)
Diabetes
Seizures
Lack of appropriate immunizations
•
•
•
•
•
Asthma
Sleep disorders
Allergies/anaphylaxis
Muscular/skeletal injuries
Psychiatric/psychological and emotional difficulties
For more information on medical risk factors, visit Scouting Safely on www.scouting.org.
Prescriptions
The taking of prescription medication is the responsibility of the individual taking the medication and/or that
individual’s parent or guardian. A leader, after obtaining all the necessary information, can agree to accept the
responsibility of making sure a youth takes the necessary medication at the appropriate time, but BSA does not
mandate or necessarily encourage the leader to do so. Also, if state laws are more limiting, they must be followed.
BOY SCOUTS OF AMERICA
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Part A
GENERAL INFORMATION
Name _________________________________________ Date of birth _____________________ Age
Malefl
Female~
Address __________________________________________________________________________ Grade completed (youth only)
City _______________________________________State ________ Zip
Unit leader _____________________________________ Council name/No.
__________________
Social Security No. (optional; may be required by medical facilities for treatnie~t)
0
z
C)
Policy No.
_________________________________________
In case of emergency, notify:
Name __________________________________________________________ Relationship
Address
a)
Home phone
ci~
Alternate contact _______________________________________________________ Alternate’s phone
E
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_________________
ATTACH A PHOTOCOPY OF BOTH SIDES OF INSURANCE CARD (SEE PART C).
IF FAMILY HAS NO MEDICAL INSURANCE, STATE “NONE.”
C,
0
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____________________
Unit No.
Religious preference
Health/accident insurance company
4.4-a
Phone No.
______________________________
Business phone
_____________________________
______________________
Cell phone
MEDICAL HISTORY
Are you now, or have you ever been treated for any of the following:
Condition
Allergies or Reaction to:
Explain
Food, Plants,
Asthma
or Insect Bites______________
Diabetes
Hypertension (high blood pressure)
Immunizations
Heart disease (i.e., CHF, CAD, Ml)
Stroke/TIA
COPD
The followiflg are recommended by the BSA.
Tetanus immunization must have been received
within the last 10 years. If had disease, put “D”
and the yeal If immunized, check the box and
enter the year received.
Ear/sinus problems
Muscular/skeletal condition
C’)
a)
Yes
Menstrual problems (women only)
a)
Psychiatric/psychobgical and
emotional difficulties
Learning disorders (i.e., ADHD, ADD)
Bleeding disorders
Fainting spells
Thyroid disease
Kidney disease
LID
DLI
Sickle cell disease
Seizures
Gl problems (i.e., abdominal, digestive)
‘
Date
Tetanus____________________
pertussis
___________________
Diptheria
Measles
___________________
Mumps
Rubella___________________
Polio___________________
Chicken pox
Hepatitis A
__________________
Hepatitis B __________________
tEl El
Sleep disorders (i.e., sleep apnea)
0
No
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F]Exemption to immunizations claimed.
Surgery
CFor more Information about Immunizations, as
Serious injury
well as the immunization exemption form, see
Other
Scouting Safely on Scouting.org.)
MEDICATIONS
List all medications currently used. (If additional space is needed, please photocopy this part of the health form.)
Inhalers and EpiPen
information must be included, even if they are for
Medication
Medication
Strength
Frequency
Reason for medication
Approximate date started
Temporary
Permanent
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a)
ECu
C
4-a
U)
Cu
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occasional or emergency use
Strength
Medication
Frequency
Reason for medication
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only.
Approximate date started
TemporaryQ Permanent
Strength
Frequency
Reason for medication
LI
Approximate date started
TemporaryD Permanent
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Medication
Strength
Frequency
Reason for medication
Medication
Strength
Frequency
Reason for medication
Medication
Strength
Frequency
Reason for medication
Approximate date started
Temporary
Permanent
Approximate date started
TemporaryD Permanent
Approximate date started
Temporary[] Permanent
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NOTE: Be
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sure to bring medications in the appropriate containers, and make sure that they are NOT expired,
including inhalers and EpiPens. You SHOULD NOT STOP taking any maintenance medication.
• ~
Parental Informed Consent and Hold Harmless/Release Agreement
I understand that participation in Scouting activities involves a certain degree of risk. I have carefully considered the risk involved and
-have given consent for myself or my child to participate in these activities. I understand that participation in these activities is entirely
-:
voluntary and requires participants to abide by applicable rules and standards of conduct. I release the Boy Scouts of America, the
local council, the activity coordinators, and all employees, volunteers, related parties, or other organizations associated with the
activity from any and all claims or liability arising out of this participation.
I approve the sharing of the information on this form with BSA volunteers and professionals who need to know of medical situations
that might require special consideration for the safe conducting of Scouting activities.
In case of an emergency involving me or my child, I understand that every effort will be made to contact the individual listed as the
emergency contact person. In the event that this person cannot be reached, permission is hereby given to the medical provider
selected by the adult leader in charge to secure proper treatment, including hospitalization, anesthesia, surgery, or injections of
medication for me or my child. Medical providers are authorized to disclose to the adult in charge examination findings, test results,
-and treatment provided for purposes of medical evaluation of the participant, follow-up and communication with the participant’s
parents or guardian, and/or determination of the participant’s ability to continue in the program activities.
LI Without restrictions.
LI With special considerations or restrictions (list)
Talent Release Form
I hereby assign and grant to the local council and the Boy Scouts of America the right and permission to use and publish the
photographs/film/videotapes/electronic representations and/or sound recordings made of me or my child by the Boy Scouts of
America, and I hereby release the Boy Scouts of America from any and all liability from such use and publication.
I hereby authorize the reproduction, sale, copyright, exhibit, broadcast, electronic storage, and/or distribution of said photographs/
film/videotapes/electronic representations and/or sound recordings without limitation at the discretion of the Boy Scouts of America,
and I specifically waive any right to any compensation I may have for any of the foregoing.
LI Yes
LIN0
I understand that, if any information I/we have provided is found to be inaccurate, it may limit and/or eliminate the opportunity
for participation in any event or activity.
Participant’s name
Participant’s signature
Parent/guardian’s signature
~f under the age of B)
Date ____________________________________________
Attach copy of insurance card (front and back) here. If required by your state, use the space provided here for notarization.
34605
BOY SCOUTS OF AMERICA
1325 West Walnut Hill Lane
RO. Box 152079
lrving,Texas75Ol5-2079
http//www.scouting.org
7
30176 34605
a
2008 Printing
Part C
Last name:
DOB:
TOUR PERMIT APPUCATION
FORTRIPS AND CAMPS UNDER 500 MILES
Local permit No. ________________________
Date received
__________________________
Date approved by council
-
A local ourperrnit Is gonted bydne council fororips of Ieuu than 500 mocouueltoa oour,dl.owned
SNot ,nalTour Pennit Is grontod bythetegion after apptouol of the council andis tequir dtort~Ipa In
,uceou of 500 roSes one way or for any tdpa o aid,the United States Am,,ica. Aoounns needs the opplitotion at Ia~st two weeks in advonue of the activity for fotol p oftu CouncIls way tequire edd,tlunui thee
pecks! a itfea, and unit leaders cornpingthpplwarionuhould
ndngfy. Unito are onongty encuwo d so arilint Myilcauting so file at pnrodts electoanlaully. Inter reproduca on tegborledger
sue p~peo
Unit title________________________ Unit No. _________ Chartered organization:
Council name/number~
Purpose of thi5 trip
/
District
__________________________
IS
From (city and state) __________________________________________________ to _____________________________________________________
Mileage round trip ____________ Dates ._.........to
Is accident insurance in force for this unit?
Total days
U Yes U
No
Company name and policy No._____________________________________
Itinerary It is required that the following information be provided for each day of the tour. (Note: Speed or excessive daily mileage increases the
possibility of accidents.) Attach an additional page if more space is required. Include detailed information on campsites and routes and include
maps for wilderness traveL
Date
Type of trip:
From
[—~-
U
U
Day trip
U
Ti
To
Mileage
V
e~~~ed.i
Short-term camp (less than 72 hrs.)
Long-term camp (longer than 72 hrs.) (Furnish copy of program and menus.)
U
High-adventure activities
Leadership and Youth Protection Training: Boy Scouts of America policy requires at least two adult leaders on all camping trips and
tours. Coed Venturing crews must have both male and female leadership. The adult leader iii charge of this group must be at least 21 years
old. All registered adults participating in any nationally conducted event or activity must have completed BSA Youth Protection Training.
At least one registered adult who has completed BSA Youth Protection Training must be present at all other events and activities that
require a tour permit. Effective for tours beginning January 1, 2009, Youth Protection Training will be valid for two years from the date completed.
1 .The adult leader in charge of this group must be at least 21 years old.
Name ______________________________________ Age
Scouting position
Expiration date
City_____________________________________________________________ State________________ Zip code
Phone _____________________________ E-mail
_________________________________
____________________
_____________________________
Youth Protection Trained
U
Yes
U
No
As the tour leader, I certify that appropriate planning has been conducted, qualified and trained supervision is in place, permissions are secured,
and I have read and have in my possession a copy of Guide to Safe Scouting and other appropriate resources. ______________________________
Adult leader’s signature
2. Assistant adult leader name(s) (minimum age 18 or 21 for Venturing crews)
Name ______________________________________ Age
Scouting position
Expiration date __________________
Address
Phone _____________________________ E-mail
_________________________________
Youth Protection Trained
U
Yes
U
No
Attach a list with additional names and information as outlined above.
Signed by mnenrber of unit cornnrlttee
Signed by tour leader
Signatures must be from two different people.
RETAIN IN COUNCIL SERVICE CENTER
OFFICIAL LOCALTOUR OR CAMP PERMIT
BOY SCOUTS OF AMERICA
Permit issued to____________ No.
This permit shbuld be in the possession of group leader at all times and displayed
when requested by Scouting officials or other duly authorized people.
Town
Type of unit
Local Permit No.
Name of tour leader
Age
Address
Name of tout leader
Age
Address
Permit covers all travel between______________________________ and
Datesoftripfrom
Date Issued
___________________
,20..._...,to ______________.20
Total youth
Total adults
_________________________________
This group ha5 given the local council every assurance that they will conduct themselves
according to the best standards of Scouting and observe all rules of health, safety, and sanita
tion as prescribed by the Boy, Scouts of America and as stated in the Pledge of Performance on
the reverse side of this permit.
These spaces are for the signatures and comments of officials where the group camps
or stays for one night or more. Signatures indicate that the cooperation and conduct
of the Cub Scout, Boy Scout, Varsity Scout, or Venturing group were satisfactory in
every way.
Date
_____________________
_________________________
Place
Signature
Comment
Council Stamp
-Not official sniess council
stamp appears here.
Council tame and address
Council phone no
Signed for the council
Revised December 2007
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2008 Printing
#34426
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3. Party will consist of (number):
4. Party will travel by:
BoyScouts
U
U
U
VarsityScouts
Total
Car
U
Canoe
U Van
C
C
Bus
Train
Boat
U
U
Plane
Foot
Bicycle
If traveling by other methods, please specify.
party will travel with another unit/crew that has a male or female (circle one) leader. This leader will be responsible for the Venturer(s) of my crew.
1~thor ~ nn
Tour involves:
Cnt,nril
U Swimming
U Boating U Climbing
U Orientation flights (attach Flying Permit. No. 19-672, required)
U Wilderness or backcountry (must carry Wilderness Use Policy and follow principles of Leave No Trace Camping)
Activity Standards: Where swimming or boating is included in the program, Safe Swim Defense and/or Safety Afloat standards are to be fol
lowed. If climbing/rappelling is included, then Climb On Safely must be followed. At least one person must be trained in CPR from any recog
nized agency for Safety Afloat and Climb On Safely. At least one adult on a pack overnighter must have completed Basic Adult Leader Outdoor
Orientation (BALOOI.Effective for tours on January 1, 2009, at least one adult must have completed Planning and Preparing for Hazardous
Weather training.
~‘~e
A°°
N~rne
Age
tPRTrsinI,rg
Agency
EoplrssIon Date
Name
Age
Sate B%LOOTratning completed
PlannIng and Prepadvo Ca, Idsas,doot
Weathertiolning roOd t,ntlI
lImo roe, fine, doI~ completed
Youth P,otevnlo,, eapirstion
Itwo years from date taken)
Name
Age
DlrobOnydatetskor,
NRA Inmuovon and/or R50
U
Silk
C
Shotgun
U
pistol
U
lk
sareryorrruer
C
Mux e-Ioadingrllte
U
Maotleriosdtr,g shotgun
INSURANCE
All vehicles MUST be covered by a liability and property damage insurance policy. The amount of this coverage must meet or exceed the
insurance requirement of the state in which the vehicle is licensed and comply with or exceed the requirements of the country of destination for
travel outside the United States. (It is recommended, however, that coverage limits are at least $50,000/$100,000/$50,000 or $100,000 combined
single limit.) Any vehicle designed to carry 10 or more passengers is required to have limits of $100,000/$500,000/$100,000 or $500,000 com
bined single limit In the case of rented vehicles the requirement of coverage limits can be met by combining the limits of personal coverage car
ried by the driver with coverage carried by the owner of the rented vehicle.
“
KIND, YEAR, AND MAKE
OF VEHICLE
ro
OWNERS NAME
DR WEe’S
LICENSE
NUMBER
WILL
~R A
EVERYONE
Sfi~5TBE[37
LIABILITY INSURANCE covERAGE
LIABILITY
PROPERTY
Each Person
Each Accident
DAMAGE
$
$
$
The local council may allow a list of the above information to be attached to the permit in order to expedite the process. Each unit may circle the
names of the drivers for an event or an activity.
TRANSPORTATION GUIDELINES
1. You will enforce reasonable travel speed in accsrdance with ntate and local laws in at nrntnr vehicles.
CD.L explratlno date _________________________________________
c. Driving Ernie Is fimited Is a maximum of 15 hours and moot be internspted by frequent lest, food,
and tecneaOioe slops.
d. Seat belts are provided, and must he used, by all passengers and driver. Eoceptinn; A school or
2. If by motor vehicle,
a. Dthrerysvrilllccrtiotnc Al drivers muss have a valid driven license sod be at least 18 years of ags.
Youth Member Exception: When traveilong loan area, reginnol or national Boy Scoot activity on
anytenswingeveotundetheleadessl9ofanadultl2l+)laorieader,aysothmembeacleoosl6
years of age may be a driver, sul4ect so the baflowing conditious: Ill Six mmtfo’ driving esguesience
as a iceroed dsfven lthnre on a leamerir permit on equivalent is not In be counted); 12) no record of
accidentsorrnoving ~iolstinns, 13) parental peonhsisn has been grsntedtu leader, drivet and riders.
commercial bus, when not reqoired bylaw.
e.
Passengers nail ride mdy in the cab If trnrchs are used.
b. tithe vehicle to be used is designed to carry msre than 15 people linclndirg driven the driver
mutt hove a comrrnencial drivert license ItOL).
OUR PLEDGE OF PERFORMANCE
1. We will use the Safe Swim Defense in any uwirsrrring activity, Safety Afloat in all oafs activity car tht wale,
and 01mb tIn Safelyforclimbing activity.
2. Wn art use Oocks only for tsanopotting equipment—no passengers except in the cob. All patlenger cars,
station waguno, recreolsonal vehicles, and cabs xl trncks will have a seas belt for each passenger.
3. We agents enforce reasonable travel speed hr accordance with natlnval state, and local laws) and use only
vehicles that are in safe mecbanicat condition.
4. We will he certain that fires are attended at all times.
S. We will applyfora fire permilfrnrrs local authorities In all areas where iris required.
6. We will stall times he a credit to the Boy Scouts of America and will nor lolerate rnwdyionr or un.Scouttike
conduct, keeping a constant check oral members of our group.
7. We will maintain highstandardo of personal cleanliness and orderliness and still npeotea dean and lanirary
camp, leaving tin a hester condition than we fomd it.
B. WewIti norlisernrhnryarrytnssh, garbage, ortin cars. Alt mbbish that cannot be horned wit beptxcedin
a tore-litter bag and taken to the nearest tecognired trash disposal or all th~ way home, if nncesuary.
9.
15.
11.
12.
13.
14.
15.
16.
17.
tt.
We will not deface trees, restrourns, or otheroh)ectswislrirdti Is or writing.
Wewillrespectshepeoperlyofothernandwillnntnnspaoo.
We will nnt con manding trees to nhrobn withoot specific perrnsission from tIe landowner or manages.
Wewitl collect only sooaenirs that are gifts no us orthat we purchase.
We will paynorown wayand riot eupectmoceolioruorentessainmensfrxm aoyindieidual orgrnlrp.
We will provide enerymerober of nor parnyanopportunityrs attend religions services on the Sabbath.
We will observe the cosriesy to write thank-you notes no persons who assisted so on our nip.
We will, in case of backcosntry expedition, read and abide by the Wilderness Use Policy of she ISA.
We will noAfy, in case of tedorn trouble, our local csunclt service center, our parents, on other local contact.
1 more than one vehicle is used no transport our group, we will establish rendezvous points at tire slart
of each day and nor attempt Is have drivers closely follow the group vehicle in front of them.
Firestone Scout ReservatiOn
19001 Tôhner Canyon Ràad
Brea, California 92821
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~X1T UhFO FROHORAflGI~ rRWY 57
SOUTh FROM YRWY 210, 10, or 60
Pxit Brea CanyDfl Road and go
South to Tonner Canyon ~cmd,
1et~t under freeway and proceed
2 mIlo* .to Camp entrance
NORTH FROM rRW~Y 91 or5
exit Tonner Canyon Road, turn
left f~o~ off ramp and proceed
mi1ei~ taC&i~p ~ntr~nc~
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FIRESTONE SCOUT RESERVATION
Loma Linda
Wlyut
C Camn Master
Archery and Tomahawk
Arthur LeLls
Green Island Campsite
Rinconcilo Campsite
Trading Post
Lakes ide Cam~sitc
Times Training Center
Ranger’s House
Cub ] ,and
Gate
Maint. Yard
Nobby Way