Samples Please separate the forms and have them in alphabetical order by the student s last name. Don Hargis

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1 Dear Youth Worker: Welcome to STRAM Camp. We know that this will be a week of fun and excitement as well as spiritual growth. This is an extreme camp. At times the youth will be challenged to push themselves beyond their comfort level. They will face their fears and hopefully overcome them by trusting God and each other. The dates for this year s Northern STRAM Camp for Youth are June 20-25, Each day the youth will be challenged through varied tracks that they will select. Samples of those track are; whitewater rafting, climbing / repelling and adventure recreation. At camp we will provide you with a list of the tracks so your youth can sign up for the tracks of their choice. There will be a description of each track and whether full day or half day. Adventure recreation, a full day of team building games and group initiatives, is a required track for first time STRAM Campers. (If a community missions project is available, each camper will be required to participate in a half day project.) We have enclosed your camp packets for Please feel free to duplicate as many copies of the materials as you may need. This packet includes: Health Form(s) Information Sheet Dress Code Sheet CampSchedule A Release of Liability for Paintball A Release of Liability for Tributary Whitewater Tours Map When you arrive at camp you will need to turn these forms in to the registrar. Be sure that all forms are signed by the student s parent or guardian. Please separate the forms and have them in alphabetical order by the student s last name. STRAM Camp exists to Strengthen spiritual lives, to provide Team building, to Reach non-christians, to Advance mission awareness and to Magnify God. These principles will be taught to the youth in each of their activities. When you are finished with each activity, there will be a debriefing to help the youth understand the practical and spiritual aspects of what they just learned. Please make certain that a list of the names, age and gender of all your campers along with the $25.00 per person deposit is received in our office, California Southern Baptist Convention in Fresno no later than June 2, The balance may be paid at camp. The rate is $ per child if paid by May 30. After May 30 the rate will be $ If you have any questions, please contact Georgia Prentiss at or Don Hargis at pastordon@newheightsfresno.org In His Service, Don Hargis

2 Youth STRAM Camp Information June 20-25, 2016 At STRAM Camp we are continually trying to help churches experience the Father through a great camping event. Each day we will meet to listen to the camp Pastor and Missionary. We will also enjoy a time of worship each day. There are three days of events that we participate in outside of the camping area. Group leaders/sponsors will need to provide transportation for the children to these locations. Location: Cisco Grove Campground & RV Park PO Box Hampshire Rock RoadSoda Springs, CA95728 Phone: , Fax: or info@ciscogrove.com Tentative Schedule of Activities for the week; Monday: Tuesday : Wednesday : Thursday: Friday: Saturday: Registration begins at 12:00 noon Tract Day 10 am 5 pm Tract Day 10 am 5 pm Tract Day 10 am 5 pm Whitewater Rafting Clean and Pack up for departure at 12:00 noon EMERGENCY PHONE NUMBER: (Pastor Don s cell phone) Churches will need to provide 1 adult sponsor of the same gender for each 6-8 campers or less as well as enough tents for your campers. Everyone will be sleeping in tents. Campers are not allowed to leave the property except for special group events and notifying the Camp Director or Assistant Director. Sponsors must notify the Camp Director or Assistant Camp Director when leaving for any reason.. Only designated food can be taken from the kitchen area, such as fresh fruit and packaged food. Shower facilities are provided. Shoes will be worn at all times, except at the waterfront and in the showers.(water socks are recommended for all water tracks.) Girls are required to wear a one-piece bathing suite. Bathing suits will not be worn around camp. Snacks may be kept in your tent. However, you are NOT allowed to sell any of your snacks to other campers. Any camper caught selling their snacks will forfeit their snacks to the entire camp. You might want to bring a can of Raid to keep the insects out. No alcohol or tobacco is allowed at STRAM Camp. Items to Bring: All forms signed and completed. Swim suite, Clothes, Towels, Bible, Pen, Sleeping Bag, Air Mattress, SUN BLOCK, Flashlight, Insect Repellent, Drinking Water Container and Toiletry items. Items NOT to bring: Illegal drugs, Cigarettes, Firearms of any nature, No cell phones, radios, CD players (If brought they will be left in the car), Fireworks and Alcohol. Dress Code for Everyone: Clothing with alcohol, gangs or non-scripture items will not be allowed. All underwear is to be covered. Dress Code for Women/Young Ladies/Girls: ONE PIECE SWIMSUITS, Tank tops are allowed, spaghetti strap tops are NOT allowed, all shorts must be to mid-thigh, No Short-shorts, No low-cut tops and No mid drifts. Dress Code for Men/Young Men/Boys: Shirt must be worn at all times, except in water sports, Wife beater T-shirts are not allowed. No sagging pants. Pants will be worn in the proper way. If a belt is needed, then bring one or a rope will be supplied to help. Other Rules for camp: No pornographic materials. All cell phones, IPads, IPods or any other electronic devices will be stored in a locked away until the camp ends Only pocket knives allowed and rules for knives must be observed. All paint ball guns will be stored in a locked area. All prescription drugs must be declared at registration. In all we do and say we do it to the glory of God and not to the glory self.

3 STRAM Camp Tracks Required Events: Adventure Recreation Full Day (First time STRAM Campers are required to attend Adventure Recreation) Ministry Project - Half day (All STRAM Campers are required to do the Ministry Project each year.) Full Day Events: Except for climbing and repelling, these events CANNOT be repeated Paintball White Water Rafting (Friday Only) Climbing/ Repelling Beginning Intermediate Advanced (Tentative) Adventure Recreation Ministry Project (Mandatory) Half Day Events: Canoeing / Kayaking Crafts Archery Hiking GPS Treasure Hunt Knots and Splicing Young Men: Becoming a Authentic Man (Thursday Only) Young Ladies: Becoming a Authentic Woman (Thursday Only) Northern STRAM Camp: Prices are subject to change. 1. Waiver: ALL PLAYERS MUST HAVE A WAIVER SIGNED BEFORE PLAYING. Please make as many copies of the enclosed waiver as needed. 2. Rentals: Equipment can only be rented to an adult (18+) so arrangements will have to be made so counselors rent the equipment for their youth. 3. Those WITHOUT own equipment: $20. Gun, mask, tank (with free CO 2), hopper, etc. $ paint balls $ paint balls $50. 2,000 paint balls 4. Those WITH own equipment: $ 3. - $4. tank refills depending on tank size $ paintballs $50. 2,000 paintballs $5. Miscellaneous components available $5. Compressed air refills

4 Youth STRAM Camp Schedule Monday Schedule: 1:00 4:00 Register and Set up 2:00 3:00 Staff & Sponsor s Meeting (Pavilion) 4:00 5:30 Camp Orientation at Pavilion 5:30 7:15 Dinner/FREETIME at Pavilion 7:15 8:00 Worship Celebration at Pavilion 8:00 9:00 FREETIME 9:30 10:30 Get Ready for Bed 10:30 Lights Out Tuesday Friday Schedule: 6:30 7:30 Rise, Shine, and Clean-up 7:30 7:45 Flag Pole 7:45 9:00 Breakfast 8:30 9:00 Staff & Sponsor s Meeting (Tuesday is Group Photo in CampT-shirt) 9:00 9:15 Moments with God 9:15 9:45 Morning Missions 1:00 1:30 Lunch 10:05 5:00 Track Events 5:00 5:30 Arrive back at Camp/Clean-up 5:30 7:15 Dinner / FREE TIME 7:15 8:00 Worship Celebration 8:00 9:00 FREETIME 9:00 9:30 Church Group Devotions 9:30 10:30 Get Ready for bed 10:30 Lights Out Saturday Schedule: 6:30 7:30 Rise, Shine and Clean up 7:30 7:45 Large Tent 7:45 9:00 Breakfast 8:30 9:00 Staff and Sponsor s Meeting 9:00 9:15 Moments with God 9:15 9:45 Morning Missions 9:45 10:45 Pack-up and Clean-up 10:45 11:45 Closing Ceremony 11:45 12:00 Break and Depart for Home

5 HEALTH INFORMATION FORM California STRAM CAMP 678 East Shaw Ave., Fresno, CA NAME BIRTH DATE SEX AGE PARENT OR GUARDIAN NAME HOME PHONE HOME ADDRESS FATHER S NAME & WORK PHONE MOTHER S NAME & WORK PHONE List two other persons other than parents in case of an emergency NAME & PHONE NUMBER NAME & PHONE NUMBER Do you have other health care insurance coverage? If yes name of carrier: HEALTH HISTORY: If YES give approximate date, or most recent date. Asthmas DATE DATE DATE DATE Ear Infections Irregular Behavior Mumps Chicken Pox German measles Ivy Poisoning Penicillin Convulsions Hay Fever Measles Rheumatic Fever Diabetes Insect Stings Other Other Diseases or Details from Above: Chronic or Recurring Illnesses: Operations and/or Serious Injuries: PARENTS AUTHORIZATION This health history is correct so far as I know, and the person herein described has permission to engage in all prescribed camp activities, except as noted. In the event I cannot be reached in an EMERGENCY I hereby give permission to the physician selected by the camp director to hospitalize, secure proper treatment for, and to order injection, anesthesia or surgery for my child as named above. PARENT/GUARDIAN SIGNATURE DATE

6 IMMUNIZATION HISTORY Immunizations are not required for camp. This is a record of basic immunizations and most recent booster doses. Exception: Camper must have had a Tetanus Booster within the last 10 years. DPT Series Booster Measles Vaccine Tetanus Booster Polio OPV Sabin Typhoid Measles Vaccine (live) Tuberculin Test German Small Pox Mumps Vaccine Other: Measles (Rubella) IMPORTANT: Please notify the camp if this camper is exposed to any communicable disease during the three weeks prior to camp attendance. RECOMMENDATIONS AND RESTRICTIONS WHILE IN CAMP Special Diet: Special Medicine: (Name) Is Parent Sending it? Permission is given for my son/daughter to receive (If needed): Swimming: Strenuous Activity: Any Specific Activities to be Encouraged? Any Specific Activities to be Discouraged? Other (Be Specific): Tylenol: YES Pepto-Bismol: YES NO NO STATEMENT OF PERMISSION TO ENGAGE INWATER ACTIVITIES AT STRAM CAMP All boating instructions will be under the supervision of competent and qualified lifeguards. The child does not go on the water until he/she has been instructed. Both, in boating and water safety, and he/she must wear a life jacket. MY CHILD HAS PERMISSION TO ENGAGE IN BOATING ACTIVITIES ACCORDING TO THE PROCEDURES OUTLINED ABOVE. Yes No MY CHILD CAN SWIM Yes No Parent s Signature: Date:

7 PAINT BALL This is a release of liability Read before signing Note: This form must be read and signed before the participant is allowed to take part in any Event PARTICIPANT S NAME DATE OF BIRTH In Consideration of being permitted to participate in any way in the sport and activities of paintball under the auspices of STRAM Camp, I acknowledge, appreciate, and agree that: 1. The risk of injury from the activity and weaponry involved in paintball is significant, including the potential for permanent disability and death, and while particular protective equipment and personal discipline will minimize risk, the risk of serious injury does exist; 2. I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, even if arising from the negligence of those persons released from liability below, and assume full responsibility for my participation; and, 3. I understand that the activities of paintball are physically and mentally intense. I understand the rules of play and will comply with all rules and regulations. If I observe any unusual or unnecessary hazard during my participation, I will bring such to the attention of the nearest official as soon as practical; and, 4. I for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE AND HOLD HARMLESS STRAM CAMP, the owners and lessors of premises used to conduct the paintball activities, their officers, officials, agents, volunteers, counselors, and/or employees (Releases). WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, OR LOSS OF PERSONAL property, WHETHER CAUSED BY THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, except that which is the result of gross negligence and/or wanton misconduct. 5. I understand and agree that this release of Liability Agreement covers each and every paintball activity and event in which I participate hereafter. I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND IT S TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITH OUT INDUCEMENT. PARTICIPANT S SIGNATURE DATE SIGNED PHONE NUMBER ADDRESS CITY & STATE ZIP PARENT OR GUARDIAN MUST READ THIS FORM AND SIGN BELOW This is to certify that I, as parent/guardian with legal responsibility for this participant, do consent and agree not only to his/her release of the above listed persons and organizations but also to release and indemnify the Releases from any and all liabilities incident to his/her involvement in these programs for myself, my heirs, assigns, and next of kin. PARTICIPANT/GUARDIAN S SIGNATURE DATE SIGNED EMERGENCY PHONE NUMBER

8 Cisco Grove Campground and RV Park Hampshire Rock Road PO Box 890Soda Springs, CA Phone: (530) Fax: (530) Cisco Grove Campground & RV Park is nestled in the Donner Summit and conveniently located off of Highway 80. East Directions : FROM SACRAMENTO: 1.Take I-80 E towards RENO approx. 78 Miles. 2.Take the CISCO GROVE exit. 3.Turn LEFT onto CISCO RD. 4.Turn LEFT onto HAMPSHIRE ROCKS RD. West Directions : FROM RENO: 1.Take I-80 W. towards SACRAMENTO approx. 52 Miles. 2.Take the CISCO GROVE exit. 3.Turn RIGHT onto CISCO RD. 4.Turn LEFT onto HAMPSHIRE ROCKS RD.

9 Tributary Whitewater Tours LLC RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT This is a release. Read it carefully before signing. This release essentially states that I know I am going on a whitewater rafting trip in a wilderness/outdoor environment. As a result of the inherent risks in this activity, I know I may die, get hurt, or damage my belongings. If any of these occur, I understand that I cannot make a claim, sue, or expect Tributary Whitewater Tours LLC, its owners, officers, agents, employees, other participants and associates including the State of California, its Dept. of Parks & Recreation, the US Bureau of Reclamation, Pacific Gas and Electric Company, Placer County Water Agency and the Sacramento Municipal Utility District (hereinafter referred to collectively as Tributary Whitewater Tours) to be legally responsible or pay for any damages. ACKNOWLEDGMENT AND ACCEPTANCE OF RISKS: I, the undersigned, hereby acknowledge that I have voluntarily chosen to go on this whitewater rafting trip with Tributary Whitewater Tours. Certain risks are inherent in any recreational activity and cannot be eliminated, altered, or controlled, and these risks that contribute to the unique character of the activity can also be the cause of injury illness, death, and damages. I know and fully understand that a whitewater rafting trip, whether on a raft, oar boat, kayak, or any other type of vessel, is an outdoor adventure activity in wilderness environment with inherent risks and hazards where serious accidents can occur, participants can die, sustain injuries and property damage. Also, I understand that Class IV and V represent the most difficult and dangerous levels of whitewater and recognize that the risks associated with whitewater rafting are greatly increased. I acknowledge and willingly assume all risks and hazards in whitewater rafting and river-related camping from the pre-embarkation rendezvous until the conclusion of the trip, including, but not limited to, (1) loss of control of the raft, falls in, out, or about the raft, collision with other participants, equipment, other rafts, rocks, trees, and any portion of the interior of the raft, and any other man-made or natural obstacles, whether obvious or not; (2) judgment, decisionmaking and conduct of the guides; (3) submersion in water, drowning; (4) encounters with animals, wildlife and insects; (5) exposure to wilderness environment, extreme temperatures, and inclement weather, remote areas, wilderness terrain, including, travel by foot or vehicle in any way related to this activity, whether at camp or elsewhere; (6) assistance in lifting and/or carrying rafting equipment; (7) rescue-related injuries; and (8) unavailability of immediate and appropriate medical attention in case of injury. I further understand and acknowledge that Tributary Whitewater Tours provides foot cups in some of its boats to assist participants in stabilizing themselves. The use of foot cups may present an increased risk of knee, ankle, or other injuries because of their restrictive nature. Use of foot cups is totally voluntary. I also understand and acknowledge that the above list is not complete or exhaustive, and that other risks, known or unknown, anticipated or unanticipated, may also exist and result in injury, illness, disease, death or damage. My participation in this activity is purely voluntary and I elect to do so at my own risk. RELEASE: In consideration for Tributary Whitewater Tours allowing me to participate on this trip, I voluntarily agree to release, discharge, and hold harmless Tributary Whitewater Tours for any and all claims of liability arising out of their negligence, fault, recklessness, or any other act or omission which causes the undersigned illness, injury, disease, death, and damages of any nature in any way connected with my participation in this rafting activity. I also expressly agree to release and discharge Tributary Whitewater Tours from any act or omission of negligence in rendering or failing to render any type of rescue, emergency or medical services. In signing this document, I fully recognize and understand that if I (or any minor on whose behalf I am signing this release) am hurt, die, or my property is damaged, I am giving up my right to make a claim or file a lawsuit against Tributary Whitewater Tours, even if they negligently or by some other act or omission cause the injury or damage. I further agree, to hold harmless, defend, and indemnify Tributary Whitewater Tours from all defense costs, including attorney s fees incurred in connection with claims for bodily injury, wrongful death, or property damage, sustained by any minor on whose behalf I am signing under 18 years of age, or which I may have caused to spectators or other third parties, whether negligent or not, in the course of my participation in this activity. As parent or legal guardian of a participant under 18 years of age, I have read and voluntarily agree that said minor may participate in this whitewater rafting trip, and I sign this release on their behalf and on the behalf of the minor s parents and/or legal guardians. In addition, I give Tributary Whitewater Tours permission to treat said minor in case of illness, injury, emergency or accident. Should emergency medical services become necessary, for the undersigned participant or minor, the expenses are sole responsibility of the participant and not that of Tributary Whitewater Tours. Personal medical and travel insurance is strongly advised for all participants. Tributary Whitewater Tours reserves the right to accept or deny service to any person. I hereby agree to follow all rules, regulations, and instructions of Tributary Whitewater Tours while on this trip. I also certify that I and any minor whose behalf I am signing, are physically and mentally capable of participation in these activities. I hereby represent that I have informed Tributary Whitewater Tours of any pertinent medical conditions that may affect my or the minor s participation in these rafting activities. I hereby agree that Tributary Whitewater Tours may use film or photographic records of this rafting trip for its promotional and/or commercial purposes. The venue of any dispute that may arise out of this agreement or otherwise between the parties to which Tributary Whitewater Tours or its agents shall be the Superior Court of California, County of Placer.. I HAVE READ THIS DOCUMENT IN ITS ENTIRETY. I UNDERSTAND THAT I AM ASSUMING ALL THE RISKS INHERENT IN THIS WHITEWATER RAFTING ACTIVITY. I UNDERSTAND THAT IT IS A RELEASE OF ANY AND ALL CLAIMS. I UNDERSTAND THAT THIS IS THE ENTIRE AGREEMENT BETWEEN THE UNDERSIGNED AND Tributary Whitewater Tours, THEIR OWNERS, OFFICERS, AGENTS, AND EMPLOYEES, AND THAT IT CANNOT BE MODIFIED OR CHANGED IN ANY WAY BY THE REPRESENTATIONS OR STATEMENTS BY Tributary Whitewater Tours OR BY THE UNDERSIGNED. I VOLUNTARILY SIGN MY NAME AS EVIDENCE OF MY ACCEPTANCE OF ALL THE PROVISIONS IN THIS RELEASE AND MY AGREEMENT TO BE BOUND BY THEM. Name: Date(s) of Trip: June 2016 River: South Fork American ½ day (Please Print Clearly) Address: Group Name: STRAM CAMP / Don Hargis City, State: Zip Date: Telephone: ( ) Signature: Youth Age: (Signature of Legal Guardian if Participant is Under 18 Years of Age) Please complete and either mail to be received prior to trip or bring completed form(s) with you. PLEASE DO NOT FAX. Thank You