Rush Copley Health-Plex Lock-In!!! Lowaneu Allanque Lodge is Inviting You!

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1 Date: March 4 th, (8pm) to March 5 th, (7am), 2017 Place: Rush Copley Health-Plex 1900 Ogden Ave / Aurora, IL Who: ALL BOY SCOUTS (you do NOT have to be in the Order of the Arrow) Rush Copley Health-Plex Lock-In!!! Lowaneu Allanque Lodge is Inviting You! There Will be Swimming, Rock Climbing, Basketball, Dodgeball, Pizza, Pop, Fellowship, & MORE! Bring a Water Bottle and if You Wish: Board Games, Playing Cards, and Video Games Too!!! Doors Will be Locked at 10pm on Saturday No Admittance After That No One Can Leave Before 7am Sunday Early Bird Registration Fee is $30 Regular Registration Fee (After 2/6/17) is $40 Registration STARTS on 1/1/17 Registration ENDS on 2/21/17 Once Registration Closes, it is CLOSED! Capacity is 250 People Register Early to Reserve Your Spot! For Registration Forms:

2 Lowaneu Allanque OA Lodge #41 Registration Packet for 2017 Lock In at: Rush Copley Healthplex 1900 Ogden Ave / Aurora, Illinois All Registration for This Event MUST be Done Online at: Due to the Use of an Outside Vendor You MUST Complete ALL Attached Forms and Bring Them to the Lock In to Gain Admittance (Do Not Mail in the Attached Forms Bring Them With You) We Have to Pay an Outside Vendor For Their Facility, So We Cannot Process Refunds for Cancelations After the Sign Up Deadline NOTE: Sunday, March 8 th is the Beginning of Daylight Savings Time - Please Plan Accordingly and Pick Your Child Up ON TIME NOTE: ALL SCOUTS MUST BE PICKED UP BY 7AM. ANY SCOUTS REMAINING AFTER 7:15AM WILL BE TURNED OVER TO THE LOCAL POLICE AS AN ABANDONED CHILD Any Group Bringing 3 or More Youth MUST Bring a PAID ADULT Who Stays for the Event

3 Lowaneu Allanque Lodge # Lock In Registration Rush Copley Healthplex / 1900 Ogden Ave / Aurora, IL From: March 4, 2017 (8pm Arrival) To: March 5, 2017 (7am Departure) Doors will be locked 10pm (Sat) and will not reopen until 7am (Sun) Release and Indemnification: I hereby release and waive any and all claims that I may have against the Boy Scouts of America, Three Fires Council #127, and their employees, agents, representatives, or volunteers arising from my child s participation in the Lock In. I agree to fully indemnify and hold harmless the Boy Scouts of America, Three Fires Council #127, BSA and their employees, agents, representative, and volunteers from any and all claims arising from my child s participation in the Lock In. This indemnification expressly includes any claims arising out of the Boy Scouts of America, Three Fires Council #127, BSA s own negligence or fault or that of their employees, agents, representatives, or volunteers. I agree that the indemnification includes the amount of the claims, the expenses of defending against the claims, court costs, and attorney s fees. In case of emergency, I understand that every effort will be made to contact me. In the event that I cannot be reached, I hereby give my permission to the physician selected by the adult leader in charge to secure proper treatment, including hospitalization, anesthesia, surgery, or injected medication for my child. Medical Information: A BSA Physical form (Parts A & B must be completed) must be brought to the event and shown to registration personnel. The form will then be kept by the adult leader of the group. Forms may be obtained on the Lodge Website at on Three Fires Council website at or at one of the Three Fires Council Scout stores. The use of the BSA Physical form is a requirement. Persons without the form completed and properly signed will not be allowed to participate or remain at the event. No medical forms other than the BSA form are acceptable. Permission for Medical Treatment and Participation: I give permission for my Scout to participate in the Lowaneu Allanque Lodge #41 event. Participation in this event implies consent to use photographic likenesses in promotional material. I give permission for medical treatment if needed. Parent approval required if participant is less than 18 years of age. THIS FORM MUST HAVE THE PARENT / GUARDIAN SIGNATURE _ Participant Name _ Parent / Guardian Signature _ Parent / Guardian Phone Number / Emergency Phone Numbers _ Date

4 1900 Ogden Avenue, Aurora, Illinois Waiver of Claims and Release of Liability Guest s Printed Name Minor s Printed Name (if applicable) Address City State Zip Phone Address WAIVER OF CLAIMS AND RELEASE OF LIABILITY By my signature, below, and in consideration of being permitted to use the Rush-Copley Healthplex Fitness Center s facilities or otherwise participate in Healthplex sponsored activities, programs, or events, I, for myself, or on behalf of my child, and on behalf of my or my child s executor, administrator, heirs and assigns, agree to defend, indemnify and hold harmless Rush-Copley Medical Center, Inc., Rush-Copley Healthplex, LLC and each of their directors, officers, employees, agents, independent contractors and representatives ( Released Parties ), from and against any claims or demands for injuries or any damage of any kind, whether known or unknown, resulting from any acts or omissions of the Released Parties. I further agree the Released Parties shall not be liable for any personal property that is damaged, lost or stolen, including, but not limited to, my automobile and/or its contents. Finally, I understand and agree that use of the Healthplex is at my own risk, that I agree to assume all risks for injuries, including death, and that I should first seek medical clearance before participating in any physical activity or exercise. Signature of Guest Date Signature of Parent/Guardian of Minor Date

5 GROUP EVENT BEHAVIOR CONTRACT Thank you so much for bringing your group to the Rush Copley Healthplex for an over night lockin. We are extremely happy that you all could join us for a fun packed event. We want each person to enjoy their experience with us. There are some guidelines that are put in place to make the lock-in a fun and safe experience. We ask that you and your parents read through the agreement and return is signed along with your waiver. Thank you. Guidelines We know that you want the fun to last all night long and if you choose to stay up all night, you must stay in the designated area. All equipment must be returned to its place without damage. If you have electronics with lights on, please be respectful and keep the brightness and sound down to a level to not disturb those who need sleep. If you are going to watch a movie, keep the volume down as to not disturb the sleepers. If you damage any equipment or if you are at an activity and you find that equipment is damaged please let the staff member know as soon as possible. You are to stay with an adult at all times. When swimming, the lifeguards in place to ensure your safety. You are to listen to and follow the rules. The climbing wall has its own set of rules. To make sure that everyone gets a chance to climb and be safe, the rules must be followed. Failure to do so may result in loss of climbing privilege. The activities for the evening are set up in designated areas. Please do not carry equipment from one activity to the next. For swimming you must bring a towel. The Healthplex does not provide towels. We do not allow the participants to shower. There are too many kids and showering would literally take all night. You are roughing it for one night. LIST: All Participants must bring swim suit, towel, pillow, sleeping bag, and wear athletic clothing and shoes. Pajamas are optional as by the time you go down to sleep it is only a few hours and it will be time to get up and go. My parent/ guardian and I have read through the guidelines and understand how I should behave during the lock- in event. By signing below, I understand that I am responsible for my behavior and will have fun during the event. Participant Parent/ Guardian

6 Attention Chaperones: Please Assist with these Guidelines & Policies An Adult MUST be in all areas where students/scouts are present at all times. Chaperones will be required to be a group leader and help supervise the participants. Chaperones are responsible for the all of the children in their group (particularly after lights out when the Healthplex staff are no longer present during overnight events.) 1:8 ratio for Chaperones is required. Announcements: Food We will have snacks and drinks in the Lower Discovery area -see schedule for time. Absolutely no food or drink unless in the Lower Discovery Club with the exception of water bottles. Please clean up any food mess. Leave all areas clean. Club Rules: For bathrooms, use the Discovery Club bathroom, lower level Family locker room, tennis facilities, or the boys & girls locker rooms ONLY. No one is allowed on the fitness floor, machines or fitness equipment. Do not take out equipment that is not part of the scheduled activities. Please do not tap the paddles/racquets for table tennis or tennis. Pool Rules: PLEASE DO NOT USE THE TOWELS (you MUST bring your own towel). No one is allowed in the pool area unless it is your scheduled time see schedule for time. Do not use Adult locker rooms - Please use Boys/Girls and/or Family locker rooms. No DIVING, spinning, or summersaults - forward jumping only and NO RUNNING. Do not leave the pool area unless you are dried and dressed. You MUST change in the CLOSED CHANGING Rooms in the Family Locker Room (not in the open area leading to the pool) Climbing Wall Rules: Only climbers are allowed on the tile. All others must wait in line or the sitting area. Start climbing when the belaying staff signals you that they are ready. For your safety listen and follow instruction from the wall staff. Speak loud and clear when you are ready to come down. When repelling sit back and keep feet on the wall slightly pushing off. No horsing around while climbing. First Aid: Rush-Copley Healthplex staff must be notified for all incidents or injury and RCHP staff must fill out Incident/Injury Report. The First Aid Kits are located at the registration Desk and Pool AED is next to the track on the lower level and behind the Front Desk. Clean up: Please assist the Healthplex staff is all cleanup efforts. Print Name Signature Date

7 Location / Times / Activity Court A All Night Volleyball Court B All Night Basketball Court B All Night Dodgeball Discovery Club All Night Table Tennis Discovery Club All Night Video Games / Board Games Discovery Club All Night Bags / Card Games Track 9pm 5am Track Tennis Courts 9pm 5am Tennis Pool 8:30pm 12:30am Swimming Climbing Wall 8:30pm 12:30am Rock Climbing (Must be scheduled at Check In to Climb) The Only Place Food is Allowed is the Lower Discovery Club! Lower Discovery Club 9:30pm 11:30pm Pizza and Soda Lower Discovery Club 11:30pm 5am Personal Snacks Basketball Court 6:30am - 7am Leave No Trace Cleanup Departure 7am THINGS TO BRING Swim Trunks Beach Towel Water Bottle Handheld Video Games Cards Board Games Dice Bag for Wet Clothes BSA Medical Form BSA Waiver Copley Waiver Personal Snacks Comfortable Clothes to Play In i.e. Gym Clothes and Gym Shoes DAYLIGHT SAVINGS TIME CHANGE TONIGHT Spring Forward!!! Be Sure Your Ride Arrives on Time Call or Text Now to Remind Them