Rio Texas Conference Youth Assembly 2017

Transcription

1 When: July 17 th 21 nd 2017 (Monday through Friday) Where: Sacramento Methodist Assembly 106 Assembly Circle Sacramento, NM (575) Cost: $ per camper (Cashier s check or Money Order made out to El Valle District Youth and Camping) Registration deadline: Friday, June 23 rd * Late Registration: AFTER Friday, June 23 rd * (+$25 late fee per camper) (* forms MUST be received, NOT postmarked, by given date) Send to: El Valle District Youth and Camping 1909 W. Harrison Ave Harlingen, TX (956)

2 2 Important Information: PLEASE read all forms and pay special attention to items in bold and underlined. Acceptance of registration forms will be on a first come, first serve basis due to the limited space available to Sacramento Methodist Assembly. No ONSITE registration will be allowed You will be given instructions as you enter the campground as to where and how to pick up your group s Camp Information Packet. Every attempt will be made to ensure youth groups are lodged together. Please be advised it may not be possible in all situations. ALL adults must have completed the Safe Sanctuary Training prior to Youth Assembly. There will not be any training at Sacramento. (Renewed every 2 years) ALL adults must have background checks prior to Youth Assembly. Please submit a copy of your Safe Sanctuary certificate and a copy of your background check with camp registration.

3 3 July 17-21, 2017 You are The Salt of the Earth and The Light of the World Matthew 5:13-16 Dear Pastors and Youth Leaders, Enclosed you will find the registration packet Youth Assembly 2017 which will be held at Sacramento Methodist Assembly in Sacramento, New Mexico July 17-21, 2016 (Monday thru Friday). Everyone attending Youth Assembly (includes all adults and staff) must have the pastor s and the youth leader s signature on each form. All adults attending must have completed and provide proof of both the Safe Sanctuary Training and Background Check which also includes campers who have reached the age of 18 and older. By signing each form, we trust your knowledge of each camper, both youth and adult, which you are confident will benefit from participating. Camp is a special time for all, but especially for the youth. Camp plays an important role in our youth s spiritual growth and provides a positive environment for youth to experience God s love and the Holy Spirit s guidance for their lives. Please take the time to meet with the youth and adults to review the rules and code of conduct. Before you begin filling out the forms please pray for God s guidance and wisdom. On the first evening of camp we will have a Banner Procession for youth groups that make a special banner in relation to the camp theme. Senior graduates are honored with a luncheon celebration. Thursday night (Consecration Night) is always a special evening for our youth to dress up as our time of Praise & Worship comes to an end as an assembly. Be sure to inform all to bring their Sunday best attire for the evening. And if you have a talent, please bring it and/or your instrument for all to enjoy in our Talent Show. As we get ready for Youth Assembly 2017, please lift us up in prayer. Be in prayer for the youth, youth leaders, teachers, staff, the praise bands that will lead worship and for our main speaker, Pastor Ray Perales. I know God will bless all who attend and I look forward to seeing each of you in Sacramento! Yours in His service, Jeremiah Gutierrez Dean of Youth Assembly 2017 (956)

4 4 Attention all Youth, Adults, and Parents! Please read and complete the following forms: Registration Form (page 5) Incomplete forms will be returned and face the possibility of not being submitted on time. All youth, adults, and staff must complete this form. Covenant of Conduct (page 6) with all signatures. All youth and adults must complete this form. Please make a copy of the forms to keep with your youth group. Workshop Selection Form (page 8). All youth must complete this form according to the instructions on the form. Adult Registration Form Addendum (page 9). All adult campers must complete and return this form. Camp Buddy (page 5) requests such as camp buddy will be considered upon room availability and will be used for accountability purposes. Camp Buddy is a friend of same gender and academic classification that you are requesting to lodge with. What to bring: Bible, casual clothes, Bible, light jacket, flashlight, Bible, linens/sleeping bag, personal items, Bible, pen & paper, Bible, spending money for snacks/canteen items, and BIBLE. ABSOLUTELY all deadlines are final. ABSOLUTELY no refunds. ABSOLUTES ABSOLUTELY only cashier s check or money orders will be accepted. (Including all staff- $200.00) Only Staff will pay $ registration. ABSOLUTELY no individual registrations will be accepted. All registrations must be sent as a group (excluding staff*). Staff may send registration separately. ABSOLUTELY all youth must be accompanied by an appropriate number of adults. One (1) adult for every seven (7) youth*. Also, if you are bringing both male and female campers there should be male and female counselors. Do not send more adults than necessary. *Due to 1-to-7 ratio; Graduating Seniors Class 2017 may lodge in separate dorms. Be advised that adults may not be assigned to every room in that dorm but supervision will be enforced; i.e. one adult to every 2 rooms. ABSOLUTELY all forms must be completely and clearly filled out. This includes all adults and staff. Forms that are Incomplete or unreadable will be returned. ABSOLUTELY NO Early Arrivals - Groups may not arrive earlier than 1:00 p.m. Mountain Time on Monday July 17 th, Registration will 1:30 p.m. Mountain Time. ABSOLUTELY all camper s (Youth & Staff/counselors) must remain in Sacramento Assembly at all times from J uly 17 21, 2017 (unless special permission is given by Camp Dean) ABSOLUTELY all visitors (adults not part of staff or staying as counselors) must leave campgrounds at start of camp. (3:00 p.m. Mountain Time) ABSOLUTELY no transportation will be able to arrive any earlier than 11:30 a.m. Mountain Time on Friday July 21, 2017

5 5 Camper Information Camper Name: Male: Female: Address: Apt.: City: State: Zip Code: Phone: ( ) Age: DOB: Grade completed in 2017: Check one: Youth Adult Staff Camp Buddy: address may be published in camp directory: Yes No My T-Shirt size (check one): XS S M L XL 2XL Other Church: Pastor: Church City: Church Phone: ( ) Adult responsible for Camper: July 17-21, 2017 You are The Salt of the Earth and The Light of the World Matthew 5:13-16 Medical Information Name of Doctor: Phone: ( ) Medical History (i.e. diabetes, epilepsy, heart murmur, asthma, etc.): First Timer: Y/N Please indicate any special needs that you may have concerning lodging or medication: (all prescribed medication must be reported to the camp nurse) Allergies (i.e. food, insects, etc.): (continue on back if necessary) Date of last tetanus shot: Group or Family Hospitalization Insurance Co.: Insurance Co. Address: Group No.: Policy No: Phone: ( ) In case of emergency call: Phone: ( ) Secondary person to call: Phone: ( ) Permission Statement I do hereby give permission for the camp nurse to administer over the counter medication such as Tylenol, Motrin, medication for cough and cold, etc. as needed. In the event of an emergency where medical treatment is required I give my permission to the church staff or youth coordinator to obtain the services of a licensed physician. Please attempt to notify me immediately concerning any such emergency. I hereby release the retreat leaders, the participating church, its staff and counselors of any liability in the event of accident or injury. Parent or Guardian s Signature: Date:

6 6 July 17-21, 2017 You are The Salt of the Earth and The Light of the World Matthew 5:13-16 All conduct shall be in the highest Christian regard and with respect for all persons. Failure to abide by the Covenant of Conduct may result in the loss of free time, change in room assignment or any other form of discipline as determined by the Dean Team Profanity will not be permitted. Smoking, possession of firearms, weapons of any kind, fireworks, narcotics, tobacco, and alcoholic beverages will not be permitted. Dress shall be in keeping with Christian standards appropriate to a Christian camp. Gang apparel and apparel with offensive language or images will not be permitted. Modesty in young women s dress is expected. Clothing that is too short, too tight, too low cut, or exposes the midriff is inappropriate. If questions arise as to the appropriateness of dress, please direct them to the Dean of Women or Dean of Men as appropriate. It is recommended that all valuables, mobile phones, pagers, MP3 players and ipods, etc, be left at home. The camp staff and Sacramento Methodist Assembly are not responsible for any lost, stolen or damaged items. Video cameras should be used by Adult counselors or STAFF and permission must be obtained from the persons being videotaped. We strongly discourage youth from using video cameras or other items that can record so as to avoid any harm or discomfort to fellow campers (adults, youth, staff and guest speakers). Music should reflect Christian values. MP3/iPods should only be used in the dorms. When listening to music in your rooms please be considerate of roommates and other campers in your dorm. Always keep the volume at an appropriate level. Boom boxes or external speakers will not be allowed at camp. These devices should not be taken to Bible Study class, workshops or praise and worship times. Devices that cause problems in or out of the dorms will be confiscated. Campers (both youth and adults) are expected to participate in all group activities (workshops, worship services, etc.). Pillow fights, shaving cream fights or any type of hazing will not be permitted. Please do not bring any items to sell at camp; this excludes items for the YSF auction and nightly concession stand. Nature walks and hiking are prohibited after dark per Sacramento Methodist Assembly Rules. All campers are expected to keep their room neat during their stay and to clean up before leaving camp. All damag-

7 7 Participation Requirements for 2017 Rio Texas Conference Youth Assembly A. Youth who have completed the sixth grade and are at least 11 (eleven) years of age by the first day of Youth Assembly will be allowed to attend Youth Assembly. Seniors who are over 18 (eighteen) years of age MUST provide a Safe Sanctuary certificate and Background Check. B. Adult staff and counselors must abide by the Rio Texas Safe Sanctuary Policy to participate and serve at the Rio Texas Youth Assembly. (Exceptions per note E). Their local pastor will be notified for verification. C. All participants (youth, adults, and staff), must be approved by their local pastor and youth coordinator. D. Participation is not restricted to Rio Texas Conference churches; however, these churches will receive precedence in the registration process. E. All exceptions will be at the discretion of the El Valle District Youth and Camping Committee, the Dean of Youth Assembly, and Local Church Pastor. All Youth, Adults, and staff must have all signatures below to attend camp. Camper Acknowledgement: I hereby acknowledge that I have read the Covenant of Conduct and the Participation Requirements for Rio Texas Conference Youth Assembly., and I agree to abide by these rules at all times during this camp. Date Camper s Signature Parent or Guardian Acknowledgement I hereby acknowledge that I have read the Covenant of Conduct and the Participation Requirements for Rio Texas Conference Youth Assembly, and I agree to accept any reasonable disciplinary action taken by the Dean of Camp and Leadership Team for the misconduct of my child including, but not limited to, the expulsion of my child for violation of above rules. I agree to incur the expenses for my child being sent home. Date Parent or Guardian Signature Pastor Acknowledgement I, the pastor of (church), hereby acknowledge that I am giving my approval for the above person to attend this camp. I also hereby acknowledge that I have met with my youth group to discuss the Covenant of Conduct and the Participation Requirements for Rio Texas Conference Youth Assembly to explain what type of conduct is expected from all campers. Pastor s Signature Date Youth Leader Acknowledgement I, the youth leader of (church), hereby acknowledge that I am giving my approval for the above person to attend this camp. I also hereby acknowledge that I have met with my youth group to discuss the Covenant of Conduct and the Participation Requirements for Rio Texas Conference Youth Assembly to explain what type of conduct is expected from all campers. Youth Leader s Signature Date MULTIMEDIA USAGE By signing these permission forms I/ we, hereby consent to the use of any video tapes, photographs, slides, audio tapes or any other audio or visual reproduction y be used for the promotional purposes including recruitment and fund-raising efforts or general publication. Promotion may include but is not limited to slide presentations, photo displays, Internet promotions, electronic multi-media or billboard display. I agree that the photograph/ image shall be free for use and release the Rio Texas Conference, its employees, volunteers and agents for any liability connected with the use of said photograph or image. I (we), grant permission for our child, (Parent or guardian s name) (Child s name) picture/video to be taken as a part of youth ministry activities & to be used in any promotion of parish youth activities including the website. Parent Signature Date

8 8 Instructions: On this page you will find the list of this year s Workshop Classes. Please indicate your first three (3) choices for a workshop in the list. Put a 1 next to your first choice, a 2 next to your second choice and a 3 next to your third choice. Workshops will be assigned on a first come, first serve basis. Be sure to get your forms in early. Feel free to contact the Dean if you have any questions. Core Workshop Classes: No. Choice Workshop Description 1. Teach Me How To Youth - Workshop Selection Form Think you are ready to take on the world? This class will show you what you need to know as you go out into the world Can You Hear Me Now (Call To Serve) Leaps of Faith (Liturgical Dance) Have you ever thought about being a Pastor? Learn about being a Pastor or Lay Leader and hear from people that are passionate about their profession. Learn how to use dance to minister during worship experiences. Use this experience to take back to you local church and lead others in worship using dance. 4. The Ships of Life 5. #StandUp4God 6. Art & Soul 7. Wild & Crazy 8. Drama in Motion 9. Rock with God School is just around the corner. Are you ready? We ll share with you ways to improve yourself as you prepare for school. (Friendships, Relationships & Hardships) What do you stand for? What do you believe in? Learn how to strengthen your faith and how you can be comfortable in your position. Learn how to defend your faith when someone asks you about it. This is a good class for kids that are proposed with questions about their faith in school. Crafty or not, spend time with others expressing your love for God through creative arts. Take home a special remembrance from Camp. Big, fun, wild, and outrageous outdoor and indoor game time. Learn new group building games to share with your youth group. *Workshop requires full participation. Learn how to use drama as part of the full worship experience. Learn to express God s love for you through motion and acting. Take part in a drama production that is presented at camp. Your musical talents with others who want to bring worship experience to Camp and take this experience back to your local church. Bring your instrument if you want to participate in this workshop and plan on incorporating it into your worship experience. 10. Shout to the Lord (Choir) Your voice brings a blessed worship experience to Camp and back to your local church. 11. Los Ecos (Multi-Media) Be a part of the Camp Newsletter. Get the word out, this is a long Youth Camp tradition. Pictures, short videos, PowerPoint presentation. Learn how you can use multi-media in you local church, retreat, and worship experience. Youth Name/Church:

9 9 - Adults Opportunity to Serve Form July 17-21, 2017 You are The Salt of the Earth and The Light of the World Matthew 5:13-16 The success of Youth Assembly is very much due to the support of the adults that serve each year. Your devotion and commitment along with God s guiding hand are what make the difference in the lives of young people today. All adults come to camp as servants to be used by God to make camp a safe and successful experience. Please mark the opportunities in which you choose to serve during the week and return this form with your registration form. The Dean Team will assign adults to help with the duties below if not enough people signup. Name: Church: Opportunities to Serve (Adults Only) During camp, there will be many opportunities to serve. Thank you for responding. Monday Tuesday Wednesday Thursday Friday Saturday Ring bell for each major activity Night flashlight patrol (monitor camper safety) Concession stand helpers (monitor snack bar traffic) Assist setup & clean up for Senior Farewell (Thurs. lunch) Assist Dean of Men/ Women (dorm patrol) Help with recreation activities (referee, scorekeeper, etc.) Los Ecos newsletter (typing, printing, copying, etc.) Oversee cleaning of dorms on Friday Monitor Point of Silence Monitor Class Attendance (Make sure campers are in class) Assist CCYM with Carnation Sales Oversee the wipe down of tables and chairs in the cafeteria Cafeteria Duty (lead grace, monitor traffic) Assist Prayer Coordinator in activities

10 Sacramento Camp and Conference Center Inc. Adventure Activities: Release of Liability and Indemnity Agreement All PARTICIPANTS/PARENT/GUARDIAN, BY SIGNING HIS/HER NAME AT THE BOTTOM OF THIS RELEASE, AGREES THAT FOR AND IN CONSIDERATION OF THE OPPORTUNITY TO BE AROUND AND/OR PARTICIPATE IN ADVENTURE PROGRAMMING, PROVIDED BY SACRAMENTO CAMP AND CONFERENCE CENTER, INC. (HEREINAFTER CALLED RELEASED PARTY ) HEREBY AGREES TO PAY FOR SUCH PARTICIPATION (IF REQUIRED), AND FURTHER AGREES AS FOLLOWS: (1) THAT RELEASED PARTY, ITS AGENTS, SERVANTS, OR EMPLOYEES, HAVE EXPLAINED TO ME THAT THE RELEASED PARTY S DUTY TO THE PUBLIC REQUIRES THEM TO DESCRIBE THE NATURE OF THIS SERVICE PERFORMED HERE IN PROVIDING ADVENTURE RELATED ACTIVITIES FOR MY USE, THAT I CLEARLY UNDERSTAND THE FAIRNESS AND MEANING OF THIS RELEASE AGREEMENT, & I ACKNOWLEDGE THAT I HAVE BEEN GIVEN AN OPPORTUNITY TO ASK ANY QUESTIONS CONCERNING THIS MATTER; (2) THAT I KNOW & UNDERSTAND THAT THESE ADVENTURE ACTIVITIES, INVOLVES SPECIFIC RISKS OF PROPERTY DAMAGE OR PERSONAL INJURY TO ME OR TO MY MINOR CHILDREN ARISING FROM ACTIVITIES RELATED TO PARTICIPATING IN THESE ADVENTURE PROGRAMS. THIS ALSO INCLUDES THE RISK THAT THE RELEASED PARTY OR ITS SERVANTS, AGENTS OR EMPLOYEES MAY ACT NEGLIGENTLY IN SELECTING, PREPARING OR MAINTAINING THE EQUIPMENT OR PREMISES, IN ASSISTING ME OR MY MINOR CHILDREN TO PARTICIPATE IN, MOUNT, DISMOUNT, LOAD, CLIMB, ETC FROM THE EQUIPMENT, APPARATUS, HORSE OR HORSE-DRAWN VEHICLE, OR IN OTHERWISE SUPERVISING THE ACTIVITIES: BUT THAT I NEVERTHELESS INTENTIONALLY AGREE TO ASSUME THESE RISKS; (3) I, FOR MYSELF AND/OR ON BEHALF OF MY CHILD OR LEGAL WARD, HAVE BEEN FULLY WARNED AND ADVISED BY RELEASED PARTY. THAT WHEN REQUIRED, WE WILL WEAR PROPERLY FITTED SAFETY EQUIPMENT OR CLOTHING SUCH AS CLOSED TOED SHOES, GLOVES, GOGGLE, ETC. OR HELMET IN ORDER TO REDUCE SOME OR ALL OF POTENTIAL INJURIES AS THE RESULT OF A FALL OR ANY OTHER OCCURRENCE ASSOCIATED WITH THIS HAZARDOUS ACTIVITY. WE REALIZE THAT WE ARE SUBJECTTO INJURY FROM THESE ACTIVITIES TO WHICH WE ARE EXPOSING OURSELVES PURELY VOLUNTARILY. (4) I HEREBY DECLARE THAT I OR MY CHILD IS PHYSICALLY FIT. I OR MY CHILD DO NOT, AND HAVE NOT, SUFFERED FROM ANY OF THE FOLLOWING CONDITIONS, WHICH I UNDERSTAND MAY LEAD TO A DANGEROUS SITUATION WITH REGARD TO OTHER PERSONS OR MYSELF DURING ADVENTURE ACTIVITIES: PREGNANCY, EPILEPSY, SEIZURES, (5) SEVERE HEAD INJURY, RECURRENT BLACKOUTS OR GIDDINESS, DISEASE OF THE BRAIN OR NERVOUS SYSTEM, HIGH BLOOD PRESSURE, LUNG OR HEART DISEASE, RECURRENT WEAKNESS OR DISLOCATION OF ANY LIMB, DIABETES, MENTAL ILLNESS, DRUG OR ALCOHOL ADDICTION, RECENT BACK INJURY, ARTHRITIS AND SEVERE JOINT SPRAINS, CHRONIC BRONCHITIS, ASTHMA, RHEUMATIC FEVER, THYROID, ADRENAL OR OTHER GLANDULAR DISORDER, RECENT BLOOD DONATION OR ANY OTHER CONDITION THAT REQUIRES THE REGULAR USE OF DRUGS, I HEREBY DECLARE THAT I HAVE NO PHYSICAL OR MENTAL CONDITION THAT SHOULD PRECLUDE ME FROM PARTICIPATING IN MY CHOSEN ACTIVITY, THAT I AM NOT PARTICIPATING AGAINST MEDICAL ADVICE OR TREATMENT AND THAT I HAVE NOT BEEN DIAGNOSED BY A REGISTERED DOCTOR AS HAVING A TERMINAL ILLNESS. I FURTHER DECLARE THAT IN THE EVENT THAT I FEEL ILL OR UNWELL, HAVE ANY PHYSICAL COMPLAINTS WHATSOEVER OR IF AN INJURY IS SUSTAINED OF ANY KIND DURING THE COURSE OF ADVENTURE ACTIVITIES, I WILL NOTIFY THE FACILITATOR/EMPLOYEE OF THE INSURED IMMEDIATELY AND BEFORE MOVING AWAY FROM THE IMMEDIATE VICINITY. (6) THAT I HEREBY RELEASE AND FOREVER DISCHARGE RELEASED PARTY, ITS AGENTS, SERVANTS OR EMPLOYEES FROM ALL PRESENT AND FUTURE CLAIMS ARISING FROM PERSONAL INJURY OR PROPERTY DAMAGE SUSTAINED BY ME OR BY MY MINOR CHILDREN DURING THE USE OF THE PROPERTY, EQUIPMENT, ATV, HORSE OR HORSE-DRAWN VEHICLE, AND ALL OTHER RELATED EQUIPMENT OF RELEASED PARTY, WHETHER OR NOT LOSS, DAMAGE OR INJURY RESULTED FROM THE NEGLIGENCE OF RELEASED PARTY OR ITS AGENTS, SERVANT OR EMPLOYEES AND RELEASED PARTY S FAILURE TO USE DUE CARE, EITHER IN ITS TRAINING METHODS OR IN ITS FURNISHING SAFE EQUIPMENT, AND I SHALL ASSUME ALL RISKS RELATED TO BEING AROUND OR OBSERVING ACTIVITY PROGRAMMING, SHOOTING SPORTS, ATVS, HORSES, HORSEBACK RIDING OR RIDING HORSE-DRAWN VEHICLES, ETC. (continued on back)

11 Sacramento Camp and Conference Center Inc. Adventure Activities: Release of Liability and Indemnity Agreement (7) THAT I WAIVE MY RIGHT TO FILE AND PROMISE NOT TO FILE ANY LEGAL PROCEEDINGS AGAINST RELEASED PARTY, ITS AGENTS, SERVANTS OR EMPLOYEES, FOR ANY PERSONAL INJURY OR PROPERTY DAMAGE SUSTAINED BY ME OR BY MY MINOR CHILDREN DURING THESE OR ANY ACTIVITY, INCLUDING DAMAGE ARISING OUT OF NEGLIGENCE BY RELEASED PARTY, ITS AGENTS, SERVANTS OR EMPLOYEES; AND I SHALL PAY ALL COSTS AND ATTORNEYS FEES FROM ANY LEGAL PROCEEDINGS WHICH I MAY BRING CONTRARY TO THIS AGREEMENT AND WHICH IS RESOLVED IN FAVOR OF RELEASED PARTY, ITS AGENTS, SERVANTS OR EMPLOYEES; (8) WHERE APPLICABLE I WILL READ ALL RULES AND REGULATIONS POSTED, HANDED OUT, OR VERBALLY EXPLAINED TO ME OR MY CHILD AND ABIDE BY THOSE RULES AND REGULATIONS (9) IF PARTICIPATION IN EQUESTRIAN ACTIVITY: THAT I SIGN THIS RELEASE AGREEMENT FOR AND IN CONSIDERATION OF THE AGREED PRICE, AND I HEREBY REQUEST RELEASED PARTY, ITS AGENTS, SERVANTS OR EMPLOYEES, TO CHOOSE FOR ME OR FOR MY MINOR CHILDREN A HORSE OR HORSE-DRAWN VEHICLE, FOR THE PURPOSE OF BEING AROUND HORSES OR RIDING SAME, KNOWING THAT RELEASED PARTY, ITS AGENTS, SERVANTS, OR EMPLOYEES ARE RELYING UPON THIS RELEASED AGREEMENT AND THE INFORMATION THAT I HAVE GIVEN TO THEM CONCERNING MY EXPERIENCE AND THAT OF MY MINOR CHILDREN WITH HORSES AND HORSE-DRAWN VEHICLES, INCLUDING THE POTENTIAL HAZARDS INVOLVED; WARNING UNDER NEW MEXICO LAW, AN EQUINE ACTIVITY SPONSOR OR AN EQUINE PROFESSIONAL IS NOT LIABLE FOR AN INJURY TO OR THE DEATH OF A PARTICIPANT IN EQUINE ACTIVITIES RESULTING FROM THE INHERENT RISKS OF EQUINE ACTIVITIES, PURSUANT TO NEW MEXICO STATUTES CAMP OUTS, CAMPFIRES, AND ALL HORSE ACTIVITIES (RIDING/WAGON RIDES/EQUINE THERAPY/ROUND PEN DEMOS) ACTIVITY ADDITIONS OR EXCLUSIONS: IF ATV ACTIVITY CHECK LEVEL OF RIDING ABILITY GOOD FAIR POOR IF HORSE RIDING CHECK LEVEL OF RIDING ABILITY GOOD FAIR POOR PRINTED NAME OF PARTICIPANT DATE OF BIRTH _ SIGNATURE OF PARTICIPANT (IF 18 OR OLDER) DATE _ PRINTED NAME OF PARENT OR LEGAL GUARDIAN (IF PARTICIPANT UNDER IS UNDER 18) SIGNATURE OF PARENT DATE OR LEGAL GUARDIAN OF MINOR LISTED ABOVE Please use remainder of this form for listing additional dependent minor children. Printed name and DOB needed on these as well. (10) THAT I HAVE READ THE FOREGOING RELEASE, AND BEING OF SOUND MIND AND AN ADULT, SIGN IT FREELY WITH FULL KNOWLEDGE OF ITS MEANING AND CONTENT. (11) THIS RELEASE FORM COVERS THE FOLLOWING ACTIVITIES ALL ACTIVITIES INCLUDE BUT MAY NOT BE LIMITED TO: ARCHERY, ARCHERY TAG, SLIP N SLIDE, SHOOTING SPORTS (.22 RIFLE, TRAP, SKEET, FIREARM SAFETY, HANDGUN INSTRUCTION, OPEN RANGE, BB GUNS,) KNIFE THROWING, CHALLENGE COURSE (INDOOR/OUTDOOR, ZIP LINE, GIANT SWING, ETC.), PAINTBALL, POCKET SHOT PAINTBALL, LASER TAG, RC CARS/BOATS, FLING THING, ATV RIDING, MOUNTAIN SCOOTERS, PEDAL CARTS, PADDLE BOATS, ROLLER/ICE SKATING, SNOW SLEDDING,(AND OTHER WINTER SPORTS), FISHING, HIKING, SEMINARS, GYM/SPORTS FIELD ACTIVITIES, (Revised 01/23/17)