Kids Summer Expedition Camps! TRAILBLAZERS - Hoodoo · PDF fileKids Summer Expedition Camps!...

Kids SummerExpedition Camps!

250 492 3888www.hoodooadventures.ca

INFORMATION GUIDE

TRAILBLAZERS

2017

Age 10 - 14Camp #1: July 17 - 28

Camp #2: August 14 - 25Monday - Friday

RATES$1349 / child

Early Bird Rate: $1295 / child. Offer ends midnight on April 30, 2017

Expedition Camp



INFORMATION GUIDE

2017

If your child has enjoyed and excelled at our adventure camps in the past, or if they are keen to be outside and challenge their skills, then the Trailblazers program may be just right! Trailblazers is a

brand new program that focuses on all the components of planning an overnight wilderness trip and then going on that trip! A sense of accomplishment is guaranteed!

WHAT IS TRAILBLAZERS?

Camp # 1 - Kayak Exploration

Okanagan Mountain Provincial Park Marine Area

7 days skill developmentOvernight 2 nights, 3 days

Skills:kayak skills, camp skills, survival

skills, trip planning, leadership and more!

PAGE 1

Camp # 2 - Mountaineering Exploration

Cathedral Lakes Provincal Park and Protected Area

7 days skill developmentOvernight 2 nights, 3 days

Skills:hiking and climbing skills, camp

skills, survival skills, trip planning, leadership and more!

July 17 - 28

August 14 - 25



INFORMATION GUIDE

2017

CONTENTS

PAGE 2

Important - Please Read 3Registration 4Where is Hoodoo, Anyways? 4Terms, Conditions and Policies (FAQ) 5, 6 Parent Check List 6Camp # 1 Kayak Camp Schedule 7Camp # 1 Kayak Camp Goals 8Camp # 1 Kayak Camp Gear List 9Camp # 2 Mountaineering Camp Schedule 10Camp # 2 Mountaineering Camp Goals 11Camp # 3 Mountaineering Camp Gearlist 12Youth Waiver and Registration Form (mandatory) 13Youth Medical Form (mandatory) 14-15Allergy / Anaphylaxis Form (only if you child has an allergy) 16

Topic Page #



INFORMATION GUIDE

2017

Welcome to the Trailblazer program!

Parents play a huge role in their child’s success. Parents also play a huge role in helping their child have a successful Summer Expedition Camp, too!

Our adventure camp for Trailblazers, kids ages 10 - 14 years old, is for really keen kids, or kids who have experience in camping, hiking or kayaking (experience is not required, though, we will teach them everything they need to know), and are looking for a real challenge: both physically and mentally - as well as a memorable summer experience!

While we do love getting kids outside, we also respect that this camp may not be for everyone. This camp is the most challenging kids camp we offer, so please be sure that both you and your child understand what it’s about, and that everyone is on board and excited to be a part of it!

This document contains all the information you need to help your child have a great time with us this summer. Please read it very carefully, and if you do have questions, please contact us directly.

Thank you for your interest in the Trailblazer program and we look forward to meeting your Trailblazer!

The Team @ Hoodoo Adventures131 Ellis Street, Penticton BC250 492 [email protected]

SUMMER CAMP SUCCESS!

IMPORTANT INFORMATION - ALL PARENTS PLEASE READ!

RESPECT...

SELF OTHERS

ENVIRONMENT

PAGE 3



INFORMATION GUIDE

2017

ONLINE: www.hoodooadventures.ca/youth-programs - Information & Full Payment OnlyPHONE: 250 492 3888 - Registration & 50% deposit

REGISTRATION POLICY:We require a 50% deposit up front to reserve space, with the remaining balance due 14 days before the camp start date. We can only take full payment online. You are welcome to pay in full up front. If you would prefer to register and pay deposit, you must call us to register. We recommend booking early as our summer camps often fill up very quickly. Very limited space, available on a first come, first serve basis. Early bird special is limited time only.

Upon registration you will receive a confirmation email which will confirm your dates, and basic pro-gram registration information, as well as this document.All parents MUST complete a registration form with waiver and medical form for each child who plans to participate. These forms are available online, and at the end of this document. They must be submitted completed on the first morning of the program at the latest or your child may be denied participation in the program.

*Rates are per child.

REGSITRATION

PAGE 4

HOODOO, WHERE ARE YOU?

PICK UP AND DROP OFF LOCATION FOR ALL CAMPS*

131 Ellis StreetPenticton, BC

Street parking only. Do not use surrounding parking lots unless you are authoirzed to do so. We are not responsible for any parking

violations

*unless otherwise communicated by Hoodoo Adventures.



INFORMATION GUIDE

2017

Please note that although we outline very strict policies, that we will always work with your child to help them find success. If you have questions about the policy and how it affects your Trailblazer, please contact us directly.

Terms and conditions: There is a 48-hour booking blocker on all kids programs. Please call for program availability inside of 48 hours.Refunds may be given before May 31, 2017 less a $150 administration fee. There are no refunds after May 31, 2017.Transfer to another participant is possible, but left at the discretion of Hoodoo Adventures. Please contact us directly if you would like to transfer your spot to another participant. All transfers require 14 days notice.

Cancellations: Our camps run rain or shine. In the event of extreme weather or unsafe conditions, and at the sole discretion of Hoodoo Adventures, we may change the camp location or modify the program in order to assure participant safety. If we need to cancel the program (or a part of the program) for any reason we will be in touch with you directly.

Shuttles:Much of our programming focuses on being outside, and some of it requires transportation to and from different trailheads or other wilderness locations. Transportation is a significant part of our programming. If you are uncomfortable with allowing your child to be transported in our vehicles, then they may be denied participation to the program on days requiring it. We will not extend refunds or credits to participants who refuse transportation at their discretion.Our company employs licensed, class-4 drivers and holds appropriate insurance and licensing permits required to operate our transport vehicles: a mini-van and a 10-passenger bus. Safety is always first and foremost at Hoodoo Adventures: if your child requires a child seat, you are required to provide it at the start of the program. You can find out more informa-tion on car seats here: http://www.icbc.com/road-safety/safer-drivers/Pages/Child-car-seats.aspxCar seats are not required for our 10-passenger bus, but may be a requirement for some children in the mini-van. We will do our best to let you know ahead of time if we may require a car seat for your child.

Medical and Other Considerations: It is the responsibility of each participant (or their parent / legal guardian) to communicate any medical conditions or mental health concerns to Hoodoo Adventures. A completed medical form is a requirement for each participant. In the event that there are concerns, we will be in touch directly to discuss and formulate an individual plan to manage any issues that may arise, such as managing medications, behaviors, etc. If you have not communicated with us in regards to any potential issues, your child may be denied access to the program, or be sent home - especially if the safety and well being of any participant is put at risk, or the participant is found to be unmanageable. This will be at the expense of the participant, and no refunds will be issued. Parents of children who require medication during the trip must provide Hoodoo Adventures with the appropriate medications and documentation / instruction on how to use it.

It is important to note that we are NOT a nut free environment (literally and figuratively).We will accommodate alergies during meal planning for overnight trips.

TERMS, CONDITIONS, AND POLICIES (FAQ)

PAGE 5



INFORMATION GUIDE

2017

Code of Conduct: At Hoodoo Adventures, respect is very important to us: respect of self, of others and of the environment. It is important that all participants feel safe and supported on our trips. We have a zero-tolerance policy for bullying, harassment, or any actions / behaviours that put participants at risk, or interferes with a positive learning environment (including drugs and alcohol). Any participants who are unable or unwilling to follow our code of conduct will be removed from the trip at the discretion of Hoodoo Adventures and at the expense of the participant. No refunds will be issued.

Wilderness Safety: Hoodoo Adventure’s instructors are experienced and passionate about running programs for kids. All of our instructors have extensive training and experience in wilderness travel, wilderness first aid, risk management, and more. Participants must be willing and able to follow directions as given by our instructors, or as stated above, may be removed from the trip at the expense of the participant, with no refunds issued.

Personal Items:Upon registration, and contained within this document, you will have access to a detailed gear list to help you prepare for the camp. It is the responsibility of the participant to bring all the gear required on the list. Hoodoo Adventures will supply all other necessary equipment, such as kayaks and safety equipment affiliated with the specific activity or any other type of specialty equipment. We will, prior to the trip or event, do a detailed check to ensure that all kids are adequately prepared for their adventure.

Hoodoo reserves the right to deny participation to any child who is deemed unprepared to participate, especially if it could interfere with the safety and wellbeing of the child or the group in any way. We will do our best to help supplement equipment, but cannot guarantee that we can provide adequate personal equipment for all participants.

Hoodoo Adventures is not responsible for lost, stolen or damaged personal items throughout the duration of the camp.

TERMS, CONDITIONS, AND POLICIES (FAQ)

PAGE 6

Waiver - Completed for each participantRegistration Form - Completed for each participantMedical Form - Completed for each participantAllergy Form - Completed if any participants have an allergy.Participant Gear List - Does my child have everything on the required list? Remember, we can deny your child’s participation if they aren’t properly prepared!

PARENT CHECK LIST

DROP OFF TIME 8:45-9am

PICK UP TIME 3:00pm

**except for overnight portion

Please be punctual. We have the circus on speed dial for any children left behind at the end of a program. We cannot guarantee that there will be staff present if you drop your kids off too early. If you are going to be late for any reason, please contact us at 250 492 3888



INFORMATION GUIDE

2017

PAGE 7

Camp #1: Kayak Camp Schedule

WEE

K 1

WEE

K 2

MONDAY (Day 1)July 17, 20179am - 3pm

TUESDAY (Day 2)July 18, 20179am - 3pm

WEDNESDAY (Day 3)July 19, 20179am - 3pm

THURSDAY (Day 4)July 20, 20179am - 3pm

FRIDAY (Day 5)July 21, 20179am - 3pm

MONDAY (Day 6)July 25, 20179am - 3pm

WEDNESDAY (Day 8)July 27, 2017Overnight

FRIDAY (Day 10)July 29, 20179am - 3pm

Introductions & icebreaker games and getting to know one another; Assessing participant camp goals, explain program, camp expectations, and setting group goals. Introducing the logbook journal. Packing up kayaks and equipment for introduction to kayaking lesson (boats, equipment, basics, fun, clean up)

Intermediate kayak lesson with focus on advancing day 1 skills and techniques, introducing more advanced skills, and emphasis on rescue techniques and paddling for a distance. Lots of games, with tentative plan to kayak to 3 Mile Beach or 4 Mile Point for lunch and return. Clean up.

Introduction to camping basics: Tents, tarps, knots, gear care, equipment needed to camp and camp-site rules. Will focus on where to set up camp, where to set up kitchen, where to build bear caches and learn about Leave No Trace and Animal Awareness.

Expand on camping basics and go over water and food safety, cooking, nutrition, etc. for the morning, followed in the afternoon by a haf day kayak trip to perfect skills further, play games and get more comfortable in the kayaks.

Trip planning: Bring your gear today - we will check for gear that was missing on Friday’s pack check. Pack group gear, as well as pack group food for the trip. All last minute preparations will take place, as well as last minute questions and answers. Preparing kayaks on trailer for early departure, etc.

Kayak trip start. Meet at Hoodoo at 8am, will load all remaining equipment and kids for shuttle to Indian Rock - will start trip and travel based on itinerary the kids have planned out under the guidance Hoodoo Instructors. Day 1 Overnight.

Day 2 Overnight. We will progress according to the trip plan created by the kids and under guidance of the Hoodoo Instructors.

Day 3 of overnight, home tonight! We will finish our trip at Bertram Creek Park in Kelowna where we will be picked up by the Hoodoo Shuttle and returned to Penticton. Anticipated 6pm finish, but we will contact parents if for some reason we may be late.

Last day of camp! Today is important because we will learn the bulk of following through on tasks by completing trip clean up (washing up gear and disposing of food stuff) - we’ll celebrate the end of the trip with a slideshow and pizza party!

Finishing touches to camp skills including navigation, trip planning, and leadership skills, followed in the afternoon by a haf day kayak trip to perfect skills further, play games and get more comfortable in the kayaks. Please bring all gear for initial pack check so you have the weekend to get things you need.

TUESDAY (Day 7)July 26, 20178am start

THURSDAY (Day 9)July 28, 20176pm finish (approx)



INFORMATION GUIDE

2017

PAGE 8

Camp #1: Kayak Camp - Goals, Expectations and Learning Outcomes

To help kids to foster a sense of achivement, success and confidence through a challenging learning environment.

GOALS

EXPECTATIONSOn the first day of camp, kids will recieve their own logbook, a personal journal to provide not just information, but also to help them to track their progress and to serve as a memento for their experience. Its use isn’t mandatory, but highly recommended as it will enhance their learning outcomes.

LEARNING OUTCOMESParticipants will learn countless hard and soft skills in this program, some of which will include....

Kayak skills: parts of kayaks, equipment, required safety equipment, launching, paddle strokes, self and buddy rescues, etc. Camp skills: Tents, tarps, knots, choosing a camp site, camp chores and priorities, bear caches, Survival skills: navigation, ten essentials, basic first aid skills, Camp cooking: food safety, preparing food, cleaning up and more.

Leadership considerationsGroup managementRisk managementTrip planningContingency planningMeal planningLeave No Trace - wilderness ethicsAnimal awareness

RESPECT...

SELF OTHERS

ENVIRONMENT

Being properly prepared by having everything you need, by dressing appropriately for the weather; managing personal hygiene, staying hydrated and eating well through the trip!

Treating other people well, just how you would like to be treated, with compassion and respect. No bullying, no harrassment, no teasing or insults. Treating the instruc-tors with courtesy, listening and engaging.

Remember that we are a part of the earth and we have a responsibility to treat the earth with respect by not littering or causing damage to it.



INFORMATION GUIDE

2017

PAGE 9

Camp #1: Kayak Camp Gear List

Note: Hoodoo Adventures may be able to help provide some equipment upon request. If you are having trouble finding equipmentplease contact us directly. We can also suggest some alternatives to buying gear, such as an alternative to the dry bag - but keep in mind the dry bag is more effective than an alternative.

Water Bottle - Minimum 1L / ChildLunch & Snacks - The healthier the better! Note: We provide food for overnight portion.Daypack - Large enough for everythingFootwear - Runners or hikers and sandals or water shoes.Weather appropriate* clothing - T-shirts, tank tops, long sleeve shirts, shorts or pants, socks, etc. Extra* clothing - Think sweaters, rain jackets, and a spare change of clothing.Sun Protection - Hat, sunglasses (on lanyards), and sunscreen (min. SPF 30)All kids are required to wear sunprotection, no exceptions.

Towel - A beach towel will do just fine!Bathing Suit

PARTICIPANT GEAR LISTRequired Every Day GearThis is gear that is required regardless of activity. Every. Single. Day. No exceptions.

Extra Water Bottle - Minimum 1L / ChildSleeping Bag - Rated 0 degrees, synthetic preferred.Compression Sack - or stuff sackSleeping Pad - A foam pad will doHeadlamp or Flashlight - In ziplock bagExtra Batteries - for the lightDry Bag - Maximum 20LToiletry Kit - In ziplock or small drybag Toothbrush, Toothpaste, Floss, etc. Hand Sanitizer (small bottle) Bush/Comb/hair elastics, etc. Toilet Paper (1/4 roll in a ziplock) Facecloth Feminine product if required w/ bag or foil to pack out waste. Bug repellantExtra Clothing 3 - 4 pairs of socks 3 shirts 3 shorts 3 undies 1 pair pants 1 sweater 1 rain jacket 1 set PJs / sleeping clothes

PARTICIPANT GEAR LISTRequired Overnight GearThis gear is required for the overnight portion of the trip only, and in addition to the every day gear (less food - which is provided).

Money, electronics (cell phones), and anything you don’t want to break or lose. We’re not replacing it. Please no smelly stuff like deoderants and purfumes on overnight trips to help us manage animals!

WHAT NOT TO BRING, EVER.

Put your name on your belongingsLost something? See our lost and found.

PRO TIPS

Small, waterproof, shockproof cameras welcome at parents

discretion.

Please avoid cotton in favor of synthetic or wool clothing.



INFORMATION GUIDE

2017

PAGE 10

Camp #2: Mountaineering Camp Schedule

WEE

K 1

WEE

K 2

MONDAY (Day 1)August 14, 20179am - 3pm

TUESDAY (Day 2)August 15, 20179am - 3pm

WEDNESDAY (Day 3)August 16, 20179am - 3pm

THURSDAY (Day 4)August 17, 20179am - 3pm

FRIDAY (Day 5)August 18, 20179am - 3pm

MONDAY (Day 6)August 21, 20179am - 3pm

WEDNESDAY (Day 8)August 23, 2017Overnight

FRIDAY (Day 10)August 25, 20179am - 3pm

Camping basics day: Carmi. Tents, tarps, knots, gear care, equipment needed to camp and campsite rules. Will focus on where to set up camp, where to set up kitchen, and where to build bear caches and learn about Leave No Trace and Animal Awareness

Climbing Day: Skaha - We will do a climbing day where we learn about climbing gear, top rope climbing with belaying, climbing technique and other cool things you can do with ropes outside. We will work on navigation basics and leadership.

Trip preparation day: Pack check day (please bring everything) - we will check thoroughly and you have the weekend to pick up anything you are missing. Will focus on meal plans, and finish the day with a hike to the waterfalls at Naramata Creek Park.

All day hike with incorporation of skills into the mix, with focus on practicing current skills and introduc-ing food safety, cooking, nutrition and stove safety. Hiking; Okanagan Mountain Park - full day hike.

Purchasing food based on meal plan and packing all food and group equipment. Creating a complete trip plan with contingency plan and a copy to leave behind. Last minute question and answers, and last minute preparations and securing of personal equipment. Recommended to leave packs at Hoodoo.

Arrive at Hoodoo Adventures. Be prompt as we have a shuttle to meet at Cathedral Lakes and must depart on time from Hoodoo to avoid missing it! Will travel to Cathedral Lakes and shuttle to the provincial park camp site and set up a base camp. Day 1 Overnight

Day 2 overnight - following trip plan created by kids but with help of Hoodoo Instructors. Will put to the test all of the learned camp skills from last week.

Day 3 of overnight. Our shuttle will be departing from the lodge at 1pm, and we will be departing back from the parking lot at 2:30pm. This should have us in Penticton for 5pm. We will contact parents if for any reason we might be delayed.

Last day of trip - super important as this is where the bulk of debriefing and following through lessons will come to an end. Clean up group gear, throw away any food stuff and garbage, etc. Will celebrate with pizza party and slideshow from the trip!

Introductions & icebreaker games and getting to know one another; Assessing participant camp goals, explain program, camp expectations, and setting group goals. Introducing the logbook journal. Loading up the shuttles to Campbell Mountain for an introductory hike.

TUESDAY (Day 7)August 22, 20177am start

THURSDAY (Day 9)August 24, 20175pm finish (approx)



INFORMATION GUIDE

2017

PAGE 11

To help kids to foster a sense of achivement, success and confidence through a challenging learning environment.

GOALS

EXPECTATIONSOn the first day of camp, kids will recieve their own logbook, a personal journal to provide not just information, but also to help them to track their progress and to serve as a memento for their experience. Its use isn’t mandatory, but highly recommended as it will enhance their learning outcomes.

LEARNING OUTCOMESParticipants will learn countless hard and soft skills in this program, some of which will include....

Hiking and climbing skills: How to hike efficently, pace, route finding, climbing equipment & rope techniques, etc.Camp skills: Tents, tarps, knots, choosing a camp site, camp chores and priorities, bear caches, Survival skills: navigation, ten essentials, basic first aid skills, Camp cooking: food safety, preparing food, cleaning up and more.

Leadership considerationsGroup managementRisk managementTrip planningContingency planningMeal planningLeave No Trace - wilderness ethicsAnimal awareness

RESPECT...

SELF OTHERS

ENVIRONMENT

Camp #1: Mountaineering Camp - Goals, Expectations and Learning Outcomes

Being properly prepared by having everything you need, by dressing appropriately for the weather; managing personal hygiene, staying hydrated and eating well through the trip!

Treating other people well, just how you would like to be treated, with compassion and respect. No bullying, no harrassment, no teasing or insults. Treating the instruc-tors with courtesy, listening and engaging.

Remember that we are a part of the earth and we have a responsibility to treat the earth with respect by not littering or causing damage to it.



INFORMATION GUIDE

2017

PAGE 12

Camp #2: Mountaineering Camp Gear List

Note: Hoodoo Adventures may be able to help provide some equipment upon request. If you are having trouble finding equipmentplease contact us directly. We can also suggest some alternatives to buying gear, such as an alternative to the dry bag - but keep in mind the dry bag is more effective than an alternative.

Water Bottle - Minimum 1L / ChildLunch & Snacks - The healthier the better! We provide the food for overnight portionDaypack - Large enough for everythingFootwear - Really good hikers (you’re going to be in them a lot!) Runners for camp.Weather appropriate* clothing - T-shirts, tank tops, long sleeve shirts, shorts or pants, socks, etc. Extra* clothing - Think sweaters, rain jackets, and a spare change of clothing.Sun Protection - Hat, sunglasses (on lanyards), and sunscreen (min. SPF 30)All kids are required to wear sunprotection, no exceptions.

Towel - A beach towel will do just fine!Bathing Suit

PARTICIPANT GEAR LISTRequired Every Day GearThis is gear that is required regardless of activity. Every. Single. Day. No exceptions.

Extra Water Bottle - Minimum 1L / ChildSleeping Bag - Rated 0 degrees, synthetic preferred.Sleeping Pad - A foam pad will doHeadlamp or Flashlight - In ziplock bagExtra Batteries - for the lightBackpack - 35L - 50L (recommended)Toiletry Kit - In ziplock or small drybag Toothbrush, Toothpaste, Floss, etc. Hand Sanitizer (small bottle) Bush/Comb/hair elastics, etc. Toilet Paper (1/4 roll in a ziplock) Facecloth Feminine product if required Bug repellantExtra Clothing 3 - 4 pairs of socks 3 shirts 3 shorts 3 undies 1 pair pants 1 sweater 1 rain jacket & 1 rain pant 1 set PJs / sleeping clothes 1 pair gaiters (recommended)

PARTICIPANT GEAR LISTRequired Overnight GearThis gear is require/ recommended d for the over-night portion of the trip only, and in addition to the every day gear (less food - which is provided).

Money, electronics (cell phones), and any-thing you don’t want to break or lose. We’re not replacing it. Please no smelly stuff like deoderants and purfumes on overnight trips to help us manage animals!

WHAT NOT TO BRING, EVER.

Put your name on your belongingsLost something? See our lost and found.

PRO TIPSSmall, waterproof, shockproof cameras welcome at parents

discretion.

Amateur Athletic Waiver and Release of LiabilityIn consideration of being allowed to participate in any way in the Hoodoo Adventure Company athletic sports program, relatedevents and activities, the undersigned acknowledges, appreciates and agrees that: 1. The risk of injury from the activities involved in this program is significant, including potential for permanent paraly sis and death, and while particular rules, equipment and personal discipline may reduce this risk, the risk of serious injury does exist; and, 2. I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLI GENCE OF THE RELEASES, or others, and assume full responsibility for my participation; and, 3. I willingly agree to comply with the stated and customary terms and conditions for participation. If however I observe any unusual significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the nearest official immediately; and, 4. I for myself and on the behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE AND HOLD HARMLESS, Hoodoo Adventure Company, their officers, officials, agents, and/or employees, other partici pants, sponsoring agencies, sponsors, advertisers, and, if applicable, owners and lessors or premises used to conduct the events (“Releasees”), WITH RESPECT TO ANY INJURY, DISABILITY, DEATH, or loss or damage to person or proper ty, WHETHER CAUSED BY NEGLEGENCE OF THE RELEASEES OR OTHERWISE.

I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHT BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.

FOR PARTICIPANTS UNDER THE AGE OF MAJORITY (UNDER AGE OF 18 AT THE TIME OF REGISTRATION)This is to certify that I, as a parent/guardian with legal responsibility for this participant, do consent and agree to his/her release as provided above of all the Releasees, and for myself, my heirs, assigns, and next of kin, I release and agree to indemnify the Releasees from any and all liabilities incident to my minor child’s involvement or participation in these programs as provided above.

X______________________________ _______________________________ ___________________Parent/Guardian Signature Parent/Guardian Name (please print clearly) Date

X______________________________ _______________________________ ___________________Hoodoo Staff Witness Signature Hoodoo Staff Name (please print clearly) Date

Youth Registration and WaiverPlease print clearly.

CHILD INFORMATION

LAST NAME FIRST NAME MIDDLE NAME/INITIALMALE FEMALE

BIRTHDATE AGE AT PROGRAM HOME PHONE NUMBER POSTAL CODE

PARENT EMAIL ADDRESS for program related correspondences

May we email you about future programming?

May we use photos of this child for marketing?

Yes

Yes

No

No

Emergency contacts Please list contacts in order of who you would like to be contacted FIRST in the event of an emergency

1.LAST NAME FIRST NAME RELATIONSHIP PHONE NUMBER(S)



CUSTODYWho has legal custody and is legally respondsible for this child?

Both Parents

Marital Status of Parents / Guardians

Joint Custody Mother Father Guardian Other (specify)

Married Separated Divorced Single Widowed Common Law Other (specify)

Youth Medical Form 1/2Please print clearly.

LAST NAME FIRST NAME MIDDLE NAME/INITIAL

DOCTOR’S NAME DOCTOR’S PHONE NUMBER

DOES THIS CHILD HAVE ANY LIFE THREATENING ALLERGIES?

Attach additional sheet if needed

Yes (You are required to fill out an anaphylaxis emergency plan.)No

SPECIAL MEDICAL CONSIDERATIONS

HEALTH CARD NUMBER must be provided

Non life-threatening allergies (be specific)

DOES THIS CHILD HAVE ASTHMA? No Yes Degree of severity: Mild Moderate Severe Activity induced

***If your child is required to carry an EpiPen or an inhaler, please provide two non-expired EpiPens or inhalers; one for the child to carry, and one for the instructor to carry***

DOES THIS CHILD HAVE EPILEPSY? Yes Details: Type, triggers, frequency, medications and treatmentsNo

IS THIS CHILD DIABETIC? Yes Details: Type, dietary considerations, medications and treatmentsNo

DOES THIS CHILD HAVE ANY OTHER SPECIAL MEDICAL CONSIDERATIONS? Yes (details)No

DOES THIS CHILD HAVE A CURRENT TETANUS IMMUNIZATION? Yes No Not sure

Attach additional sheet if neededSPECIAL EMOTIONAL CONSIDERATIONSIn the past year, has there been any changes in the family?

Birth Marriage Divorce Separation Death None Other (specify)

Does your child easily make friends with... Younger Older Own age Adults

Is your child... Eager to attend Urged by parent to attend

DOES THIS CHILD HAVE ANY OTHER SPECIAL EMOTIONAL CONSIDERATIONS? Yes (details)No

MEDICATIONS and LIMITATIONS Attach additional sheet if needed

IS THIS CHILD CURRENTLY TAKING ANY MEDICATIONS? Yes (details: drug name, dosage, time given, purpose, etc.)No

LIMITATIONS (details: does your child have any physical, emotional or other limitations that may affect their enjoyment of the program?

I, __________________, do hereby declare that I am the parent or legal guardian of the above participant, and consent that he/she may participate in activities at Hoodoo Adventure Company. I certify that the above information is true and accu-rate, and agree to advise Hoodoo Adventure Company, in writing, of any change to the medical condition of the person listed above. I understand that unless Hoodoo Adventure Company hears from me otherwise, they will assume all medical information is unchanged from the date of this agreement.

Signature of parent/ giardian Full name Date

Youth Medical Form 2/2Please print clearly.


DENTIST / ORTHODONTIST NAME DENTIST / ORTHODONTIST PHONE NUMBER

VegetarianDIETARY RESTRICTIONS

HEALTH CARD NUMBER must be provided

Treatments: Will your child be taking any treatments while at camp?

Information collected here is considered to be confidential and will be shared amongst healthcare providers (such as Emergen-cy Health Care Providers, Walk-In Clinics, etc). This informationwill only be shared with Hoodoo Staff on a strict need-to-know basis to ensure the physical and mental well being of my child. To the best of my knowledge, my child is in good health. I will notify Hoodoo Adventures in writing prior to arrival if there is any change in my child’s health, or if he or she is exposed to any communicable disease within 3 weeks prior to the camp. In the case of a medical emergency, I understand that every effort will be made to contact parents or guardians. In the event that I cannot be reached, I hereby give permission to Hoodoo Adventures to facilitate proper care for my child such as hospital-ization, securing proper treatment, order injection, anesthesia, or surgery for my child as named above. I agree to reimburse Hoodoo Adventures for any prescrptions or medical expenses incurred for this camper. I will submit any changes to this health form in writing to Hoodoo Adventures prior to arrival.


Vegan Lactose Intolerant Gluten Intolerant / Celiac Other:

Yes Details: please explain treatments, purpose, etc. No

HEALTH HISTORY Has your child experienced or is currently experiencing any of the following conditions that may affect their overnight experience?

BedwettingChrons / Colitis / IBSConstipation / DiarrheaDental Braces / Caps / Bridges

Fetal Alcohol SyndromeHerniaHomesicknessKidney Disease

Nightmares / TerrorsSkin ProblemsSleepwalkingTonsillitis

Please explain

Is there any other information / concerns that you would like to discuss with Hoodoo Adventures Staff?

IMPORTANT INFORMATION - PLEASE READ CAREFULLY

Youth Allergy Emergency Plan FormPlease print clearly.


The undersigned patient, parent or guardian authoizes any adult to administer epinephrine to the above named person in the event of an anapylactic reaction. The patient’s physician has recommended the above protocol, or attached an alternative.


DO NOT SUBMIT THIS FORM UNLESS YOUR CHILD HAS A LIFE THREATENING ALLERGY

LIFE THREATENING ALLERGEN Check all that apply.

FOODS Please note that Hoodoo Adventures is NOTa nut-free environment.

INSECT STINGS OR ENVIRONMENTAL

OTHER

HISTORY OF ANAPHYLAXIS

YESNo

last use of medication:

MEDICATION MANAGEMENTDOSE #1

Location

DOSE #2

Location

Expiry Date

Dosage (mg)

EpiPen

Allerject

Other

Expiry Date

Dosage (mg)

EpiPen

Allerject

Other

Signs and Symptoms Emergency Protocol

1. Skin - Hives, swelling (face, lips, tongue), itching, warmth, redness2, Respiratory System - Coughing, wheezing, short-ness of breath, chest pain or tightness, throat tightness, hoarse voice, nasal congestion or hay fever symptoms, trouble swallowing3. Gastrointestinal - nausea, pain or cramps, vomit-ing, diarrhea4. Cardiovascular - paler than normal skin, blue color, weak pulse, passing out, dizziness, lighthead-edness, shock5. Other - anxiety, sense of impending doom, headache, uterine cramps, metallic taste in mouth.

1. Give epinephrine auto-injector at first sign of a known or suspected anaphylactic reaction2. Call 911 and inform dispatcher of situation3. Give a second dose of epinephrine after the first dose if patient does not improve or worsens.4. Get to the nearest hospital (ideally by ambulance) even if symptoms are mild or have stopped. Reac-tion could still come back, especially if you cannot manage triggers, or do not have enough medication. Patients, especially children, should be monitored closely as decided by an emergency physician.5. Call emergency contact person (parent, guardian, etc.) in order given on registration form.

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