“As a Navigator, I promise to do my best to create a world free of prejudice and ignorance.To treat people of every race, creed, lifestyle and ability with dignity and respect.

To strengthen my body and improve my mind to reach my full potential.To protect our planet and preserve our freedom.”

-NavigatorsUSA Moral Code

A b o u t N a v i g a t o r s U S ANavigators USA is an all gender, secular scouting movement that welcomes all people – children and adults, nomatter what gender, race, lifestyle, ability, religious or lack of religious belief. We believe the greatestchallenge for the future of the planet is to learn how to get along with people different than ourselves.

Our Mission is to help children and their parents spend more time outdoors, getting to know what nature has to offer while getting to know each other. By using unstructured play with curriculum, we promoteinterpersonal skills along with achievement.

Core Navigator USA values are NATURE, INCLUSION, and COMMUNITY and we will participate in group activities that help us learn about, support and grow these values. Activities may include: making new friends, reading about different cultures, cooking and eating foods from different cultures around the world, volunteering in a soup kitchen, writing letters to a pen pal from another part of the world, exercise, outdoor free play, yoga,nature hikes, gardening, recycling, litter clean up, learning about the many other animals we share the planetwith and how to protect and care for them, learning scouting and safety skills, and much more!

Chapter 230 is the first Navigators USA Chapter in Dallas. This fall 18 spots are available for White RockMontessori (WRM) 1 st through 6th graders. We welcome and encourage whole family participation. Pleaseplan to share your time and talents with us – we’re going to have lots of fun!

S c h e d u l eMeetings will take place at WRM in the multi-purpose room on the 2 nd and 4 th Mondays of each month from 3PM to 4:30 PM, beginning on Monday, September 24 th , 2018 and running through Monday, May 6 th , 2019. Wewill not meet on any Mondays that fall on school holidays.

We also plan to offer at least two community service opportunities on Saturdays during the fall semester andsome of these will be open to the entire WRM community. Our first community service opportunity will beparticipating in a Second Saturday Shoreline Spruce Up at White Rock Lake in October.

C o s tChapter dues are $70 per child for the year and include a Navigators USA t-shirt and handbook. Certainactivities (e.g. field trips and other outdoor adventures, building personal first aid kits, and some badges) mayincur additional costs. Chapter 230 families will also be asked to provide meeting snack once per semester.

N a v i g a t o r s U S A , C h a p t e r 2 3 0 � 2 0 1 8 – 2 0 1 9 S c h o o l Ye a r

w w w. n a v i g a t o r s u s a . o r g � c h a p t e r 2 3 0 @ n a v i g a t o r s u s a . o r g

We’re excited to have you join us this year!

Student Name:

Age: Classroom: Date:

Shirt size (included with registration fee). Please circle one:

Youth S Youth M Youth L Youth XL

Annual fee per student is $75.00 which includes shirt and handbook. Certain activites will be an additional fee. Please make checks payable to Navigators USA Chapter 230. Drop off this form tothe front desk at WRM.

Junior Navigator Registration

Chapter No. _______

Date: ________ _

Junior Navigator

_______________________ __________________ _______________________________ First Name Middle Name Last Name ______________________________ __________ _____________ _______ _______ __ Address Apt.# City State Zip Code _________________ ___________________ ___ Date of Birth School Parent/Guardian Information Relationship ___________________________________

__________________________ _________________ _____________________________ First Name Middle Name Last Name __________________________________________________________________________ Address (if different than above) ______________________ _____________________ _____________________________ Home Phone Cell Phone e-mail __________________________________________________________ _______________ Parent/Guardian Signature Date Personal Health History

Allergies: Food,medicines,insects,plants Yes___No___ Explain__________________________________________________ ADHD (Attention Deficit Asthma Y__N__ Convulsions Y__N__ Heart Trouble Y__N__ High blood pressure Y__N__ Hyperactivity Disorder) Y__N__ Cancer Y__N_ _ Diabetes Y__N__ Hemophilia Y__N__ Kidney Disease Y__N__ List any medications to be taken at camp___________________________________________________________________ List any physical or behavior conditions that may affect or limit full participation in swimming, backpacking, hiking long distances, or playing strenuous physical games _____________________________________________________________ List equipment needed such as wheelchair, braces, contact lenses, etc.___________________________________________ Immunizations (give date of last inoculation)

Tetanus toxoid ______________ Pertussis ________________ Mumps ______________ Polio ______________ Diphtheria __________________ Measles ______________ __ Rubella ______________ Name of personal physician or clinic_____________________________________________Telephone_________________ Personal health insurance carrier_______________________________________________Policy No. _________________ Parent Authorization:

This health history is correct so far as I know, and the person herein described has permission to engage in all prescribed activities, except as noted by me. In the event of illness or accident in the course of such activity, I request that measures be instituted without delay as the judgment of medical personal dictates. Signature_____________________________________________________________________ Date _________________ Parent or guardian

Navigators USA, Inc. 56 Bogart Street 4E

Brooklyn, NY 11206

ANNUAL AGREEMENT PLEASE READ THIS ENTIRE DOCUMENT CAREFULLY BEFORE SIGNING

Navigator Members and this Agreement

Navigators USA, Inc., is a not-for-profit organization engaged in outdoor activities including: hiking, camping, rock climbing, biking, canoeing, kayaking, downhill and cross-country skiing, snowboarding, skating, and other activities that require travel (collectively “Activities”). Every member is required to sign this Agreement (“Agreement”) as a pre-condition to participating in Navigator USA Activities.

Acknowledgment of Risk

I recognize and acknowledge that Navigator USA Activities may be inherently dangerous and exceptionally risky and hazardous, and that Activities involve numerous individuals any of whom might cause or create a hazardous condition leading to a member’s injury. I nevertheless voluntarily assume and accept full responsibility and all risk (both known and unknown) for injury to myself (including an injury which leads to my death) and damage or destruction to my personal property while participating in Activities.

Release of Liability

I hereby release the Navigators USA, it’s members, volunteers and paid staff, to the maximum extent permitted by law, in regard to any claim or liability for any injury to me arising out of my participation in Activities, including that which arises either wholly or in part as a result of the negligent acts or omissions, or other misconduct, of one or more Navigator USA officers, members or volunteers. I recognize that there may be rules or practices which others might consider necessary or prudent for safe participation in Activities which have not been adopted by, or which are not enforced by the Navigators USA or one or more officers or members, including those designated as trip leaders or assisting a trip leader. I hereby release the Navigators USA, and the its members, in regard to any claim or liability for any injury to me arising out of or by reason of the failure of the Navigators USA or any member acting in any capacity whatsoever to adopt or to enforce any rule or practice. I recognize that one or more Navigators USA members or volunteers may negligently omit to give me information, or may give me false or misleading information pertaining to the difficulty of Navigators USA Activities or my ability to safely participate in Navigators USA Activities. I affirm that I alone am responsible in each instance for determining whether I can safely participate in Navigators USA Activities, whether I have sufficient skills and physical conditioning, whether I have sufficient and accurate information upon which to base this decision, and whether any equipment and supplies I might use are sufficient and appropriate for the Navigators USA Activities in which I am engaged. I hereby release the Navigators USA, the Navigators USA’s members, and the Navigators USA’s volunteers, in regard to any claim or liability for any injury to me arising out of or by reason of any such acts or omissions.

Covenant Not to Sue

I hereby agree not to sue the Navigators USA, the Navigators USA’s members or the Navigators USA’s Guests, in regard to any claim or liability for any injury to me arising out of my participation in Navigators USA Activities, or for any injury to me arising out of or by reason of the failure of the Navigators USA or any Navigators USA member acting in any capacity whatsoever to adopt or enforce any rule or practice, or for any injury to me arising out of or by reason of any act or omission by the Navigators USA or any Navigators USA member.

Indemnification

I hereby agree to indemnify and hold the Navigators USA and the Navigators USA’s members harmless from and against all claims, penalties and expenses, including reasonable attorney’s fees, arising out of my own acts or omissions in connection with Navigators USA Activities. I also hereby agree to indemnify and hold the Navigators USA and the Navigators USA’s members harmless from and against all claims, penalties and expenses, including reasonable attorney’s fees, arising out of any claim made by any minor child of mine or any minor child who is introduced to the Navigators USA by me. I recognize that minors may not have the capacity to waive rights for claims of negligence or omissions and I take full responsibility for any minor who participates in Navigators USA Activities pursuant to my invitation.

Miscellaneous

The undersigned agrees that in the event that any action were to be commenced arising out of or relating to this Agreement or to Navigators USA Activities, it shall be governed by New York law, and be brought in the courts of the State of New York, in the County of New York, without regard to where the circumstances giving rise to the claim or cause of action may have occurred. This agreement shall be binding on my heirs, legal representatives, successors and assigns. I have read and understand this Agreement, and I acknowledge receipt of a duplicate copy for my permanent reference. This Agreement may be signed in counterparts, all of which taken together shall constitute and be deemed to be one agreement. The facsimile signature of a Navigators USA officer set forth below shall have the same force and effect as an original signature. If any portion of this Agreement should be deemed unlawful or unenforceable, it shall not affect the remaining provisions, which shall continue in full force and effect.

PARENT OR GUARDIAN NAME: CHILD’S NAME:

________________________________________________________ Emergency contact Information

Name:__________________________________________________ (signature) (date)

______________________________________________________________________ Cell: ___________________________________________________ (print name & tel. no.)

______________________________________________________________________ e-mail: _________________________________________________(address)

 

MEDIA CONSENT FORM

By  signing  this  form,  I  hereby  grant  to  Navigators  USA  the  right  to  create  via  photography  or  other  means,  and  the  right  to  reproduce,  display,  and  disseminate   worldwide   and   in   perpetuity,   in   any   tradi>onal   or   electronic  media   format,   such   photographs   or   other   image   of   my   likeness.    Furthermore,  I  grant  Navigators  USA  the  right  to  use  these  images,  in  whole  or   in   part,   for   non-­‐profit   purposes,   or   other   non-­‐commercial   use  without  requiring   Navigators   USA   to   no>fy   me,   seek   my   permission,   or   owe   any  form  of  compensa>on.     I  understand  that  these   images  will  be  used   in  an  appropriate  and  respecEul  manner.    I  confirm  that  these  images  were  taken  with  my  knowledge  and  consent.  

Signature  (if  subject  is  a  minor  include  Guardian  signature,  please)  

______________________________________________________________________________Name  (please,  print  both  names  (minor  and  guardian)  if  applicable)  

Address  

______________________________________________________________________________  Phone  and  e-­‐mail