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Sons

Colorado Trek 2019 Information Binder

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Contact Information

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Participant Contact List

Last Name First Name Cell Email

1) De La Pena Alberto and Stefan (214) 535-4716 alberto.delapena@ymail.com

2) Kulas Jason and William (214) 797-2671 jasonakulas@gmail.com

3) Landry Gary and Alex (469) 358-0505 glandry@pobox.com

4) Lovnander Lars and Lucas (214) 228-7597 lars.lovnander@ericsson.com

5) Monfared Masoud and Arya (469) 855-7575 mmonfared@hksinc.com

6) Shafer Andy and Grant (214) 998-2869 ashafer@halff.com

7) Volpi Mark and Jack (972) 567-0744 mjvolpi@gmail.com

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Capulin Volcano National Monument - 1st Saturday 46 Volcano Road Capulin, NM 88414 (575) 278-2201 MapQuest

latitude longitude

36.778533 -103.979727

Great Sand Dunes National Park 1st Saturday Night Mosca, CO (719) 378-6395

Adventure Experience Camp Sunday - Saturday morning #2 Illinois Creek Almont , CO 81210 (970) 641-4708 http://www.advexp.com/ MapQuest

latitude longitude

38.765219 -106.612291

Owner's: Linda Program Director: Lewie Foltz Program Assistant: Addy

Noah's Ark Whitewater Rafting - 2nd Saturday 23910 US HWY 285 Buena Vista, CO 81211 (719) 395-2158 http://noahsark.com/ MapQuest

latitude longitude

38.765875 -106.096223

AEI camp does all set up and communication with Noah's Ark

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Best Western

Best Western Windsor Inn - 1st Friday Night 1701 S Dumas Ave Dumas, TX 79029 (806) 935-9644 MapQuest

latitude longitude

35.846155 -101.973381

**You will need to make this reservation on your own. There are plenty of other places to stay but we would prefer everyone to stay at the same hotel. Make your reservations as early as possible.

Best Western Alamosa Inn - 1st Saturday Night 2005 Main St Alamosa, CO 81101 (719) 589-2567 MapQuest

latitude longitude

37.470116 -105.88279

**This reservation is made for you by HATS. Best Western Plus- Raton Hotel - Saturday Return Home 473 Clayton Rd Raton, NM 87740 (575) 445-8501 ext. 132 www.bwratonhotel.com MapQuest

latitude longitude

36.884945 -104.434744

**You will need to make this reservation on your own.

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Lunch and Dinner

287 Road House - Friday Dinner in Dumas - 1st Friday Night 1621 S Dumas Ave Dumas, TX 79029 (806) 935-0287 http://www.287roadhouse.net/ Located next door to Best Western Windsor Inn Saturday Lunch - 1st Saturday Lunch You can eat anywhere along you way to Alamosa. San Louis Valley Pizza - Saturday Dinner in Alamosa - 1st Saturday Dinner 2069 First St Alamosa, CO 81101 Main Number: (719) 589-4749 MapQuest

latitude longitude

37.472912 -105.887161

Owner: Randall Cell: (719) 298-0223 Son: Alex Pizza - Delivered to Best Western at 9:45PM - Should be $10 per person including gratuity

14 Pizzas (for 55 people) assorted toppings

6 or 7 Pizzas (for 20 people)

Salad

Tea and Lemonade

Gluten Free option - 10 inch **You will need to order this pizza when you get in town K's Old Fashioned Burgers - Sunday Lunch in Buena Vista - 1st Sunday lunch 223 Highway 24 Buena Vista, CO 81211 (719) 395-8695 MapQuest

latitude longitude

38.853205 -106.167062

You are not required to eat here, but it is highly recommended. They get food out quickly and there is a nice park behind the restaurant to eat lunch and relax AND IT IS DELICIOUS!! Try to eat before noon.

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Schedule &

Itinerary

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Colorado Trek - Itinerary

Friday, July 12 – Leave for Colorado (if this fits in your schedule) Arrive in Dumas - check into

Best Western then eat dinner.

Saturday, July 13 – Leave Dumas (8:00am) to climb Mt. Capulin volcano (this is optional) then

head to Alamosa. Lunch at Sand's Restaurant 12:30PM

Saturday, July 13 – Arrive in Alamosa, check into hotel by 4:45PM then to Great Sand Dunes.

Dinner at 9:45PM at Best Western.

Sunday, July 14 – Drive to AEI camp. Lunch in Gunnison. Arrive at AEI by 3:30PM.

Monday, July 15 – Low Ropes and High ropes course day

Tuesday, July 16 – Rock Climbing and Other Activity

Wednesday, July 17 – Backpacking (3 days)

Thursday, July 18 – Peak Assent

Friday, July 19 – Return to AE camp from backpacking- sauna, and showers!

Saturday, July 20 – White Water Rafting day (ends about 4) & begin drive back to Dallas

Sunday, July 21 – Finish Drive back to Dallas

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HATS COLORADO TREK OVERVIEW (For Mom)

ITINERARY 7/12 – Depart Home for Best Wester** in Dumas 7/13 – Dumas to hike Mt. Capulin, then lunch at Sand’s Restaurant, then check in at Best Western Alamosa Inn, followed by hiking at Great Sand Dunes and finally at Best Western Alamosa Inn 7/14 – Best Western Alamosa Inn to Gunnison for lunch, then on to Adventure Experience Camp (AE Camp) 7/15 – At AE Camp = Low Ropes Course and High Ropes Course 7/16 – At AE Camp = Rock Climb and activity 7/17 – Depart AE Camp for backpacking 7/18 – Peak Ascent 7/19 – Return to AE Camp from backpacking, followed by sauna and showers 7/20 – AE Camp to Noah’s Ark Whitewater Rafting then drive to Best Western Plus Raton** 7/21 – Return Home

LODGINGS

Participant Contact List

July 12 Best Western Windsor Inn 1701 S Dumas Ave Dumas, TX 79029 (806) 935-9644 **This will vary depending on where you make a reservation

July 13 Best Western Alamosa Inn 2005 Main St Alamosa, CO 81101 (719) 589-2567

July 14 - 20 Adventure Experience Camp #2 Illinois Creek Almont, CO 81210 (970) 641-4708

July 20 Best Western Plus Raton 473 Clayton Road Raton, NM 87740 (575) 445-8501 x132 **This will vary depending on where you make a reservation

Last Name First Name Cell Email

1) De La Pena Alberto and Stefan (214) 535-4716 alberto.delapena@ymail.com

2) Kulas Jason and William (214) 797-2671 jasonakulas@gmail.com

3) Landry Gary and Alex (469) 358-0505 glandry@pobox.com

4) Lovnander Lars and Lucas (214) 228-7597 lars.lovnander@ericsson.com

5) Monfared Masoud and Arya (469) 855-7575 mmonfared@hksinc.com

6) Shafer Andy and Grant (214) 998-2869 ashafer@halff.com

7) Volpi Mark and Jack (972) 567-0744 mjvolpi@gmail.com

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CAMP DIRECTOR AGENDA AND NOTES COLORADO TREK 2019

July 12 - 21, 2019

FRIDAY July 12: Suggest to group to travel as far as possible on Friday, arriving in Dumas would be ideal. If you do stay in Dumas, most HATS teams stay at the Best Western. A great place for dinner is 287 RoadHouse, located next door to the Best Western, they can accommodate a large group and the food is good, if you want to eat with the group meet there at 7:00PM! Let everyone know to gas up and make any last minute purchases at the Walmart on Friday night; we will be leaving early Saturday morning.

A number of teams made it to Amarillo or further and arrived in Alamosa on Saturday more refreshed than the Dallas group leaving Saturday at 5:00 AM. This group did arrive in Alamosa by 4:00 PM and had time to check in get into their rooms and were ready for the Great Sand Dunes by 4:45.

EVERYONE PUT A HATS STICKER ON YOUR CAR, THIS REALLY HELPS WITH CARAVANING!

SATURDAY, July 13:

6:00 - 7:30 AM. Breakfast.

8:00 AM. Meet in parking lot, cars should already be packed and ready to go.

Take roll call and a count of how many vehicles there are

Discuss logistics about Mt. Capulin – There are a limited number of

parking spots so get in as few cars as possible, there is a $5 fee per car.

The sooner you get there the better! There is also a parking lot at the

bottom of the mountain where you can leave extra cars. The office is also

located here; you will need to go inside to make payments. Don’t forget

to take a group picture at the top.

Load cars - lose convoy is fine - leave by 8:10

12:30PM. Lunch at Sand's Restaurant in Raton - Handout T-Shirts and Bandannas

1:30 PM. Leave lunch and head to Best Western in Alamosa

4:00 PM. Camp director should arrive in Alamosa to check into room, work with

hotel staff, set up meeting area and oversee welcoming reception in the lobby. Also

call Randall at San Louis Valley Pizza to order pizza and setup delivery to hotel.

5:45 PM. Head back to rooms to gather up day packs, rain gear, flash lights, water,

snacks. Highly recommend long pants and shirts, hats, bandanas, flash light and sun

glasses or SKI GOGGLES! It will get very cool at sun set and if the wind is blowing at

all, it is like a sand blast on arms and legs. We wore tennis shoes (or light hiking

boots) with gaters to keep sand out of shoes and socks. Some of the girls hiked bare

footed on the dunes which worked ok until it got cold

6:30 PM. Arrive at Great Sandunes Nat’l Park at the main parking lot (2nd parking

lot). Car convoying is not necessary and the travel arrangements and arrival times

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varied for the group (late arrivals at hotel needed more time to unpack and repack

for the Dune evening). Take group pictures and head for the dunes. At the

entrance/exit hang some glow sticks on the trees in a bundle so you can see the exit

when it’s dark.

Walk the ridge lines to the top and drop over the edge about 30 feet to get out of

the wind and for best viewing of the sunset. Encourage all to go to the peak as it is a

memorable experience! MAKE SURE YOU FILL UP GAS TANKS ON THE WAY BACK TO

THE BEST WESTERN. THIS WILL SAVE A GREAT DEAL OF TIME ON SUNDAY!!

9:45PM. Arrive back at hotel, chow down on pizza in lobby, clean out sand, go to

bed!

SUNDAY July 14:

6:30 AM – 8:15 AM. Continental Breakfast at the hotel is very good and plenty of

food. Pack up cars. Camp director give check for hotel bill.

8:30 AM. Group meeting.

Play the Name game: Have each Son say what she would like to be when

she grows up and then have dad say what he wanted to be (at age 15)

when he grew up and have him say what he does now.

Talk about the schedule for the day. Explain that if each person is late 5

to 10 minutes for each meeting during the week, we as a group will lose

½ day of our week! To illustrate, hold up a dollar in one hand and a dime

in the other hand. The saying is “A dollar waiting on a dime”! Ask group

which has the most value, a dollar or a dime? How many pennies make

up a dollar? How many pennies make up a dime! Is it fair for 100 to be

waiting on 10? Remember this saying this week and don’t you keep a

dollar waiting on a dime!

Go over map and directions at group meeting. Basically very one needs

to meet in Buna Vista around 11:00 AM.

9:00 AM. Head out in a loose convoy for Cottonwood Pass, stop for lunch along the

way

2:00 PM. Load up and head to AE camp. AE entrance is hard to find. See photo of

house on the left side of the road with wraparound porch. There is a pink flamingo

on mail boxes on the right side on the road, turn right after this line of mail boxes.

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3:30 PM. Arrive AE Camp. Pull up to office parking lot and have everyone gather at

fire ring assembly area.

Assign cabins - if a large group have everyone draw out of a hat

Assign groups - if there are more than 10 teams

DAD AND SONS SIT TOGETHER AT MEALS!

Brief Guides Sunday: We have all been together 5 years / 75 mirror

questions / 30 team building games/ please keep everything positive,

upbeat with bonding in mind NOT the activities.

HATS goal for this week is to strengthen the bonds, not the bodies!

4:00 PM. Admin meet to go over paperwork while teams moves into cabins.

5:50 PM. Meet for dinner at double doors of dining hall.

6:00 PM. Dinner DAD AND SON ALWAYS SIT TOGETHER - DON'T BE SCARED TO CALL

SOMEONE OUT!!!

7:30 PM. Beattitudes in Chapel

8:30 PM Circle up & group name game

Break into backpacking groups (if there are more than 10 teams, if there

are less than 10 teams do all this as 1 group) - Hand out bandanna's HATS

group only (guides receive theirs at the end of the week)

Come up with group name and chant

# system for counting off

Nametag girls (2) there are 2 rolls of duct tape.

Take group picture and video of chant

Small group name game

What will the Son’s main activity be her sophomore year?

What was dad’s main activity his sophomore year?

What high school they went to/go to?

If time - # game 1-10 : go in random orders around the circle and see if

you can count to 10. If two people say the same number at the same

time you start over! You cannot go in a specific order

9:00 PM Dad & Son breakout questions in chapel

What do you want to get out of this week?

What are you scared of?

What are you really excited about doing?

How do we make sure we have our own time together aside from the

group?

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What can we do to make our own time together when we get back

home?

9:20 PM Go to cabin & get ready for bed

MONDAY July 15:

8:00 AM Breakfast

9:00 AM Meet to begin games

9:50 AM Potty break, picture of group

10:00 AM Head to Low Ropes

12:30 PM Lunch – Dad & Son photos on porch

1:45 PM High Ropes

6:00 PM Dinner

After Dinner – duck tape poopie bags for backpacking –

different colors of duck tape

Monday Night Break out Questions

What was the hardest part for us to do together on

the pamper pole?

How did you control your fears during the high

ropes course?

How did I help you/support you throughout the

ropes course day?

What will we remember most about this day in 5 years?

TUESDAY July 16:

6:40 AM Breakfast

7:30 AM Leave for Rock Climbing and activity

1:00 PM Rock Climbers & activity arrive at Trading Post – switch, eat lunch in cars (if

there are two groups)

4:30 PM Back to AE Camp – Rock Climbers start showers

6:00 PM Dinner

7:30 PM Gather gear for Backpacking and spend the rest of the night packing your

backpack and taking showers

8:00 PM Dad's if you need to get backpacking gear from your car let an AEI guide

know and they will bus you to the cars and bus you back.

WEDNESDAY July 17 - FRIDAY July 19

Backpacking!!!!! Don’t forget pictures!

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Return Friday for showers and sauna

5:00-6:00 PM Dad's pickup cars while sons are in the chapel signing bandannas for

the AE guides that helped with your group - all sons sign every bandanna - also do

one for Kipp and Megan - Megan likes to put them on the walls in her office :)

6:00 PM. Dinner - Present tip and bandannas to your guides

7:30-8:30 PM. Yarn Toss in groups - everyone picks a person to toss the yarn to and

tell them about something they did this past week that inspired you/ made you

proud of them ext.

8:30 - 9:00 PM. Everyone circle up and say your Thanks for the week - what were

you thankful for this week.

9:00 - 10:00 PM. Pack your cars and leave at the cabins

SATURDAY July 20:

Breakfast at 8:30, then we head to WHITEWATER RAFT!!!

We recommend paddle boats. The only boats to ever flip in the past were the oar

boats and when you get to paddle it's so much more fun!

Scenic River Tours might say the girls are too young to paddle in the oar rafts. Please

let them know the girls have been whitewater kayaking and are very fit to

whitewater raft. I have talked to them so there should be no problems.

Raft all day finishing around 4:00PM

Most will drive back to Raton and stay at the Best Western.

SUNDAY July 21:

Finish driving Home!!

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Gear Lists

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AEI Base Camp provides most of the necessary wilderness equipment for your trip. You will provide the personal items listed below. Please keep in mind that the weather in Colorado can change rapidly. Rain or snow showers are likely and temperatures can vary from 25 degrees to 80 degrees on any day in May through August. This means that wool and synthetic blends are preferred. Please try to AVOID bringing COTTON clothing. Try to bring “layering” clothes that are wool/synthetic. Synthetic means polyester, polypropylene, polartec, fleece, synchilla, capilene, etc. Storage space is limited so please keep this in mind when packing. You can wear clothing multiple times and/or for multiple days as our environment is dry and on the cooler side. Our Base Camp is around 10,000 ft. in elevation and altitude sickness is a common occurrence. Drink plenty of WATER prior to arriving, as it combats altitude sickness. BRING:

___ 2 Water Bottles (1 Liter Capacity each) ___ Rainwear (jacket with hood/poncho, pants preferred) ___ T-shirts (some can be cotton, at least 1 synthetic) ___ Shorts ___ Long Pants/Insulated Pants (NO JEANS) ___ Long Sleeved Shirt or Wool/Synthetic Sweater ___ Flannel/Sweat Shirt ___ Socks (wool/synthetic, NO COTTON) ___ Underwear ___ Hat/Beanie (wool/synthetic) ___ Sun Hat/Baseball Cap (if backpacking) ___ Athletic Shoes ___ Long Underwear (wool/silk/synthetic, NO COTTON) ___ Mid-Height Hiking Boots (if hiking or backpacking) ___ Rafting Shoes (must have HEEL strap, Chacos, Tevas, etc.) ___ Prescribed Medication in ORIGINAL container/bottle

___ Swimsuit(s) (if rafting, 2 needed) ___ Sunscreen and Chapstick ___ Sunglasses ___ Insect Repellent ___ Bible, notebook, pen/pencil ___ Bandana (if backpacking) ___ Camera (optional) ___ Moleskin/Blister Care (optional) ___ Sleeping Bag (M:15-30 degrees; W:0-20 degrees) ___ Insulated Jacket Mummy Sleeping Bag ___ Stuff Sack for Sleeping Bag ___ Flashlight/Headlamp (extra batteries) ___ Toiletries ___ Towel &/or Washcloth ___ Alarm Clock (optional) ___ Pillow ___ 2-3 Clif Bars/Protein Bars/Luna Bars ___ Portable Charging Device (no outlets in cabins)

DO NOT BRING: Jeans, cell phones, iPods/MP3 players, illegal drugs, over-the-counter medication, marijuana, THC edibles, vapor pens/e-cigarettes, tobacco products of any kind, guns/explosives, weapons/knives, fireworks, blow-dryers, curling irons, electronic games, pets, personal harness/rock climbing equipment, valuables/personal prized possessions WE PROVIDE: Backpacks** Tents** Cooking Stoves/Fuel Compasses/Maps** Water Purification (Filters, etc.)

Cooking/Eating Utensils** First Aid Kits** Sleeping Pads**

**Note: Please feel free to bring PERSONAL items listed above (optional) ADDITIONAL INFO:

Sleeping Bag Rentals $7/night

20 Degree Mummy Sleeping Bags

Camp Store T-Shirts, Hats, etc.

Cash, Checks, Credit Card Accepted

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Colorado Backpacking Trip Equipment List

1. Duffle bag 2. Backpacking sleeping bag (down to zero degrees). 3. Sleeping pad 4. Sleeping bag liner 5. Camping pillow 6. Backpack 7. Backpacking tent 8. Day Pack 9. First Aid kit 10. Toiletries 11. Camera - extra batteries/charger and extra memory cards 12. Knife 13. Insect repellent (one medium-size can or bottle per camper) 14. Sun Screen (both cream and spray) 15. Chap Stick 16. At least 4 Carabiners of various sizes (to clip shoes, water bottles, etc to packs) 17. Snacks (Power Bars/nuts/fruit snacks/trail mix, etc.) 18. Bath towel and wash cloth 19. Moist towelettes and/or diaper wipes 20. Backpacking toilet paper 21. Chap stick 22. Headlamp and small flashlight 23. Two 32-ounce water bottles (Nalgene) 24. Two pairs of convertible pants (Columbia, North Face) 25. Two pairs of wicking material underwear (Under Armour or other brand) 26. Two wicking material short sleeve T-shirts (Under Armour or other brand) 27. Two wicking material long sleeve T-shirts (Under Armour or other brand) 28. One long sleeved over shirt 29. Fleece jacket and/or vest 30. Long underwear 31. Pair of gloves (Plainsman or other brand) 32. Rain gear (with hooded jacket) 33. Mess kit 34. 3-5 HATS T-shirts 35. Hiking boots 36. Camp shoes (water shoes, enclosed-back sports sandals, or athletic shoes) Note: Flip flops and

Crocs are not permitted on White Water rafts 37. 3-4 pairs of wool socks 38. 2-3 pairs of cotton socks 39. 2-3 extra pairs of regular underwear 40. Cap with sun visor 41. Wool cap that goes over ears (HATS cap) 42. At least two extra changes of clothes (for drive in and drive out) 43. Enclosed wrap around sunglasses or sun goggles (to keep out dust while riding ATVs and hiking

in the wind) 44. Crazy Creek or other brand of outdoor camping chair 45. Bungee cords and/or rope (for tying food in trees to prevent access by chipmunks) 46. At least one large garbage bag and one tall kitchen garbage bag with draw strings (to protect

sleeping bag and clothes in backpack)

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47. Used gallon and quart size zip lock bags (to protect various items and to carry out refuse from camp sites)

48. 2-3 extra bandanas

Optional but Highly Recommended

1. Trekking Poles 2. Ear Plugs (to protect against snoring disruptions) 3. Gaiters (to protect legs when hiking) 4. Anti-itch cream 5. Water bladder (at least 3 liters) 6. Reading material 7. Note book and pen/pencil 8. Watch with alarm 9. Pain Reliever (aspirin, etc.)

Optional

1. Water filter 2. Water purification tablets 3. Back Packing stove 4. Instant Coffee

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Maps &

Directions

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Directions and Map

Capuulin Volcano

Interstate 25 is the major north/south route through the state. The monument is located 33 miles east of Interstate 25 at Raton, NM, via US Highway 64/87. The park entrance is on New Mexico Highway 325, 3 miles north of the town of Capulin which is at the junction of NM Hwy 325 and US Hwy 64/87.

From the east, the monument is 58 miles west of Clayton, NM, also via US Hwy64/87.

Great Sand Dunes National Park

To access the main park area, including the Dunes Parking Lot, Visitor Center, and Pinyon Flats Campground, take Highway 150 from the south or County Road 6 from the west. Both are paved highways.

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Cottonwood Pass The road to Cotton Wood Pass is at the main light on Main Street. THE ONLY LIGHT. Hwy 306. It is about a 30 minute drive to the top of the pass. There is a large parking area at the summit.

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Directions to Adventure Experiences Base Camp Taylor Park, Colorado

(970) 641-4708

Coming from the East side of the Continental Divide

(when Cottonwood Pass is open)

From Colorado Springs Airport: I-25 North to the Cimmaron/Hwy 24 exit. On Hwy 24, go West until you "T" at 285. Go left on 285 to Johnson Village and another "T". Go right (N) to Buena Vista, Colorado (North of Salida, South of Leadville) From Denver Airport: Drive West on Pena Blvd to I-70 West. Take I-70 to 470. Take 470 to 285 and 285 West to Buena Vista In Buena Vista You will turn West at the mail intersection (Road 306 toward Cottonwood Pass). Stay on this road, up and over Cottonwood Pass, until it dead ends at Taylor Reservoir (about 1 hour). At Taylor Reservoir Turn right (North) on Co. Rd 742. This road will turn into a gravel road. You will pass Texas Creek. From here you will drive 2.2 miles to Illinois Creek. You will see several mailboxes on your right at Illinois Creek. Turn right at these mailboxes. Follow the signs 1.5 miles up the bumpy, dirt road to the AE Base Camp. The Lupine lodge is the building with the swings on the large front porch.

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Tips &

Tricks

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Colorado Advice From Tom Harrison

Drink water until you think you will get sick….and then drink some more.

Don’t give up regardless of how tired you get.

Rely on your Son.

Make sure there is a John Parrish in the group so they can carry a second backpack with a camper is exhausted and thinks they can’t finish.

Take tons of pictures regardless of how much the girls protest.

Buy the best raingear you can get and pray you don’t need it.

Even though you are tired on the trail up the mountain, make sure you take the time to pick a good ten location and to protect yourselves from rain.

Altitude will change lots of things. Be prepared for somewhat “foggy” thinking.

Do not change course up the mountain. Complete the original plan.

Take a few granola bars for energy.

Take layered clothing, sunglasses, sunscreen, gloves.

Don’t be cheap. Buy GOOD hiking boots. The great deal you got will be forgotten when your feet or your Son’s feet are hurting.

Break the boots in BEFORE you go to CO. Wear them to work. Good advertising for HATS!

Be prepared to laugh, love and maybe even cry a little at the beauty of the surroundings and having your Son all to yourself.

Get wet on the white water rafting and splash the other boats with a vengeance.

Be a kid again.

Disney calls their parks the “Magic Kingdom”…..they can’t hold a candle to spending time with a precious Son. Being with them creates a truly “Magic Kingdom”.

We will be with them in spirit.

Tom

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Paperwork &

Check List

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Colorado Trek Paper Work Check List

Please make sure you have all your paperwork before sending it in

Due June 2 - Paperwork Due June 2 - Full payment of $2400

NAME_____________________________________________________________

HATS Release Form

Adventure Experience Release Form

Dad

Son

AE Camp Registration Form

Health Statement Form

Dad

Son

Health History Form

Dad

Son

Immunization Forms - Son only: MUST BE FILLED OUT ON FORMS

PROVIDED

Noah's Ark Forms

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WAIVER, RELEASE, AND INDEMNITY AGREEMENT

In consideration of my and/or the minor’s participation in any way in any activity (“Activity”) organized or

sponsored by HIGH ADVENTURE TREKS FOR DADS & SONS, INC., a Texas non-profit corporation

(“H*A*T*S”), I, for myself, the minor and each of our respective heirs, executors, legal representatives, successors

and assigns hereby execute this WAIVER, RELEASE AND INDEMNITY AGREEMENT (the “Agreement”):

1. I understand the nature of the Activity and represent that I and the minor are each qualified, in good health

and proper physical and emotional condition to participate in the Activity. If at any time I believe

conditions to be unsafe, I and the minor will immediately discontinue further participation in the Activity.

2. I understand and acknowledge that (a) the Activity involves risks and dangers of SERIOUS BODILY

INJURY, INCLUDING PERMANENT DISABILITY, PARALYSIS AND DEATH, as well as property

damage or loss (“Risks”). These Risks can arise from, among other things, (a) rafting, canoeing,

swimming, bicycling, mountain biking, indoor or outdoor rock climbing, hiking, backpacking, horseback

riding, and other outdoor, athletic, or physical activities; (b) NEGLIGENT use or failure of facilities and

equipment at such activities; (c) the NEGLIGENCE or lack of adequate training of H*A*T*S personnel,

including those who seek to assist with or direct the Activity, rescue operations, or medical or other help

either before or after bodily injuries or property damage have occurred.

3. I and the minor expressly assume all of these Risks. My and the minor’s participation in the Activity is

purely voluntary and we each elect to participate in the Activity in spite of their Risks and the limitations

imposed upon our legal rights by this Agreement.

4. The minor and I hereby voluntarily WAIVE, RELEASE, FOREVER DISCHARGE AND COVENANT

NOT TO SUE H*A*T*S, its officers, directors, agents, employees, representatives, members, volunteers,

successors and assigns, and any other party indemnified and held harmless by H*A*T*S (collectively, the

“Releases”) from any and all liability, claims, loss, demands, actions or rights of action, costs or expenses

(including attorney’s fees and expenses) related to, arising directly or indirectly from or attributable in

whole or in part to the minor’s or my participation in the Activity, INCLUDING but not limited to those

arising from, caused by or alleged to arise from or be caused by the NEGLIGENCE OR GROSS

NEGLIGENCE OF ANY OF THE RELEASEES (collectively, “Claims”).

PLEASE INITIAL ______________________

5. If, despite this Agreement, I, the minor or anyone else on my or the minor’s behalf, makes any Claim

against any Release, I will INDEMNIFY, SAVE, AND HOLD HARMLESS the Release from any and

all expenses, fees, liability or damage award, or cost of any type (including without limitation attorney’s

fees and expenses) which they may incur as the result of such Claim, even if the Claim arises from, is

caused by or is alleged to arise from or be caused by the NEGLIGENCE OR GROSS NEGLIGENCE

OF ANY OF THE RELEASEES.

…………………………………………………………….PLEASE INITIAL ______________________

6. I understand and agree that H*A*T*S shall have no obligation to pay or furnish insurance to pay for any

property damage, medical, dental hospital, or other charges, costs or expenses that I or the minor may

incur. I certify that the minor and I have health, accident and liability insurance to cover any bodily injury

or property damage the minor or I may cause or suffer while participating in this event, or else I agree to

bear the costs of such injury or damage myself.

7. The terms of this Agreement are to be governed by and construed under the laws of the State of Texas,

without regard to its rules regarding choice of laws. I agree that exclusive jurisdiction and venue for any

dispute arising between H*A*T*S and me or the minor involving his Agreement will be in the District

Courts of Dallas County, Texas. Should any term or provision of this Agreement be found to be

unenforceable or void, in whole or in part, the balance of the Agreement shall remain in full force and

effect.

8. I understand and agree that this Agreement is intended to and shall inure to the benefit and protection of

H*A*T*S, its agents, owners, directors, officers, employees, volunteers and any other persons or entities

acting in any capacity on its behalf.

MY SIGNATURE BELOW ACKNOWLEDGES THAT I HAVE HAD SUFFICIENT OPPORTUNITY TO READ

THIS ENTIRE AGREEMENT, THAT I HAVE READ IT, THAT I UNDERSTAND IT SUBSTANTIALLY

AFFECTS MY AND THE MINOR’S LEGAL RIGHTS, AND THAT I AGREE TO BE BOUND BY IT.

Adult participant: ____________________________________ Minor ____________________________________

Signature of adult participant: ___________________________________________ Date _____________________

Address: _______________________________________________________ Phone ________________________

EMERGENCY CONTACT INFORMATION Name:_____________________________________ Relation:___________________ Phone:________________

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Son's Form

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Dad's Form

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PLEASE COMPLETE - DAD

Group Name: Trip Date:

Participant: Date of Birth: Ht.

Address: Gender: Wt.

City: Zip:

Home Phone: Fax/Email:

PLEASE COMPLETE - SON

Group Name: Trip Date:

Participant: Date of Birth: Ht.

Address: Gender: Wt.

City: Zip:

Home Phone: Fax/Email:

In Case of Emergency Notify:

Parent/Guardian/Spouse:

Home Phone: Work Phone:

Home Address:

Work Address:

If not available, notify: Relationship:

Home Phone: Work Phone:

Home Address:

Health Care Information:

Name of Physician: Phone:

Address:

Date of last physical exam: (within the last 24 months for those under 18)

Do you carry family medical/hospital insurance? YES NO

Carrier: Policy or Group #

Do you have any special food needs? (ie: vegetarian)

Please describe:

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Health Statement by Licensed Medical Personnel Dad's From

Participant's Name: Birth Date:

Trip Date:

This program proposed for the above named participant requires participation in activities which are

physically challenging, at "high altitude" (9,000 to 13,000+ feet) and in a remote, wilderness environment.

These factors can cause surges in blood pressure and heart rates as well as other conditions. Therefore, all

participants must be free of medical or physical conditions which might create undue risks to themselves or

others. Your response to these questions will aid in the medical screening and care of the participant.

I have examined the above participant within 12 months of program date. Date of examination:

In my opinion, the above participant IS IS NOT able to participate in the described program.

Description of any limitations or restrictions on program activities:

The participant is under the care of a physician for the following conditions:

Current treatment at the time of this report includes:

Prescribes medications being used by participant:

Over-the-counter medications used by participant:

Any dietary restrictions:

Known allergies or drug reactions:

Signature of Physician or Nurse Practitioner:

Printed Name: Title:

Address:

Phone: Date:

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Health Statement by Licensed Medical Personnel Son's From

Participant's Name: Birth Date:

Trip Date:

This program proposed for the above named participant requires participation in activities which are

physically challenging, at "high altitude" (9,000 to 13,000+ feet) and in a remote, wilderness environment.

These factors can cause surges in blood pressure and heart rates as well as other conditions. Therefore, all

participants must be free of medical or physical conditions which might create undue risks to themselves or

others. Your response to these questions will aid in the medical screening and care of the participant.

I have examined the above participant within 12 months of program date. Date of examination:

In my opinion, the above participant IS IS NOT able to participate in the described program.

Description of any limitations or restrictions on program activities:

The participant is under the care of a physician for the following conditions:

Current treatment at the time of this report includes:

Prescribes medications being used by participant:

Over-the-counter medications used by participant:

Any dietary restrictions:

Known allergies or drug reactions:

Signature of Physician or Nurse Practitioner:

Printed Name: Title:

Address:

Phone: Date:

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AEI Base Camp Health History Form Dad's Form

(Please Print Neatly)

The purposed program provided by Adventure Experience, Inc. requires participation in physical activities which are, by nature, physically demanding.

many of the activities as well as being high altitude will challenge you, both of which can cause surges in blood pressure and heart rates. it is imperative

that you are free of any heart related or other diseases. therefore, all participants must be free of medical or physical conditions which might cause undue

risks to themselves or any others who depend on them. Good physical condition will increase your enjoyment of outdoor activities. As required by the

State of Colorado, participants under the age of 18 must submit a statement confirming a physical examination within the last 24 months by a physician

or nurse practitioner.

Name: Birth Date: Age:

Health History: (Circle the appropriate response and describe any yes answers.)

Have you had or do you currently have any heart problems, i.e, strokes, heart attacks, and/or heart related diseases? YES NO

Do you frequently suffer from pains/pressures in your chest? YES NO

Do you often feel faint of have spells of sever dizziness? YES NO

Has a doctor ever told you that you have high blood pressure? YES NO

Are you a smoker? YES NO (NOTE: If you have had any heart related problems you will need to have a release from a physician in order to participate in any camp activities.)

Do you have arthritis, joint or back problems that might be aggravated by exercise? YES NO

Have you had any operations, serious injuries or illnesses? (dates) YES NO

Do you have any disabilities or communicable diseases? YES NO

Are you allergic to any medications, insects or pollen? YES NO

Are you allergic to any foods? YES NO

Do you have Asthma? YES NO

Do you have Epilepsy? YES NO

Do you have Diabetes? YES NO

Do you have any prescribed meal plan or restrictions? YES NO

Are you currently sick and/or using a medication not listed above? YES NO

List any activities to be limited or prohibited:

Suggestions or health related information for A.E. Personnel:

General Health Statement:

REPRESENTATION AND EMEMRGENCY 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. I hereby give permission to the medical personnel selected by Adventure Experiences, Inc. or its agents to order x-rays, routine tests and

treatments as well as injections and/or surgery for me or my child as named above. Such authorization for emergency treatment shall also include, but

no be limited to, changes incurred for the providing of aid and arranging evacuation if Adventure Experience, Inc. or its agents, determine that such

evacuation in necessary or desirable. i further agree to assume responsibility for the costs of any specialized means of evacuation and of any medical

care and acknowledge that these costs are the financial responsibility of the undersigned. I also understand and agree to abide with the restrictions

placed on my camp activities.

Signature of Participant: Date:

Signature of Parent/Guardian (if under 18): Date:

Witness: Date:

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AEI Base Camp Health History Form Son's Form

(Please Print Neatly)

The purposed program provided by Adventure Experience, Inc. requires participation in physical activities which are, by nature, physically demanding.

many of the activities as well as being high altitude will challenge you, both of which can cause surges in blood pressure and heart rates. it is imperative

that you are free of any heart related or other diseases. therefore, all participants must be free of medical or physical conditions which might cause undue

risks to themselves or any others who depend on them. Good physical condition will increase your enjoyment of outdoor activities. As required by the

State of Colorado, participants under the age of 18 must submit a statement confirming a physical examination within the last 24 months by a physician

or nurse practitioner.

Name: Birth Date: Age:

Health History: (Circle the appropriate response and describe any yes answers.)

Have you had or do you currently have any heart problems, i.e, strokes, heart attacks, and/or heart related diseases? YES NO

Do you frequently suffer from pains/pressures in your chest? YES NO

Do you often feel faint of have spells of sever dizziness? YES NO

Has a doctor ever told you that you have high blood pressure? YES NO

Are you a smoker? YES NO (NOTE: If you have had any heart related problems you will need to have a release from a physician in order to participate in any camp activities.)

Do you have arthritis, joint or back problems that might be aggravated by exercise? YES NO

Have you had any operations, serious injuries or illnesses? (dates) YES NO

Do you have any disabilities or communicable diseases? YES NO

Are you allergic to any medications, insects or pollen? YES NO

Are you allergic to any foods? YES NO

Do you have Asthma? YES NO

Do you have Epilepsy? YES NO

Do you have Diabetes? YES NO

Do you have any prescribed meal plan or restrictions? YES NO

Are you currently sick and/or using a medication not listed above? YES NO

List any activities to be limited or prohibited:

Suggestions or health related information for A.E. Personnel:

General Health Statement:

REPRESENTATION AND EMEMRGENCY 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. I hereby give permission to the medical personnel selected by Adventure Experiences, Inc. or its agents to order x-rays, routine tests and

treatments as well as injections and/or surgery for me or my child as named above. Such authorization for emergency treatment shall also include, but

no be limited to, changes incurred for the providing of aid and arranging evacuation if Adventure Experience, Inc. or its agents, determine that such

evacuation in necessary or desirable. i further agree to assume responsibility for the costs of any specialized means of evacuation and of any medical

care and acknowledge that these costs are the financial responsibility of the undersigned. I also understand and agree to abide with the restrictions

placed on my camp activities.

Signature of Participant: Date:

Signature of Parent/Guardian (if under 18): Date:

Witness: Date:

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