Coronado Area Council Summer Camp Forms

Coronado Area Council

Summer Camp Forms

Coronado Area Council, BSA 644 S. Ohio Street, PO Box 912 Salina, KS 67402-0912 785- 827-4461 toll free 866-950-7750 www.coronadoscout.org

Camp Hansen Summer Camp Forms Table of Contents

Camp Hansen Stewards 3 Early Bird Camp T-Shirts Order Form 4 Early Bird Golden Eagle T-Shirts Order Form 5 2020 Reservation Information 6 2020 Reservation Form 7 Registration Payment Form 8 Registration Roster 9 Troop Roster 10 Youth Leaving Early Form 11 /12 CAC Nomination for Campership 13 / 15 Medication Form 16 Cowboy Action Participation & Hold Harmless Agreement 17 Refund Request Form 18 Block Schedule for Merit Badges & Activities 19 Leader’s Record of Scouts’ Schedules 20 ATV Program/Weekend Camping 21

CAMP HANSEN STEWARDS

The Camp Hansen Stewards program is built on the premise of funding programs, equipment and other items deemed necessary to provide a great experience for our camping participants. Donors may give throughout the year attaining different levels. Donor’s names and amounts will be maintained regardless of the amount given.

Levels of Giving: Bronze Level $500 to $1500 Silver Level $1500 to $3000 Gold Level $3000 to $5000 Platinum Level $5000 to $10,000 Scout Executive Level $ 10,000 to …

Name:______

Address:______

City:______State:______Zip Code:______

Donation Amount:$______Check #______

Send to: Camp Hansen c/o Rex Lowe PO Box 122 Kirwin, Kansas 67644

EARLY BIRD CAMP T-SHIRT ORDERS You may pre-order Camp Hansen t-shirts by completing this order form and mailing it to address below. The order must be received by May 1st. Payment must be included with your order.

QUANTITY/T- Quantity/Polo SIZE Price/T- Price/Polo TOTAL Shirt Shirt 10-12 $15.00 N/A 14-16 $15.00 N/A S $15.00 $25.00 M $15.00 $25.00 L $15.00 $25.00 XL $15.00 $25.00 XXL $17.00 $28.00 XXXL $18.00 $30.00 TOTAL

Mail orders to: Rex Lowe Camp Hansen PO Box 122 Kirwin, KS. 67644

EARLY BIRD GOLDEN EAGLE T-SHIRT ORDERS

You may pre-order Golden Eagle t-shirts by completing this order form and mailing it to address below. The order must be received by May 1st. Payment must be included with your order.

Mail orders to: Rex Lowe Camp Hansen PO Box 122 Kirwin, KS 67644

Camp Hansen Summer Camp 2020 Reservation Information

The Troop understands and agrees that:

1. Acceptance of your $260 deposit secures your choice of week at camp. The reservation deposit is NOT REFUNDABLE if the Troop fails to attend Summer Camp.

2. The reservation deposit is an advance on camper fees to aid the council in making purchases prior to camp.

3. Troops must provide proof of accident insurance for their Scouts and leaders (registered and unregistered). The Coronado Area Council has an accident insurance for Coronado Area Council Troops.

4. Two qualified adult leaders, one of whom is at least 21 years of age, will be in attendance with each Troop at all times during the entire period the troop is in camp.

5. While it is possible to request sharing a campsite with a specific troop, both units must so request and make their individual troop reservations at the same time. This does not absolve each troop of their responsibility to provide two-deep leadership.

6. While an attempt is made to honor a Troop’s campsite preference, the camp administration reserves the right to make campsite assignments. All campsites are designed to hold up to 30- 40 campers and are arranged to permit two or more small units at the same time.

7. Camp capacity is 160 Scouts per session.

8. Only BSA registered Boy Scouts/Varsity Scouts may be in camp as a youth camper.

9. Two-man wall tents may be rented on a first-come, first-served basis by contacting the Camp Ranger.

10. The Camp Hansen Adult Leader’s will be available at the February Roundtables and on line at www.coronadoscout.org.

Camp Hansen Summer Camp 2020 Reservation Form

Troop/Crew Town District

Please complete all information requested below. Indicate troop/crew’s preferences for week of attendance (1st, 2nd, and 3rd choices). The $260 deposit must accompany this form in order to secure your session.

WEEK OF ATTENDANCE ESTIMATED ATTENDANCE Circle One June 2-8 Number of Scouts: June 9-15 June 16-22 Number of Leaders:

List four campsites in order of preference.

1. 2. 3. 4.

Troop/Crew Contact:

Name:

Unit Position:

Address:

City: State: Zip:

Phone #: Cell #:

Email:

Payment Information

Date Received: Check #: Coronado Area Council Scouts BSA 644 S. Ohio Street Salina, Kansas 67401-0912 (785) 827-4461 (866) 950-7750

Camp Hansen Summer Camp Registration Payment Form

Council______District ______Troop #______

Unit Leader (Treasurer)______Date Registration______

WEEK OF ATTENDANCE TENT RENTAL FORM Circle One

June 2-8 Request ______tents at $10.00 June 9-15 per tent June 16-22

NOTE: Units will be charged for 2 leaders. This meets BSA Youth Protection requirements.

Number of Fee Total Early Registration Fee Scouts $215.00 In by April 30,2019

Early Registration Fee Leaders $130.00 In by April 30,2019 Regular Registration Fee Scouts $235.00 After April 30,2019 Regular Registration Fee Leaders $150.00 After 30,2019 Per Leader Pre-Registration Fee Minus $260.00

Camperships Minus

Total

! Troop Reservation Fee: The Reservation Fee of $260 is a non-refundable fee if the troop fails to attend camp. This fee will be applied toward leader’s fees only.

! Tent reservations are 2 Scouts or 2 adults per tent. Tent fees will be paid at camp.

! A roster must accompany this registration form to verify information.

! List Scout Names for Camperships / Deadline Sensitive

Registration Roster

Last Name First Name Campership Total Youth

Adults

This roster must accompany your unit registration fees.

Camp Hansen Summer Camp Troop Roster

Troop #______District ______Council______5 Copies Needed Please Print Count this summer’s camp as a year at camp

Scout Rank Years as Years at Golden Eagle Rank Medical Names a Hansen Form camper

Leader Troop Year as Years Golden Phone Medical Names Position a at Eagle Number Form camper Hansen Rank

Camp Hansen Summer Camp Youth Leaving Early Form Page 1 of 2 INSTRUCTIONS: Youth desiring to leave camp prior to the pack’s / troop’s departure or not as a part of the pack/troop must have a release signed by their parent/guardian and approved by the unit leader at camp with the youth. Youth will normally only be permitted to leave accompanied by their parent/guardian. The BSA considers the Scout leader in charge as the in-camp guardian of their youth while they are in camp and release of the youth only with the approval of the Scout leader in charge. The form below must be used in handling all such departures. Turn this form in at the time of registration at Headquarters.

In an emergency, it may not be possible for a parent/guardian to sign the release. In this event, sufficient information must be recorded attesting to the telephone call or means of communication by which word arrived, asking for the release of the youth. This information should document the person from whom the call was received from and give detailed reasons for the requested release.

REQUEST IS MADE THAT

HOME ADDRESS

CITY STATE ___ ZIP

TROOP NUMBER CAMPSITE

BE PERMITTED TO LEAVE BOY SCOUT RESIDENT CAMP FOR THE FOLLOWING REASON:

YOUTH IS TO LEAVE ON: DATE: TIME:

METHOD OF TRAVEL:

ACCOMPANIED BY:

THE YOUTH IS TO RETURN ON: DATE: TIME:

In signing the request for release, BSA and the youth’s parent(s) or guardian(s) mutually acknowledge that upon the youth’s departure from the camp the BSA or its representatives shall not be liable for any loss or injury to the youth’s person or property.

Camp Hansen Summer Camp Youth Leaving Early Form Page 2 of 2

This request is made by:

PARENT/GUARDIAN SIGNATURE DATE

ADDRESS

TELEPHONE NUMBER: (H) ______(C)

UNIT LEADER’S SIGNATURE OF APPROVAL:

ON-SITE REQUEST

Before leaving the camp, youth must check out with their unit leader and the camp headquarters.

APPROVALS:

SIGNED: UNIT LEADER UNIT # DATE

SIGNED: HEADQUARTERS ______DATE

Examples when used: Examples when not used: Scout leaves for baseball game, Field trip for a merit badge class, Birthday, vacation, funeral, or other related Coronado Area Council homesick, injury at camp, etc. trips requiring the Scout to leave camp.

IF YOU KNOW A SCOUT WILL BE LEAVING CAMP EARLY, HAVE THIS FILLED OUT BEFORE YOU ARRIVE.

Camp Hansen Summer Camp Coronado Area Council Nomination for Campership

The following guidelines will apply to all “Nomination for Campership” requests:

1. The unit had to camp at Camp Hansen/Camp Brown the prior year. 2. Only one Scout/youth per application. 3. Adults are not eligible for Coronado Area Council Camperships. 4. Out of Council Scouts or adults are not eligible for Coronado Area Council Camperships. 5. The Coronado Area Council will not consider any request for “Campership” if a Scout plans to attend a second week of Boy Scout Summer Camp (Camp Hansen), an Out of Council camp, or a National or International Scouting event in the same calendar year. 6. Council Camperships – Maximum Request Amount – See Below 7. The “Nomination for Campership” form must be completed in its ENTIRETY. 8. The Scoutmaster or Cubmaster and the Committee Chair must sign the form. Two signatures are required. 9. The Council Camping Committee encourages UNIT LEADERS to review “Nomination for Campership” forms in their entirety prior to mailing. Please be sure all information requested in this form is complete and accurate. The “Nomination for Campership” form must be completed in its ENTIRETY. The more information listed will help committee members.

" Maximum Request Amount – ½ of Early Registration Fee / Boy Scout Resident Camp " Maximum Request Amount – ½ of Early Registration Fee / Cub/Webelos Resident Camp " If Requests are greater than funds, funds will be allocated evenly. " Request Deadline: March 15, 2019//Notification Date: March 31, 2019

Coronado Area Council 2019 Request for Campership: Cub & Boy Scout Resident Camps

Scout/Youth Name: ______Age______Rank______Unit #______

District______#Year(s) registered with Unit______#Year(s) attended camp______

Camp session dates______Amount of Request ______

This nomination is for the current year only. Scoutmaster or Cubmaster, and Committee Chair must sign for this request to be processed. Only original signatures will be accepted—no photocopy signatures please. SIGNATURES: Unit Committee Chair: Approved______Date______Cub/Scoutmaster: Approved______Date______Parent/Guardian: Approved______Date______2019 Request for Camperships / Calculation Section: Total Fee for Cub/Boy Scout Resident Camp…………………………… a)______Total Campership requested (Up to 50% of camp early fee, based on rubric)… b)______What other Scouting event(s) are you planning to attend –(Second week Boy/Cub Scout Resident camp, Out of Council camp, National or International Scouting event) c)______Check the following: Troop must have camped at Camp Hansen in 2018. Scout must not be attending another Scout or High Adventure Camp. Use the Campership Rubric on following page to complete the score levels: Popcorn Sales Camping Troop Other Fund Total Score (1-4) Participation Participation Raising (1-4) (1-4) (1-4)

CONTACT INFORMATION: Parent/Guardian Name: ______

Address: ______

City/State/Zip Code: ______

Phone #: Cell: ______Home: ______

Cub/Scoutmaster Name: ______

Address: ______

City/State/Zip Code: ______

Phone #: Cell: ______Home: ______

E-mail Address: ______

“The “Nomination for Campership” form must be completed in its ENTIRETY. Request Deadline: March 15, 2019//Notification Date: March 31, 2019

Non-Negotiable Requirements to Receive Scholarship Consideration

⃝ Troop must have camped at Camp Hansen the prior year ⃝ Scout must not be attending another Scout or High Adventure Camp

Boy Scout Campership Rubric

Parent / Scout or Pack / Troop Popcorn Sales Camping Participation Troop Meeting Participation Contributions Score Levels • $1001.00 and • Attended 90% to • Attended 90% to 100% Pack / • 100% of the 50% of Camp fee 4 above popcorn 100% of Pack / Troop meetings, service projects, will be provided by the Parent / sold Troop campouts activities, court of honors, etc. Scout or Pack / Troop

• $751.00 – • Attended 51% to • Attended 51% to 89% Pack / • 75% of 50% of the Camp fee will 1000.00 89% of Pack / Troop meetings, service projects, be provided by the Parent / 3 popcorn sold Troop campouts activities, court of honors, etc. Scout or Pack / Troop

• $501.00 - • Attended 26% to • Attended 26% to 50% of Pack / • 50% of the 50% of the Camp $750.00 50% of Pack / Troop meetings, service projects, fee will be provided by the 2 popcorn sold Troop campouts activities, court of honors, etc. Parent / Scout or Pack / Troop

• $250.00 to • Attended 25% or • Attended 25% or less Pack / • 25% or less of the remaining 500.00 of less of Pack / Troop Troop meetings, service projects, Camp fee will be provided by popcorn sold campouts activities, court of honors, etc. the Parent / Scout or Pack / Troop 1

Score of 14 to 16 - awarding of up to 100% of scholarship requested. (Not more than 50% of the camp fees) Score of 9 to 13 - awarding of not more than 75% of scholarship requested Score of 4 to 8 - awarding of not more than 50% of scholarship requested Score of 1 to 3 - awarding not more than 25% of scholarship requested

Awarding of scholarships are dependent on the complete applications and rubrics being turned in by the Troop Scoutmaster. All forms must be completed and signed by the Scoutmaster and Committee Chairman. Any forms without signature will not be considered.

Scholarships will be awarded based on funding availability and on the number of scholarships requested.

Camp Hansen Summer Camp Medication Form

Medication must be in Original Container (One form per medication, copy as needed)

Unit # District Council

Camper’s Name

Name of Parent or Guardian Phone #( )

Doctor’s Name Phone #( )

Medication/Strength

Time(s) of Day Medication Taken

Amount of Medication Taken

Reason for Medication

When was medication started Temporary Permanent

Side Effects (reactions to food, dehydration, stress, iodine, other meds, decreased balance, motor activity, concentration, drowsiness, lethargy, etc)

_____

List other important information about this medication since access to medical information or facilities could be delayed due to geographical area

_____

Special Storage Instructions

Expected action if medicine is not taken as directed

_____

Waiver: This information is confidential and is provided to Name of Leader in Camp

For the express purpose of helping to ensure a healthy, safe camping experience for my child. This form may be shared with medical personnel should the necessity arise.

Signature of Parent/Guardian Date

Camp Hansen Summer Camp Cowboy Action Participation and Hold Harmless Agreement

Camp Hansen, (Dane G. Hansen Scout Ranch, Coronado Area Council) will be conducting a Scout cowboy action shooting program. In this program, Scouts will shoot a rifle, pistol, and shotgun under the supervision of an NRA Range Safety Officer and NRA certified instructors. Scouts will be required to wear eye protection and hearing protection at all times while on the range. Scouts are expected to abide by all safety rules and the instructions of the Range Safety Officer(s) and rifle, pistol, and shotgun instructor(s). I, the undersigned, give my child, , permission to participate in this program. I understand that participation in the activity involves a certain degree of risk. I have carefully considered the risk involved and have given consent for my child to participate in the activity. I understand that participation in the activity is entirely voluntary and requires participants to abide by the rules and standards of conduct. I release the Boy Scouts of America, the local council, the activity coordinators, and all employees, volunteers, related parties, or other organizations associated with the activity from any and all claims or liability arising out of this participation.

For safety, my child and I agree that he/she will do the following or he/she will be removed from the program. I understand that any additional cost associated with participation in this program will not be refunded if my child is removed for not following the rules below: 1. Complete a range safety briefing. 2. Wear all safety gear at all times while on the range. 3. Follow all the safety rules provided in the briefing. 4. Follow the instructions of the Range Safety Officer(s) and rifle, pistol, and shotgun instructor(s). 5. Do not handle the firearms until instructed to do so by the instructor(s). 6. Is 14 years of age, or 13 and has completed the eighth grade, as of the start of the class and will be in full compliance with all local, state, and federal guidelines, including age restrictions and original equipment manufacturer standards. Participant signature Date:

Parent/guardian signature Date:

Parent/guardian printed name

Home phone Cell phone

Email address

Camp Hansen Summer Camp Refund Request Form

This form must be completed in its entirety and be received at Camp Hansen or the Coronado Area Council Office no later than 30 days following the scout’s camping session.

Scoutmaster’s Name: Unit #

Address:

City: State: Zip Code:

Home Phone #( ) Cell Phone #( )

E-Mail:

Scout/Adult Name:

Reason for Scout and/or Adult requesting refund:

Scout/Adult Signature:

Scoutmaster Signature:

Physician Signature:

Coronado Area Council:

Approved: Y___ N___ Denied: Y___ N___

Coronado Area Council Representative’s Signature & Date:

Camp Hansen Summer Camp Block Schedule for Merit Badges and Activities

Scout’s Name Unit #

Time Monday Tuesday Wednesday Thursday Friday

8:30 AM - Block A Block B Block A Open Block B 10:30 AM

10:40 AM - 11:40 AM

12:00 Noon - Lunch Lunch Lunch Lunch Lunch 1:00 PM

1:00 PM - 2:00 PM

2:00 PM - Block C Block D Block C Open Block D 4:00 PM

4:00 PM - 5:00 PM

BLOCK STYLE SCHEDULE

The block style schedule is illustrated above. Four blocks are offered: A block – Monday & Wednesday, 8:30 – 10:30 a.m. B block – Tuesday & Friday, 8:30 – 10:30 a.m. C block – Monday & Wednesday, 2:00 – 4:00 p.m. D block – Tuesday & Friday, 2:00 – 4:00 p.m.

10:40 – 11:40 a.m. and 4:00 – 5:00 p.m. are open each day for additional merit badges in most program areas. Rifle and archery ranges will be open for merit badge students to continue to qualify targets or for other campers to attend open shooting. The pool will be open for swimming at 4:00 p.m.

Camp Hansen Summer Camp Leader’s Record of Scouts’ Schedules

Scout’s Name 8:30 - 10:30 AM 10:40 - 11:40 2:00 to 4:00 PM 4:00 to 5:00 PM AM

Camp Hansen ATV Program/Weekend Camping

Date: Alternate Date #1 Alternate Date #2

Scouts: (14 -15 years of age) Scouts (16 years and older) Leaders

CONTACT INFO: Unit Leader Unit # Phone #’s: Cell# Other: E-mail Address:

REQUIRED DOCUMENTS: BSA Hold Harmless & ASI Hold Harmless Forms Health History REQUIRED CLOTHING: Long sleeve shirt Full length pants Boots

This Reservation is based upon the schedule of Coronado Council ATV Training Staff members. Plan a weekend campout for your unit, and your younger Scouts can practice Scout skills and enjoy the lake.