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 1 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 2 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 3 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 4 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. 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 5 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. 6 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 7 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 8 Registration Roster Last Name First Name Campership Total Youth Adults This roster must accompany your unit registration fees. 9 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 10 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. 11 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. 12 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.