2021 AZMN Royal Rangers Camp Guidebook - Arizona ...
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2021 AZMN Royal Rangers
Camp Guidebook
2021 AZMN ROYAL RANGERS CAMP Dear Leaders, Welcome to AZ Rangers Camp 2021! Last year was a challenging year for those in ministry...event cancellations, government orders and community unrest. But this one thing is still true - God is still in control! He is not on His throne wringing His hands and wondering what to do next. Proverbs 19:21 tells us, “Many are the plans of a man, but it is the purpose of the Lord that will stand.” I believe this event will be a powerful moment in the life of every boy or man who attends. My prayer is for all to have a genuine encounter with God and learn how to be GOD’S WARRIOR! Your role as a leader directly influences those who follow you. As you model Christian behavior daily, the boys you lead will discover what it looks like to have a real relationship with Jesus. Help demonstrate the gospel by the way you model a lifestyle of Christ. I’m sure you realize the weight and responsibility you carry as a leader at Camp. God has positioned you this weekend, to redeem what is lost and call out God’s purpose in the life of each boy. Please come prayed up, mentally focused and physically READY to serve where help is needed. We realize that it’s impossible to prepare for every scenario; however, we can walk confidently and with God’s strength. Please review the 2021 Camp Guidebook. Veteran and rookie leaders alike will benefit from becoming familiar with the information within. Please take the time to note any questions you may have. If you have a question, please email: royalrangers@azag.org We’d been planning for a few years to move to the Network Campground in order to experience a different kind of camp atmosphere. The pandemic made it timely for us to finally do it. We’ll be trying it for a few years and working the kinks out. At the same time the we’ve been strategizing with the Network Men’s Department on how to incorporate a Father / Son event in 2021. SO it turns out we’re trying both at the same time! We’ll be imparting blessing on the boys so make plans now to invite the fathers in your church and attend with your outposts and church family. Bring your pastors, youth and kids leaders and...FATHERS! Most of all come with an expectant heart because God is going to move in the lives of His children. GET READY, Pastor Bill Weaver Arizona Ministry Network Royal Rangers Director
COVID-19 PROTECTIVE MEASURES
As our good governor stated, COVID-19 is not going away. We need to learn to live with it. This is
not in any way diminishing the virus and its seriousness – it’s just a fact of life. The AZMN Royal
Rangers are committed to running an event that does everything possible to ensure the safety of
our district in accordance with the latest recommendations by state and national health experts.
Here are the measures the staff is taking to ensure the best and safest possible result for Camp:
• First off, if you are sick (exhibiting symptoms of COVID-19), or suspect you have been
exposed to anyone that was sick with the virus within 14 days leading up to the camp, DO
NOT ATTEND. If you travelled outside the U.S. within 14 days leading up to the camp, DO
NOT ATTEND.
• To the extent possible, we will practice social distancing while at camp. This includes
waiting lines at events, social gatherings such as meals and services, and any other group
settings.
• Masks should be brought to camp. Since we are outdoors, mask wearing will not be
mandated UNLESS a person is within 6’ of another for any extended period of time. Anyone
5 years or older should have a mask with them at all times, or with their leaders should the
need arise.
• Each outpost is responsible for bringing extra masks and hand sanitizer for their outpost
use. Water and soap should be available for everyone to wash their hands, and hand
washing should be encouraged before meals.
• Campers should cover their mouths when sneezing or coughing, or cough into their elbow.
• Temperatures of every camper attending (forehead scan) will be taken when campers arrive,
and before each service. If someone is found to have a temperature (in accordance with
CDC guidelines), they will be quarantined and control measures taken.
• If someone is found to have a temperature or becomes ill while at camp (COVID-19
symptoms), they should be brought to the medical cabin where they will be quarantined. If
it is a kid, their parents will bring them home immediately, or be called to come and get
them. If a leader or adult becomes ill, they will need to leave immediately. Outposts need to
ensure they have a sufficient number of leaders or adults to tend to their kids should an
adult/leader need to leave.
For more information on the COVID-19 virus and preventive measures, go the AZ Dept. of
Health Services website: WWW.AZDHS.GOV
You will be required to fill out and sign a Covid-19 disclaimer and questionnaire at Check-in in
order to complete registration. (Page 24)
AZMN ROYAL RANGERS STAFF
District Director: Rev. Bill Weaver
District Aide-de-Camp Troy Stone
Outreach Coordinator: Rev. Sergio Custodio
Communication Coordinator: Pete Seilhymer
FCF President: Pete “Fierce Badger” Seilhymer
Training Coordinator: Matt Craft
JLTA Coordinator: Todd Mills
SECTION COORDINATORS
Central Valley Section: Gayle Jarrell
East Central Section: Rev. Dennis Van Gorp
Northwest Section:
Northwest Valley Section: Todd Mills
South Section: Matt Craft
Southeast Section: Larry Adamson
Southeast Valley Section: Rev. Jesse Vela
West Valley Section: Sterling Nuesca
East Section: Ronald Maxemchuk
CAMP STAFF RESPONSIBILITY
District Camp Director Rev. Bill Weaver
District Camp Coordinator Troy Stone
FCF Village Pete “Fierce Badger” Seilhymer
Registration Rev. Rick Casto
Archery Range Safety Officer Todd Mills
Health and Safety Officer
CAMP THEME
God’s Warrior
Exodus 15:3
GRANITE HILLS RETREAT AND CONFERENCE CENTER
https://www.granitehillscamp.org/
The campground has several "dorm" style buildings that sleep 8-12 per room with comfortable bunk
beds including a private bathroom and shower in each room. No food in the dorms!
The camp is at 5,000 feet elevation, and temperatures should be in the low 70’s during the day and
down to the 40’s at night. Also, don’t plan on getting to the camp too early, our reservation starts at
3:00 PM on Friday.
Water is available on site, so bring an empty bottle or thermos. Bottles will be for sale in the snack
bar. Plan on bringing sunscreen and a hat.
There are RV hookups. They are first come, first served. There’s an additional charge to hook up but
not to dry camp, space permitting.
There are no pets allowed at all at the camp. There are no exceptions, so don’t ask and don’t bring
one.
HEALTH AND SAFETY
Health is everyone's responsibility.
1. In the event of high fire danger, No Campfire! Commanders, your supervision is necessary to
insure a safe Camp for your outpost and the total encampment. The safety committee will be
checking.
2. Safety First!! DO NOT throw pinecones, rocks, or any other objects outside of competition
activities. People could get hurt very easily.
3. An emergency care consent form for all children under 18 must be available to the Outpost
Coordinator at all times.
4. If any student needs to take medicine, they must bring a note signed by his parents stating the
name of the medicine and the time it must be taken. The note and medicine must be in the
possession of his Outpost Coordinator in transit or Camp Medical Staff onsite.
5. Use the Adventures in Camping Handbook for guidelines on Fire Craft, Tool Craft, Safety and
Sanitation.
6. No firearms are allowed in the camp other than those used for competition events.
7. If anyone gets hurt, bring him to the Camp Medical Staff with his emergency care consent
form. Anyone injured at the Camp MUST obtain an insurance form from the District Staff or the
Camp Medical Staff. This form must accompany the injured person to the hospital or doctor
for treatment. Failure to follow this procedure will result in YOU paying the cost of treatment.
8. It is REQUIRED that every adult, 18 years of age and older, complete the Medical/Consent form
and turn in a copy at the registration table upon arriving to Camp.
CAMP ELIGIBILITY
For Royal Rangers OUTPOSTS:
rd th
• Camp is open to boys who are in Discovery Rangers (3 -5 grades) through Expedition Rangers
(High School).
nd
• Ranger Kids (K-2 grades) can attend only if their dad is a Commander, AND is attending Camp
with his outpost.
• Every adult 18 and older must have a signed medical/consent form to attend Camp. The form is
included with this booklet.
• Every student under 18 years of age must have a signed medical/consent form to attend Camp.
The form is included with this booklet.
• Copies of ALL Royal Rangers medical/consent forms must be handed in on site when finalizing
the registration process. Original forms should remain with the outpost leaders for use during
camp and when traveling.
• Female Commanders are welcome and will have their own cabin to use together. They will NOT be
permitted in or around any dorm areas.
For FATHERS AND SONS Attending WITHOUT an Outpost:
• Fathers and Sons are welcome as long as they fully comply with the requirements of the staff.
rd th
• Camp is open to boys between 3 -12 grades. THESE BOYS WILL BE PLACED WITH AN
OUTPOST TO BUNK AND COMPETE.
• Camp is open to fathers over 18 years and older. THESE MEN WILL BUNK WITH OTHER MEN IN
ADULT DORMS.
• Every male 18 and older must have a signed medical/consent form to attend Camp. The form is
included with this booklet.
• Every male under 18 years of age must have a signed medical/consent form to attend Camp. The
form is included with this booklet.
• Copies of ALL Royal Rangers medical/consent forms must be handed in on site when finalizing
the registration process. Original forms should remain with the outpost leaders for use during
camp and when traveling.
INSURANCE:
In the event any camper being injured while in attendance, they must obtain an insurance form from
the Camp Medical Staff and notify the District Director before leaving the camp for medical
treatment.
EVENING WORSHIP and CHURCH SERVICE:
Everyone at Camp will be required to attend the Friday and Saturday evening Worship Services and
Sunday Church Service. We owe this to God, our Pastors, and ourselves.EVENTS
Main Rule: As with any Royal Ranger boys participating in any of these events, an adult must be
present for any kids that want to participate. Students will NOT be allowed to do the following
without either an outpost leader or adult directly responsible in attendance: Shoot any weapon
(Archery, etc.), throw knife or hawk, start a fire with flint & steel, or participate in any other physical
events at the camp.
FCF Village: The FCF Village includes blacksmithing, leatherwork, hawk and knife throwing, flint and
steel and several displays. Additionally, there will be a trading post for kids to trade money or items
for cool things.
Archery: An archery range is available for all ages.
Shooting Range: A shooting range will be set up IF safe to do so. BB guns or pellet guns will be
available for all ages. A range safety officer will be present to ensure all safety rules are followed.
All minors must have an adult in attendance.
Knife & Hawk: A full knife and hawk walk is planned for FCF members, and extra blocks will be set
up in the FCF village for anyone that wants to have some fun. Remember, Rangers and all other kids
must have an adult with them.
Flint & Steel: A flint & steel event is planned for all FCF members. Additionally, any kids with adult
supervision are welcome to try their hand at striking a flame! Availability depends on forest service
fire restrictions.
Additional Camp Events: Some other fun games and competitions are planned. Prizes will be
awarded at the Service on Sunday. Ropes Course, Swimming Pool, Climbing Tower and Giant
Swing!
Sectional Events: Each section will bring one event that is set up in the central space designated for
events. If the section wants to track and award prizes for event participation, they may award prizes
during the Sunday morning awards ceremony.
Snack Bar: Snack bar is available most of the camp time, so bring extra money if you want to keep
your energy level up!
District Event/Big E: Given the mixture of participants at Mega Camp, the Big E competition will not
be awarded this year. There will be no campsite judging or district event typically used for the Big E.
IMPORTANT INFORMATION
1. EVENT RESPONSIBILITY: The various Sections will run an event. NOTE: Each section is
responsible to bring the equipment necessary to run their event.
2. All outposts must have their dorms inspected for cleanliness before receiving their patches
and leaving the Camp on Sunday.CAMP SCHEDULE
Friday (No Dinner)
Camp Registration / Snack Bar OPEN 3:00 PM
Fathers and Commanders Meeting (Dining Hall) 6:00 PM
Kids Orientation (Amphitheater) 6:00 PM
Service (Amphitheater) 7:00 PM
Night Games (Optional) 9:00 PM
Back to Dorms 10:00 PM
Lights Out 10:30 PM
Saturday
Wake Up 7:00 AM
Breakfast (DH) 8:00 AM
Morning Assembly (Amphitheater) 9:00 AM
(Wear clothes in preparation for activities, NO uniforms)
Games (Field) / Snack Bar OPEN 9:30 AM
Lunch (DH) 12:00 PM
Events / Pool OPEN 1:00 PM - 4:00 PM
Dinner (DH) 5:00 PM
Service (Amphitheater) 6:30 PM
(Wear FCF Outfits)
Night Games (Optional) 9:00 PM
Back to Dorms 10:00 PM
Lights Out 10:30 PM
Sunday
Wake Up 7:00 AM
Breakfast (DH) 8:00 AM
Service (Amphitheater) 9:00 AM
(RR’s wear Utility Uniforms)
Check Out / Snack Bar OPEN 11:00 AM
Remember: Everyone must be present at all services.WHAT TO EXPECT
1. Commanders, you’ll be assigned a group of campers for whom you are responsible. You’ll eat,
share in recreation, lead group discussion, and attend all activities and services with them.
2. There will be at least one dorm leader (Commander) per room. In the event we have more
dorm leaders than we need, we will assign extra leaders to co-lead a room. TWO is the goal.
Please bring enough Commanders.
3. All dorm leaders will need to help campers get up on time, be on time to all activities, evening
services, and help enforce camp guidelines. Most importantly, show them Jesus in everything
you do.
4. Assist in monitoring the health and well being of students.
5. You will be the key to successful discipline. Your skill in dealing with campers will determine
how well they enjoy and benefit at camp.
6. Take advantage of down times, and know your own physical limitations. A tired or sick leader
doubles the workload for someone else.
7. Maintain your daily time with God! You can’t give what you don’t have.
8. Record spiritual growth of students prior to departure.
9. Assist in the upkeep of the campgrounds.
10. Oversee the cleaning of your specified area before departure from camp. Remain at your dorm
until Camp Coordinator (Aide-de-Camp) or Camp Staff has checked your dorm.
WHAT TO BRING
• Bible, Notebook and Pen • Shower Shoes • Modest Swimwear • Water Bottle
• Bedding (pillow, sheets, blanket, or sleeping bag) • Plastic Bag for wet/dirty clothes
• Bath Towel, Washcloth, and Towel for water games • Medicines (See policy, Pages 6 and 13)
• Toiletries: Soap, Shampoo, Deodorant, Toothbrush/paste, Etc.
• Camp Guidebook
• Outdoor Athletic Wear for team competitions
• Modest, Appropriate Clothes for Services
• Warm Jacket/Hoodie/Sweater for the cool evenings
• Sunscreen/Hat • Flashlight • Camera
WHAT NOT TO BRING
• Gum (mints are good)
• Pets
• Weapons (this includes fireworks)
• TV’s, Video Game Players
• Illegal drugs. If we find drugs, we will call the Sheriff. If a camper turns himself or herself in, we
will contact pastor, and parents will hold camper accountable.ROLES & RESPONSIBILITIES
1. Be familiar with the Camp Guidebook. Follow all guidelines.
2. Dorm Leaders (Commanders) may NOT leave the campgrounds at anytime unless given
permission by Camp Director or Camp Coordinator (Aide-de-Camp).
3. Get acquainted immediately with each camper in your dorm. Learn names!
4. Know where your students are at all times.
5. Attend scheduled meetings with Camp Director and/or Camp Coordinator.
6. Be responsible to see that you and your campers attend every activity on time.
7. Monitor the dress of your campers. You may be asked to have your camper change into more
appropriate clothing.
8. Deal with minor disciplinary problems as related to camp guidelines. Major infractions of the
guidelines are to be reported to the Camp Coordinator.
9. After Lights Out, all Dorm Leaders should remain in their assigned dorm. All Dorm Leaders
must abide by the curfew set by the Camp Coordinator.
10. Be available to pray with campers at the altars during the evening services.
11. Report any dorm problem (i.e. plumbing, toilet paper etc.) to the Camp Coordinator.
DRESS CODE
• All dress will be modest and appropriate for camp
• No offensive t-shirts
• Shorts must be at least mid-thigh length
• Shoes must be worn at all times. No sandals & flip-flops during games
• Camp Coordinator and leadership will be the final authority on the dress code
CELL PHONES
We leave it up the leader from each church to make a decision if they will allow students to bring cell
phones to camp. However, we will only allow students to use their cell phone during meal times. All
other times their phones must be put away. If a parent sends a cell phone to camp, the student will
be allowed to call home during meal times or right before bedtime and the student must be with their
dorm leader or leader from their church and away from other campers most likely at the Camp
Office.STUDENT GUIDELINES
1. Respect your Commander, father and leaders at all times.
2. Conduct yourself as a responsible person at all times.
3. Must attend all services and required activities.
4. All medication must go to camp nurse.
5. Help keep the campgrounds clean. Throw trash in trashcans.
6. No food or soda in Dorms, Worship Center, or The Zone.
7. No horseplay, pranks, or throwing rocks.
8. No skateboarding at anytime unless at the skate park.
9. Stay off the rocks at night.
10. Wear sunscreen, and stay hydrated (drink LOTS of water).
11. No boys in men’s dorms. No men in boy’s dorms. No women in ANY DORMS! Campers are not
to be in dorm rooms that are not their own. Dorms are off limits when activities are planned.
12. Camper or church will be financially responsible for repairs to any damage caused to
campgrounds (i.e. broken windows, holes in walls).
13. No leaving camp boundaries or campgrounds, and absolutely no sneaking out at night. If you
do, we will immediately call your parents and have you dismissed.
KITCHEN CLEANUP
THINGS TO DO:
• Throw away all trash
• Wipe down tables
• Empty trash cans
• Check with Food Coordinator to see what help she needs in the kitchen
DORM CHECK OUT INSPECTION LIST
• All luggage needs to be out of the dorms by 11:00 AM
• Clean commode, shower, sink and mirror
• Sweep floor, mop and empty trash
• Leave shower curtain closed so water can drain off
• Put mattress covers on each mattress, if soiled, place in front of room
• Leave bathroom door open
• Close all windows, turn off lights and lock the door
• Any articles left in the room should be brought to office
• Have your area checked by the Camp Coordinator…Thank you for your help keeping Camp clean!MEDICATION All medication of campers or Dorm Leaders must be turned into the Camp Medical Staff. No Exceptions! The Camp Medical Staff will administer all medication, however, it is the student and Dorm Leaders responsibility to have the student to the medical staff at the time the medicine is to be administered. It is the student and Dorm Leader’s responsibility to pick up the prescription(s), the last day of camp. If the prescription(s) are not claimed by the close of each camp, it will be discarded. No medication should be in the dorm rooms at any time where students have access to them. As a leader, you can keep your medication if you can put it in suitcase that can be locked or lock the medicine in your car. All medications should be: • In its original container • Clearly labeled with the camper’s name • Have the name of the prescribing physician • Have the date prescribed and the prescription number HEAD LICE POLICY Every student MUST be examined for head lice prior to camp. It is the responsibility of the OUTPOST COMMANDER to make sure their students are Lice-Free prior to arriving at the camp. (See Page 27) We reserve the right to perform a head check upon arrival at camp. If lice is found, and depending on the severity of the case, campers may be sent home. If the case is not as severe and is isolated, then we will ask a leader from the church the camper is with to treat the camper. If a camper must be sent home, it will be at the expense to the parent and/or church.
Rangers Director Rangers
Rangers Director
3. Bill Weaver
Rangers Director
Rangers DirectorREGISTRATION INFORMATION
REGISTRATION: Everyone MUST register on-line. On-line registration can be
completed by going to the District website and clicking on the Events tab, then finding
the link to register on-line. On-line registration will require a credit card.
You must have the following items when checking in at Camp:
• A list of students by Outpost Age Group. (Held by Outpost Senior Coordinator)
• A properly signed medical/consent form for each student under age 18. NO
EXCEPTIONS. (Held by Outpost Senior Coordinator)
• A signed copy of the medical/consent form for each adult 18 years of age and
older (Left at the Registration Table)
• A signed and completed Covid-19 Disclaimer and Questionnaire.
• A signed and completed Lice Check form.
1. Please be accurate on your pre-registration. No refunds can be made at the
camp. The staff will make every effort to connect overpayments by outposts
with other outposts needing to pay for extra campers.
2. Please understand that the registration fee covers insurance, all awards,
speakers, camp patches, camp rental, food, and other necessary costs.
THERE WILL BE NO ONSITE REGISTRATION.
3. Pre-registration allows District Staff to make accurate planning in details.
Pre-registration is done by registering on-line or by completing the
registration form in the camp guidebook.
4. MAKE CHECKS PAYABLE TO “AZ MINISTRY NETWORK”
Remember, every camper’s temperature will be checked when arriving at camp.
Bring a Pastor, Church
Leader or Friend!2021 CAMP REGISTRATION FORM
Church Name _________________________________ Outpost No. ______________
Church Address __________________________________________________________
City: _______________________________ State: _________ Zip: ________________
Royal Rangers Number @ $79 for each camper
Discovery Rangers
Adventure Rangers
Expedition Rangers
Commanders
Adult NOT a leader (parents,
pastors, etc.)
Students NOT in a RR Outpost
Totals:
Attach a single check written to
“Arizona Ministry Network”
Mail by Apr 23rd, 2021 to receive by Apr 26th.
Mail to:
AZMN Royal Rangers
PO Box 227, Queen Creek, AZ 85142
ONLY COMPLETE THIS FORM IF YOU ARE NOT REGISTERING ON-LINE.2021 Camp Medical/Consent Form - ADULTS
Adult (18+) Pastor’s Certification for Church Worker: I am personally acquainted with the adult
applicant, and in my opinion they are competent and qualified youth worker. I know of no facts or
allegations that raise and questions concerning their suitability for working with minors in any Royal
Rangers activity. The church has on file the applicant’s workers screening form.
____________________________________________________________ Pastors Signature/Date
ADULT APPLICANT’S SIGNATURE: My signature acknowledge that I have truthfully abided by the
requirements as stated on this application form. My signature verifies I am 18 or older, and I have
received my Pastors signature as required. My signature also indicates my permission for
emergency treatment should the need arise while at Mega Camp. I agree to abide by and cooperate
with all policies, commanders and fellow campers. I agree to abide by the camp rules.
___________________________________________________________ Applicant Signature/Date
Health History
Check either Yes or No. If Yes is checked please explain under "Remarks and Medical Facts"
Sinus Condition YES NO Shortness of Breath YES NO Hepatitis past 6 mos. YES NO
Ear Problem YES NO Skin Infection YES NO Any disorder preventing YES NO
strenuous activity?
Lung Problem YES NO Hearing Difficulty YES NO
Heart Trouble YES NO Bad Eyesight YES NO Taking prescription YES NO
medications?
High Blood Pressure YES NO Wear Eyeglasses YES NO
Allergy/Asthma YES NO Wear Contacts YES NO Any reaction to drugs or YES NO
medicine of any kind?
Fainting or Dizzy Spells YES NO Any Medical Care within YES NO
past year?
Diabetes YES NO Homesick easily? YES NO
Appendix removed YES NO Special diet required? YES NO Sleep walker? YES NO
Any surgeries within YES NO Exposed to infections YES NO Nervous or upset easily? YES NO
past year?
Dental Appliances YES NO Disease past 3 weeks YES NOFood or Drug Allergies:___________________________________________________________________
Current Medications:_____________________________________________________________________
Remarks and Medical Facts:_______________________________________________________________
Give latest date of inoculation or vaccination against the following:
Tetanus____/____/____ Small Pox____/____/____ Measles ____/____/____ Typhoid ____/____/____
Diphtheria____/____/____ Polio ____/____/____
Birthdate: ____/____/____2021 Camp Medical/Consent Form - MINOR (FRONT)
Print Complete Name of minor:______________________________________________________________________
Parent/Legal Guardian Consent: The signature of a parent or legal/Consent guardian is required for a minor (under the
age of 18) to attend 2020 Mega Camp. The parent or guardian signature below indicates permission to administer
medical attention to the minor in the event of an emergency, permission to the physician selected by the Camp
Commander (or delegate) to hospitalize and secure proper treatment (including surgery). It is understood that the camp’s
official makes a conscientious effort to locate emergency contacts listed on this form. I/we will fully pay for the medical
expenses incurred. If injury occurs at camp, it MUST be reported.
Parent/Legal Guardian Signature:_____________________________________________ Date:__________________
Shooting Events Permission: I give my child permission to participate in accuracy events, including rifle and BB gun
shooting and archery. I understand all such events are conducted under the direct control of qualified range safety
officers. I will hold harmless any and all leaders and officers of any unforeseen accidents, even though great care for
safety is always taken.
Parent/Legal Guardian Signature:____________________________________________ Date:____________________
List any activities you do NOT want your child participating in:
_______________________________________________________________________________________________
Health History
Check either Yes or No. If Yes is checked please explain under "Remarks and Medical Facts"
Sinus Condition YES NO Shortness of Breath YES NO Hepatitis past 6 mos. YES NO
Ear Problem YES NO Skin Infection YES NO
Any disorder preventing
YES NO
strenuous activity?
Lung Problem YES NO Hearing Difficulty YES NO
Heart Trouble YES NO Bad Eyesight YES NO
Taking prescription
YES NO
medications?
High Blood Pressure YES NO Wear Eyeglasses YES NO
Allergy/Asthma YES NO Wear Contacts YES NO
Any reaction to drugs or
YES NO
medicine of any kind?
Fainting or Dizzy Spells YES NO
Any Medical Care within
YES NO
past year?
Diabetes YES NO Homesick easily? YES NO
Appendix removed YES NO Special diet required? YES NO Sleep walker? YES NO
Any surgeries within past
YES NO Nervous or upset easily? YES NO
year? Exposed to infections
YES NO
disease past 3 weeks
Dental Appliances YES NOFood or Drug Allergies:_____________________________________________________________________________ Current Medications:_______________________________________________________________________________ Remarks and Medical Facts:________________________________________________________________________ Give latest date of inoculation or vaccination against the following: Tetanus____/____/____ Small Pox____/____/____ Measles ____/____/____ Typhoid ____/____/____ Diphtheria____/____/____ Polio ____/____/____ TURN OVER AND SIGN BACK OF FORM
2021 Camp Medical/Consent Form - MINOR (BACK) Print Complete Name of minor:________________________________________________________ Name of Parent/Guardian completing form:______________________________________________ Address:_________________________________________________________________________ City/State/Zip:_____________________________________________________________________ Home Phone: (_____) ____________________ Work Phone: (_____) ________________________ Cell Phone: (_____) ______________________ Age and birthdate of minor: _______________ years old Born: ______/______/______ Insurance Information: ______________________________________________________________ Physician Name and Phone Number: __________________________________________________ Additional information that we should know: ______________________________________________________________________________________ __________________________________________________________________________ ______________________________________________________________________________________ __________________________________________________________________________ All minors must have a copy of this completed/signed MEDICAL/PERMISSION FORM with them when traveling to the event. A copy must also be sent in with their registration form or turned in upon arrival at camp. Additional Remarks: ___________________________________________________________________________ Parent/Legal Guardian Consent & Model Release: (required for all applicant under the age of 18 years of age) I, the undersigned, as parent or legal guardian of the above named minor do hereby consent to his participation in this event and authorize the use of emergency medical care at the discretion of the adult event leadership. I further acknowledge my understanding that media footage, including audio, video and photos, may be recorded at this event for future promotional use and hereby consent to the of such items containing images of my child in any form and relinquish all rights or ownership or compensation. It is further understood that acceptance of these terms is a condition of my child’s participation at this event. __________________________________________ ___________________________________________ Parent/Guardian’s Name (print) Parent/Guardian’s Signature __________________________________________ ___________________________________________ Parent/Guardian’s phone number Parent/Guardian’s address Applicant’s Signature: (Required for all minor applicants) I, the undersigned, hereby acknowledge that to the best of my knowledge, I qualify for participation in this event and do hereby agree to abide by the rules and standards established for this event by its appointed leadership. I acknowledge that the information provided on my Personal Medical Record is true and correct and I consent to the administration of emergency medical treatment at the discretion of the event leadership. I further acknowledge my understanding that media footage, including audio, video and photos, may be recorded at this event for future promotional use and hereby consent to the use of such items containing images of me in any form and relinquish all rights or ownership or compensation. __________________________________________ ___________________________________________ Applicant’s Name (print) Applicant’s Signature
COVID-19 DISCLAIMER AND QUESTIONNAIRE
Father/Outpost Coordinator must complete this form before check-in at Camp.
By attending AZMN Royal Rangers Camp, I voluntarily assume all risks for myself or
church group related to exposure to COVID-19.
Each church group must be temperature checked upon arrival to camp. Individuals
with temperatures 100 and above will not be allowed to enter, nor will anyone in their
group. I understand that if anyone from our group develops symptoms of COVID-19
while at camp, they will be evaluated by the medical team and may be asked to leave
camp at the discretion of the Camp Medical Staff. I understand that if a camper or
leader should be sent home or isolated due to a failed screening, this will be at the
expense of the parent and/or church.
According to the Centers for Disease Control and Prevention, AZMN Royal Rangers
Camp is categorized as highest risk. Highest Risk is defined by the CDC as: Campers
mix between groups and do not remain spaced apart. Although we will limit exposure
by assigning dorms, seating, and teams based on local geographic areas, campers
may be unintentionally exposed to other campers from other local geographic areas
(e.g., community, town, city, or county).
I understand that if any participant in my group answers yes to any of the below
questions, they will be prohibited from attending camp.
1. Has any participant personally been tested positive for COVID-19 or had contact
with someone who tested positive for COVID-19 in the past 14 days?
YES NO
2. Has any participant traveled to any of these locations in the past 14 days? - China,
Iran, South Korea, Italy, Japan, California, New York, Florida, Texas?
YES NO
3. Has any participant had any of these symptoms in the past 14 days? - Fever greater
than 100 (unmediated), Difficulty breathing, Cough, Shortness of Breath, Chills,
Muscle Pain, Sore Throat, New Loss of Taste or Smell.
YES NO
Due to the nature of camp, social distancing practices WILL be in effect but have the
potential to be compromised. I understand and agree to allow my students to
participate in activities that may compromise social distancing. I also understand that
students and leaders will NOT be required to wear a mask.I release AZ Ministry Network from all liability associated with the risks listed above. By signing below, I agree to the assumed risks and confirm that I have checked each participant in my group for viral symptoms. Everyone in my group did not answer yes to any of the above questions. Pastor/Designated Camp Coordinator Name: _____________________________________________ Church Name: _______________________________________ Church City: _____________________ Outpost: ___________ Pastor/Designated Camp Coordinator Signature: ________________________ Date: _____________ List all participants’ names that have been temperature checked and lice checked by a qualified person prior to arriving to camp. Make copies of form as needed. Participant Name Temperature (non medicated) ___________________________________________________. _______________________________________________ ___________________________________________________. _______________________________________________ ___________________________________________________. _______________________________________________ ___________________________________________________. _______________________________________________ ___________________________________________________. _______________________________________________ ___________________________________________________. _______________________________________________ ___________________________________________________. _______________________________________________ ___________________________________________________. _______________________________________________
Participant Name Temperature (non medicated) ___________________________________________________. _______________________________________________ ___________________________________________________. _______________________________________________ ___________________________________________________. _______________________________________________ ___________________________________________________. _______________________________________________ ___________________________________________________. _______________________________________________ ___________________________________________________. _______________________________________________ ___________________________________________________. _______________________________________________ ___________________________________________________. _______________________________________________ ___________________________________________________. _______________________________________________ ___________________________________________________. _______________________________________________ ___________________________________________________. _______________________________________________ ___________________________________________________. _______________________________________________ ___________________________________________________. _______________________________________________ ___________________________________________________. _______________________________________________ ___________________________________________________. _______________________________________________
LICE CHECK CHURCH NAME: ___________________________________________________________ CHURCH CITY: __________________________________ OUTPOST: ________________ Students are required to have a head check for lice BEFORE registration on the first day of camp. Being checked for lice at camp should be avoided if at all possible. Please have a lice check at your church BEFORE leaving for camp. If you suspect a student might have lice, check early enough so the student and items brought to camp can be treated before camp. Have a qualified person (teacher, nurse, etc.) give each student a thorough check and sign this form. If a case of lice is discovered during camp, depending on the severity of the case, the camper may be sent home. If the case is not severe, and is isolated, we will ask a leader from the church the camper came with to treat the camper and their belongings. List all students on this form that have been checked for lice prior to arriving to camp. Duplicate form as needed. I have checked each camper listed on this form for lice and they are lice free. I understand that if campers are brought to camp with lice, they may be sent home at the expense of the parent and/or church. Signature of qualified person checking for lice: Signature: ______________________________________________ Date: ____________ CAMPER NAME Lice Free CAMPER NAME Lice Free ______________________ [ ] ______________________ [ ] ______________________ [ ] ______________________ [ ] ______________________ [ ] ______________________ [ ] ______________________ [ ] ______________________ [ ] ______________________ [ ] ______________________ [ ] ______________________ [ ] ______________________ [ ] ______________________ [ ] ______________________ [ ] ______________________ [ ] ______________________ [ ] ______________________ [ ] ______________________ [ ] ______________________ [ ] ______________________ [ ]
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