UNDERGROUND XTREME CAMP 2017

June 24-29, 2017 | Alliance Redwoods Conference Grounds

Summer camp is almost here!! It is the event you’ve all been waiting for! Here’s what you need to know and do. Please read this completely. We want you to be in the loop! Bring your friends for a fun and crazy week at camp. Our theme is JOY. Come and experience a great week of Joy.

CHRIS DEW OUR SPEAKER: Chris was born in Raleigh, NC with a severe stutter and unquenchable emptiness. He looked for anything that would calm his nerves and fill his void, which soon led him to drugs. By age 17, he was shooting up heroin daily and selling drugs to continue his habit. On December 18th of 2010, Chris entered into yet another rehab program weighing 100 lbs, deathly addicted to heroin, and still without the ability to talk. Six days later, he attended a church down the street from the rehab center and heard the Gospel. That night everything changed. Jesus snatched him out of hell and gave him a taste of the pleasure he'd been looking for. Shortly after that Jesus called him to preach. Over the next few years, Jesus literally healed Chris's voice and began to open doors for him to share his story and preach the gospel on many different platforms.

DAVE STOVALL OUR WORSHIP BAND: Dave Stovall is a worship leader, bassist for Audio Adrenaline and all around nice guy. Born into a family of musicians, Dave desires to convey an atmosphere of fun in his music with a message about God and the relationship we can have with Him. CALIFORNIA REGULATIONS: California has regulations that affect all camps, one of

which requires us to do LICE CHECKS on EVERYONE before we leave for camp. We suggest you check your kids head for lice yourself the week before, so in case you find any lice you can take care of it before camp. If we find lice, your student will not be allowed to go to camp. When you arrive to depart for camp, hair must be THOUROUGHLY washed and dried WITH NO HAIR PRODUCTS IN IT. NOTE: Clean hair takes seconds to check. Dirty hair takes a lot of time and causes embarrassment to your student. Thanks for your cooperation!

SONOMA CANOPY TOURS: Alliance Redwoods Conference Grounds (ARCG) offers Sonoma Canopy Tours. The discounted cost for students while at 'Xtreme Camp is $69 (Great Deal). You must fill out the Participant Agreement for Sonoma Canopy Tours and send the signed form with your student with the $69 CASH to be turned in upon arrival at camp.

FORMS: Medical Release Forms: Medical history form for ARCG, as well as the Bridges Medical and Liability Form. WHITE half sheet Medication: ALL MEDICATION NEEDS TO BE TURNED IN at the registration table. Place the form and medications in original containers in a Ziploc bag. Paintball Waiver Form: All camp attendees need to sign this form. Sonoma Canopy Tours Participant Agreement: If you want to zipline, see above.

ROOMING ASSIGNMENTS: Will NOT be changed the week we leave. Make sure you indicate the one person you’d definitely like to room with, and we will make our best effort to get you into a cabin that you’re going to have a blast with for the week! COST: The early bird rate for camp is $400, and the cost of camp goes up to $425 after April 30th. A $50 non-refundable deposit and ALL required forms will hold your early bird rate. Registration CLOSES on June 4th, and all balances and forms are due at that time. To offset costs, we will have a barbeque fundraiser at church as well as some fundraiser nights at local restuarants. The dates for those fundraisers are March 27 Blaze Pizza Pacific Commons, April 2 Hot Dog Fundraiser @ Bridges Community Church, April 18 Chick Fil A Mowry Ave. We also have lollipops that students can sell. Sell one bag of 60 lollipops @ $1 each and receive $40 credit toward camp. Once you have registered, you will be put on an email contact list for Camp Updates.

WHEN & WHERE:

Departure: Saturday, June 24th. Report to LICE CHECK no later than 12pm, get cleared, then check-in at registration table. Buses will be loaded and we will depart shortly thereafter. Return: Thursday, June 29th between 4:00-5:00pm – we cannot be more accurate than that due to traffic. We will inform you via social media with a more specific time as we get closer.

WHAT TO BRING:

Clothing for a week of fun, nighttime, messy games, & swimming. MODESTY is the policy. o Girls must bring a 1 (ONE) PIECE BATHING SUIT or plan to wear a NON WHITE shirt. No spaghetti straps

and no skin showing on tummies, no SHORT shorts. o Boys no Speedos & no boxers hanging out. o Plain White T-shirt that will come home dyed after REC (possibly). Buy a package with a friend.

Money for paintball $20, snacks and drinks, merchandise from talent & also for the gift shop. They can spend a wad or no money at all. $69 for Sonoma Canopy Tours plus the signed Participant Agreement.

A Refillable WATER BOTTLE with your name on it.

A Bible & pen! If you don’t have one, then let us know and we’ll hook you up!

ONE bag!! That is 1, not 2, not a suitcase & a bag, not two bags & a backpack, ONE bag! You may bring a SMALL carry on backpack. Space is limited.

A sleeping bag, pillow, & flashlight (optional). Most likely the pillow will go with you to your seat on the bus. Your bag/sleeping bag will go under the bus. To protect your sleeping bag you may want to put it in a plastic bag clearly marked with your name.

2 towels, one for bathing and one for swimming.

Soap, shampoo, toothpaste and brush, deodorant, and anything else you need 2B clean.

Any medication that you will need for the week. It will need to be turned in when you check in with the enclosed WHITE form filled out.

WHAT NOT TO BRING:

Paintball Equipment…ARCG provides all the needed equipment.

Skateboards…the skateboard park no longer exists.

Electronic devices…video games

SPEAKERS for iPODs or other music devices are not allowed. Your IPOD with headphones will only be allowed on the bus. They will be confiscated if we see them. We’re going up to experience something outside our normal lives. There is little to no cell phone service, and we will be so busy having a BLAST you’ll have no time for the noise. Let’s leave the “stuff’ behind so we can be fully present to God and each other. You won’t regret it!

Cell phones will not be allowed while at camp. Cell phones and all other electronic devices will be collected once we arrive at camp. They will be permitted on the bus ride up and back.

Anything illegal. Substances or weapons of any type. Enough said.

Bad attitudes. We’re gonna have a blast! So start out on the right foot.

Valuables, nice clothes, more than 1 bag. P.S. If you get motion sickness take something on Saturday before we leave and bring an additional dose for the trip home. You may send a letter or care package to your child to the address below…remember it takes several days to get there. Plan ahead.

CAMP ADDRESS: A.R.C.G. MS ‘Xtreme Camp, 6250 Bohemian Hwy, Occidental, CA 95465-9107 Ph#: 707-874-3507

1

MEDICAL & LIABILITY RELEASE

Event: UNDERGROUND XTREME SUMMER CAMP 2017 Dates: June 24-29, 2017

PERSONAL INFORMATION Please PRINT clearly

Last Name: _______________________First Name: _________________ Age: ______ Gender: M [ ] F [ ]

Home Tel: _________________ Cell Tel: _________________ Grade: __________ DOB: ____/____/____

Address: __________________________________________City/State: _________________ Zip: _________

Student’s Email: _______________________________ Parent’s Email: _______________________________

Father’s Name: _______________________ Tel: _____________________ Cell Phone: __________________

Mother’s Name: _______________________ Tel: _____________________ Cell Phone: __________________ (List phone #’s where you can be reached during the trip dates) Emergency Contact (other than parent): _____________________________ Phone: _____________________

Doctor: __________________ Phone: ____________ Dentist: __________________ Phone: ______________

Insurance Company: _____________________________________ Policy #: ___________________________

Address: _______________________________________________ Insured ID #: ______________________

ADULT Shirt Size: [S] [M] [L] [XL] [XXL] I want to room with: _______________________________

MEDICAL HISTORY

Allergies:

Drugs (list below): ____ Hay Fever: ____ Hives/Rash: ____ Insect Stings: ____

Foods: ____ Special Dietary Needs/Restrictions: _____Vegetarian: _____

_______________________________________________________________________________________________________________

_______________________________________________________________________________________________________________

Have you been a patient in the hospital during the past 2 years? Yes [ ] No [ ]

Have you been under the care of a medical doctor during the past 2 years? Yes [ ] No [ ]

Have you had surgery? If yes, please list date & type___________________________________________________ Yes [ ] No [ ]

Have you taken any medicine or drugs during the past 2 years? Yes [ ] No [ ]

What medicines do you take now? List name & dosage __________________________________________________________________

_______________________________________________________________________________________________________________

Please complete the medical table below. Check ALL appropriate boxes. PLEASE DESCRIBE any of the checked conditions below and any

other serious illness not listed (use Pg 2 if nec)___________________________________________________________________________

_______________________________________________________________________________________________________________

CONDITION Y N CONDITION Y N CONDITION Y N CONDITION Y N CONDITION Y N

Heart Trouble/Disease Bruise Easily Emphysema Yellow Jaundice Frequent Colds

Heart Murmur Anemia Tuberculosis Kidney Problems Glaucoma

Irregular Heartbeat Excessive Bleeding Cancer Renal Dialysis Stroke

Angina/Chest Pain Sickle Cell Disease Radiation (X-ray Treatments) Thyroid Disease Convulsions

Heart Attack/Failure Hemophilia (Bleeding

Problem)

Chemotherapy Parathyroid Disease Epilepsy/Seizures

Congenital Heart

Disorder

Recent Blood Transfusion Stomach/Intestinal Dis-

ease

Arthritis/Gout Fainting/Dizziness

Mitral Valve Prolapse Leukemia Ulcers Rheumatism Tumors/Growths

Scarlet Fever Swelling of Limbs Recent Wt. Loss Cortisone Medicine Psychiatric Care

Rheumatic Fever Lung Disease Frequent Diarrhea Artificial Joints Anxiety

Artificial Heart Fever Breathing Problems Diabetes Excessive Whining On Special Diet

Heart Pacemaker Shortness of Breath Excessive Thirst AIDS Wear contacts

Heart Surgery Frequent Cough Hypoglycemia HIV Positive Hearing problems

High Blood Pressure Hay Fever Liver Disease Drug Addiction Do you smoke?

Low Blood Pressure Sinus Trouble Hepatitis A (infectious) Cold Sores Do you use smokeless

tobacco products?

Blood Disease Asthma Hepatitis B or C Fever Blisters

If any of these allergies are checked, please give

details (i.e. include normal treatment of allergic

reactions, types of reactions, foods allergic to, etc.

Date of last Tetanus: ——-/——-/———

BRIDGES COMMUNITY CHURCH

2

OTHER PERTINENT MEDICAL INFORMATION Please PRINT Clearly

If participant should require medical attention for this trip for injuries received or illnesses contracted prior to coming on this trip, please

send us the information necessary to ensure proper medical service if necessary: _____________________________________________

______________________________________________________________________________________________________________

______________________________________________________________________________________________________________

List any other medical information or special needs we should be aware of: __________________________________________________

______________________________________________________________________________________________________________

LIABILITY WAIVER, RELEASE AND MEDICAL AUTHORIZATION

The undersigned participant (and participant’s parent(s)/guardian(s), if applicable) hereby authorizes BRIDGES COMMUNITY CHURCH,

Fremont, California (“BRIDGES”), acting through any adult volunteer or leader or other authorized agent, to consent to medical care

(including, for example, any x-ray examination, anesthetic, medical or surgical diagnosis or treatment, and dental diagnosis or treatment)

and/or hospital care to be rendered to the participant by or under the supervision of a physician and surgeon or dentist licensed under

applicable law. This authorization is given pursuant to California Civil Code section 25.8 and shall remain in effect until revoked in writing by

participant or participant’s parent or guardian, as the case may be. BRIDGES and its volunteers, employees and agents are authorized to

release medical information provided to them by participant (or participant’s parent(s)/guardian(s) if applicable) to medical providers and

emergency personnel in connection with any medical treatment provided to, or medical evaluation of, participant.

If participant is unable to complete the planned stay on the event identified above for any reason, participant (and participant’s parent(s)/

guardian(s), if applicable) will reimburse BRIDGES for the reasonable cost of transporting participant from the event location to Bridges’

Fremont campus. I further agree to pay all incurred charges for dental, medical, or hospital care or treatment.

Participant (and participant’s parent(s)/guardian(s), if applicable) authorizes BRIDGES and its partners and agents to use, copy, reproduce,

display, distribute, publish and exhibit without restriction any pictures, video, audio reproduction or narrative description of the participant

that may be created with respect to the event. Participant (and participant’s parent(s)/guardian(s), if applicable) waives any right

participant (and participant’s parent(s)/guardian(s), if applicable) might have to inspect and/or approve such items or the use to which they

may be put.

Participant (and participant’s parent(s)/guardian(s), if applicable) hereby releases and forever discharges and agrees to hold harmless

BRIDGES and its elders, trustees, employees, volunteers and agents from any and all liability, claims and demands of whatever kind or

nature, either in law or in equity, that may arise from participant’s activities in connection with the event. Participant (and participant’s

parent(s)/guardian(s), if applicable) understands and acknowledges that this Release discharges BRIDGES and such persons from any

liability or claim against BRIDGES or such persons with respect to bodily injury, personal injury, illness, death, or property damage that may

result from the participation of participant in the event. BRIDGES does not assume any obligation to provide financial or other assistance to

participant (or participant’s parent(s)/guardian(s), if applicable), including but not limited to medical, health or disability insurance, in the

event of injury, illness, death or property damage. Bridges Auto Insurance policy covers responsibility for all individuals riding in our insured

vehicles. Any injury resulting from an accident of our vehicle in route to, at, and from the event/camp back to our church is covered by our

auto insurance policy. Injury arising from any other cause on our vehicle will be the responsibility of the church supervising that individual.

Participant (and participant’s parent(s)/guardian(s), if applicable) understands that this Release applies to, covers and includes unknown,

unforeseen, unanticipated and unsuspected damages, losses or liability and the consequences thereof, that result from the activities of this

event as well as those now known to exist.

I (we) certify that the information provided above is correct and I (WE) HAVE READ, UNDERSTAND AND AGREE TO THIS LIABILITY

WAIVER, RELEASE AND MEDICAL AUTHORIZATION.

Participant Signature: ______________________________________________________________ Date: ____/____/____

Parent (with custody of Participant) or Guardian Signature: ________________________________ Date: ____/____/____

PRINT PARENT OR GUARDIAN SIGNATURE: ____________________________________________

BRIDGES COMMUNITY CHURCH, 505 Driscoll Road, Fremont, CA 94539 (510) 651-2030

RESTRICTIONS

Swimming Restrictions: Yes [ ] No [ ] Activity Restrictions: Yes [ ] No [ ] Other restrictions (please specify): ________

MEDICAL & LIABILITY RELEASE FORM

Event: UNDERGROUND XTREME SUMMER CAMP 2017 Dates: June 24-29, 2017

BRIDGES COMMUNITY CHURCH

For Everyone

AllianceRedwoodsConferenceGroundsWAIVERANDRELEASEOFLIABILITY

InconsiderationofTheAllianceRedwoodsConferenceGroundsfurnishingservicesand/orequipmentand/orusingmyownequipmenttoenablemetoparticipateinropescourse,biking,kayaking,canoeing,rockclimbing,skateboarding,inlineskating,scooters,paintballgamesoranyotheractivities,Iagreeasfollows:

IFULLYUNDERSTANDANDACKNOWLEDGETHAT:A) Risksanddangersexistinmyuseoftheequipmentandmyparticipationintheactivitiesstatedabove;

B) Myparticipationinsuchactivitiesand/oruseofsuchequipmentmayresultininjuryorillnessincluding,but

notlimitedtobodilyinjury,disease,strains,fractures,partialand/ortotalparalysis,deathorotherailmentsthatcouldcauseseriousdisability;

C) Theserisksanddangersmaybecausedbythenegligenceoftheowners,employees,officers,oragentsofTheAllianceRedwoodsConferenceGrounds;thenegligenceoftheparticipants,thenegligenceofothers,accidents,breachesofcontract,theforcesofnatureorothercauses.Theserisksanddangersmayarisefromforeseeableorunforeseeablecauses;butnotlimitedto,guidedecisionmaking,includingthataguidemaymisjudgeterrain,weather,faultyequipment,trailorriverroutelocation,andwaterlevel,risksoffallingoutofordrowningwhileinaraft,canoeorkayakandsuchotherrisks,hazardsanddangersthatareintegraltorecreationalactivitiesthattakeplaceinawilderness,outdoororrecreationalenvironment;

D) Andbymyparticipationintheseactivitiesand/oruseofequipment,Iherebyassumeallrisksanddangersandallresponsibilitiesforanylossesand/ordamages,whethercausedinwholeorinpartbythenegligenceorotherconductofowners,agents,officers,oremployeesofTheAllianceRedwoodsConferenceGrounds,orbyanyotherperson.I,onbehalfofmyself,mypersonalrepresentatives,andmyheirsherebyvoluntarilyagreetorelease,waive,discharge,holdharmless,defendandindemnifyTheAllianceRedwoodsConferenceGroundsanditsowners,agents,officersandemployeesfromanyandallclaims,actionsorlossesforbodilyinjury,propertydamage,wrongfuldeath,lossofservicesorotherwisewhichmayariseoutofmyparticipationinanyoftheactivitiesstatedabove,oranyotheractivities.IspecificallyunderstandthatIamreleasing,discharging,andwaivinganyclaimsoractionsthatImayhavepresentlyorinthefutureforthenegligentactsorotherconductbytheowners,agents,officersoremployeesofTheAllianceRedwoodsConferenceGrounds.Ihavereadthiswaiverandreleaseofliabilityandbysigningitagree,itismyintentiontoexemptandrelieveTheAllianceRedwoodsConferenceGroundsfromliabilityforpersonalinjury,propertydamageorwrongfuldeathcausedbynegligenceoranyothercause.IalsounderstandthatinsigningasaparentorguardianintheeventofanemergencyifIcannotbereached,IherebygivepermissiontothephysicianselectedbyTheAllianceRedwoodsConferenceGroundsstafftohospitalizeortosecurepropertreatment,orderinjections,anesthesiaorsurgeryformychild.Pleaseprint

NAMEOFGROUP(e.g.schoolorchurch)_______________

PARTICIPANTNAMEDATE

ADDRESS

CITY STATE ZIP

SIGNATURE PHONE (Parentorguardianmustsignforparticipantunderage18)

AllianceRedwoodsConferenceGrounds,6250BohemianHwy,Occidental,CA.95465(707)874-3507,Fax(707)874-2509

For Students Medical and Liability Release

Please be sure to read and understand this document and then sign and date both shaded areas at the end of this page

I agree to allow the ALLIANCE REDWOODS CONFERENCE GROUNDS Health Care Staff to render care to, arrange transportation for and administer over-the-counter medications to, the named minor, within the Staff scope of practice, and as deemed beneficial to the health and well-being of the named minor. I further agree that the over-the-counter and prescription medications, brought to camp will be collected by and then only administered by, the ALLIANCE REDWOODS CONFERENCE GROUNDS Health Care Staff, in accordance with all applicable prescriptive direction and/or on an as needed basis. No medications having reached an expiration date will be accepted or administered. In the event I cannot be reached by phone at the time of an injury or illness to the named minor, I hereby give, as parent/legal guardian, my permission to the doctor selected by the ALLIANCE REDWOODS CONFERENCE GROUNDS to hospitalize, access and procure necessary medical records, and secure appropriate treatment, including but not limited to, injections, anesthesia, testing, radiology, or surgery for the named minor as deemed necessary. Medical insurance coverage by the ALLIANCE REDWOODS CONFERENCE GROUNDS’ insurer is secondary to your medical insurance policy, and available only following the usage of your policy to the limit of your policy coverage or if you have no medical insurance of your own.

I understand that in signing this form that I am providing both a Medical and Liability Release to the ALLIANCE REDWOODS CONFERENCE GROUNDS for the minor named on the front page. I hereby acknowledge that during his/her attendance at a camp session certain risks exist, which may be known or unknown at this time, and may result in physical injury or illness. In signing this Liability Release, I assume full responsibility for mitigation of such an incident, and I am granting permission for the participation of the named minor in all session related activities, unless specifically noted on this form. This release is intended to stand on the behalf of the named minor, and in place of all claims by any family member or agent. These releases of ALLIANCE REDWOODS CONFERENCE GROUNDS shall be in effect only for the duration of the camp session as indicated, and only while the named minor is on the grounds of ALLIANCE REDWOODS CONFERENCE GROUNDS, and/or under the direct supervision of ALLIANCE REDWOODS CONFERENCE GROUNDS employees.

I agree that, in the event of dispute between myself as guest or parent/legal guardian of, or on behalf of, the named minor, I will submit to arbitration by an organization sanctioned for this purpose, in lieu of pursuing litigation in a court of law. I further agree as parent/legal guardian, to absolve and hold harmless the ALLIANCE REDWOODS CONFERENCE GROUNDS a Non-profit Corporation, its Board of Directors and Trustees, agents and employees against liability for; damages, losses, or injuries or illnesses to; myself, my property, or the named minor.

Non-compliance with disclosed behavioral standards and instructions, written or oral, may result in disciplinary actions, up to and including, being asked to remove the named minor from the grounds. Anyone asked to leave the grounds shall forfeit all camp fees previously paid, while remaining liable for any fees due.

I hereby give my permission to the ALLIANCE REDWOODS CONFERENCE GROUNDS to use photography of the named minor taken while on the grounds for promotional purposes.

School Name:____________________________________________________________________________

Student’s Name, First and Last, Please Print:__________________________________________________

Please sign here:

Parent/Legal Guardian: _____________________________________________ Date: ___________________

Please check one of the following options and sign box below.

I will be transporting the named minor to and from ALLIANCE REDWOODS CONFERENCE GROUNDS

The following person or organization has my permission to receive and transport the named minor from the care and facilities of the ALLIANCE REDWOODS CONFERENCE GROUNDS at the conclusion of the camp session as indicated.

Please fill in name of approved person/organization: ___________________________________________________________________________

Please sign here:

Parent/Legal Guardian: _____________________________________________ Date: ___________________

Alliance Redwoods Conference Grounds 6250 Bohemian Hwy Occidental, CA 95465 (707) 874-3507 Fax (707) 874-2509

Please complete both sides and sign the shaded areas on the back of this form in ink.

GROUP NAME:_______________________________________ Start Date ______________ End Date _____________

Minor Name ____________________________________________ Age __________ Birthdate __________________________

Primary Parent or Guardian

Name(s) __________________________________________________

Home Address ______________________________________ City _______________________ ST ______ ZIP _______

Home Phone (______) _______________________________ Work Phone (_____) _______________________________

Occupation ________________________________________ Employer ________________________________________

Additional Emergency Contact Person In Case The Above Cannot Be Reached

Name(s) ___________________________________________________

Home Address ______________________________________ City _______________________ ST ______ ZIP _______

Home Phone (______) _______________________________ Work Phone (_____) _______________________________

Occupation ________________________________________ Employer ________________________________________ Health Care Provider

Medical Insurance Company _______________________________ Policy # ____________________________________

Physician or Clinic Name __________________________________ Phone # ____________________________________

Dental Insurance Company ________________________________ Policy # ____________________________________

Dentist or Orthodontist Name ______________________________ Phone # ____________________________________

Health History

Last Tetanus Shot _____/ _____/ _____

Please indicate any condition(s) which apply:

Diabetes ______ Headache ______ Heart Condition ______

Seizures ______ Nosebleed ______ Other ______

Asthma ______ Fainting ______

Other Medical Problems

________________________________________________________________________________

Please indicate any allergies : Food ____________________ Insect _________________ Drug ___________________

Name and dosage of any medication that must be taken: ____________________________________________________

Condition requiring medication _________________________________________________________________________

Over the counter and/or prescription medications to avoid ___________________________________________________

Physical disabilities

___________________________________________________________________________________

Restriction of activities _______________________________________________________________________________

For office use only

CABIN # __________ Medical Form

ForStudentsALLIANCEREDWOODSSUMMERCAMPMEDICALPROCEDURES

ThecampworksundertheNationalguidelinesofACA(AmericanCampingAssociation)Please follow these directions: 1. Parents of attending students will need to fill out Alliance Redwoods’ medical form.

a. All medical forms must be copied back to front on ONE sheet of paper. b. All medical forms must be signed in BOTH places by a legal guardian.

NO FAXES OF THE MEDICAL FORM ARE PERMITTED. 2. Medicines should be in plastic Ziploc bag.

a. All bags should be labeled with CHURCH and STUDENT’S name. b. MEDICATION FORM with directions regarding medicine in bag. (Below) c. All medicine in original prescription bottle or original labeled box (for non

prescription). d. NO LOOSE PILLS OR MIXED PILLS IN SINGLE CONTAINER.

3. Do not send Tylenol, Advil, cough drops or any first aid supplies as the Medic has all these supplies.

4. Put all of student’s Ziploc plastic bags into ONE box labeled with church’s name.

Cut along line and put in Ziploc bag with medication

ALLIANCEREDWOODSSUMMERCAMP

MEDICATIONFORM

CAMPER’SNAME:________________________________________CHURCH:__________________________CABINNAME/#:_________________________________________ASNEEDED

TAKENDAILY

NAMEofMEDICATION DOSAGE/TIME REASONFORMEDICATION

PLEASE:Placecamper’smedicineinoriginalprescriptionbottleororiginalover-thecounterlabeledbottle(fornon-prescription)togetherwiththisforminaZiplocBag.

NOLOOSEPILLSWILLBEACCEPTEDORGIVENTOCAMPERS.

ForEveryoneARCGPaintballRuleAgreement

Theserulesweredesignedwiththeintentofcreatingafunandsafetymindedenvironmentinwhichtheguests(willbereferredtoas“players”fortheremainderofthedocumentofAllianceRedwoodsConferenceGrounds)mayparticipateinthegameofPaintball(willbereferredtoas“thegame”fortheremainderofthedocument).ItisthedutyoftheRefereestoenforcetheserulesandpromoteafair,unbiased,minimizedriskgameinordertoencourageteamworkandgoodsportsmanship.

TheseruleshavebeenreviewedbyAllianceRedwoodsConferenceGrounds(ARCG)Leadership,includingthePaintballManager,ProgramCoordinator,andProgramDirector.Thepreviouslylistedpartiesarethefinalauthoritiesontheserulesandmaychangeattheirdiscretion.Modificationstotheserulesmayberequiredbasedonspecificsituationsandwillbeaddressedonacasebycasebasis.Theplayerswillbenotifiedofanychangesbeforethegamebegins.AlldecisionsmadebytheHeadRefereeduringthegamearefinalandunarguable.

AllplayersmustreadandsignacopyoftherulesbeforeplayingPaintball,agreeingthattheyunderstandandwillfollowalloftherules.Anyplayerwhofailstocomplywiththerulesissubjecttobeejectedfromthegameand/ordisqualifiedfromfurtherparticipationinpaintballatthediscretionoftheHeadReferee.Playerswhofailtocomplywiththeruleswillnotberefundedanyofthemoneytheypaidtoparticipateinthegameorforanyadditionalcharges(extrapaint,gearrental,etc.).

Allplayersareexpectedtobeawareofwhattimetheirsessionofpaintballbeginsandareexpectedtobeontime.AnyplayerwhofailstoarriveontimeissubjecttobeingdisqualifiedfromthegameatthediscretionoftheHeadRefereeformissingthemandatorysafetybriefing.

TheagelimitatARCGhasbeendeterminedbasedonthedifficultylevelofourcourseandtheaverageskilllevelofourplayers.Playersmustbe13yearsofageoroldertoparticipateinhighvelocitypaintball.Playersmustbe10yearsofageoroldertoparticipateinlowvelocitypaintball.Allplayersshouldconsultaphysicianpriortoarrivaliftheyhaveanyconditionsthatmightpreventthemfromsafelyplayingthegame.

PlayersandspectatorswillmaintainapositiveandencouragingatmospherewhileatPaintball.AnyplayerorspectatorwhofailstodemonstrategoodsportsmanshipintheirconductwillbeejectedfromPaintballfortheremainderofthegame

Allplayersareexpectedtowearappropriateattire.Dresses,skirts,and/oropentoedshoesareprohibited.

StagingArea(Off-Course)

1. Keepbarrelsheath(cover)on

2. Keepsafetyon(Thesafetyisadeviceonthemarkerthatpreventsorallowsittofire.TheRefereeswilldemonstratehowtoproperlyusethesafetywhenyouarriveatPaintball.)

3. Keepthegun(willbereferredtoas“marker”fortheremainderofthedocument)pointedattheground

On-Course1. Wearmaskproperlyatalltimes,thisincludeswhileexitingthecourse

2. Removebarrelsheathandplaceinbucketoncourse

3. Donotfireuntilhornblowsanddonotfireaftergameisfinished

4. Staywithinboundaries

5. Donotpickuppaintofftheground

6. Donotclimbtrees

7. CallforaRefereeifyouneedassistanceduringgameplay

8. Acknowledgethatyouarehitifthepaintballbreaksonyourbody,mask,ormarker

9. Whenyouareoutyell“I’mout.I’mout.”,putyourmarkeroveryourhead,andquicklyreturntothestagingarea

10. Putthebarrelsheathbackonthemarkerbeforeenteringthestagingarea

11. AnyadditionalpaintthathasbeenpurchasedwillbetakentothefrontofficeforyoutopickupasyouleaveARCG

DoNotFire

1. Atanyonewithin10feet(surrenderrule)

2. AtReferees

Equipment

1. Playersmustwearamaskbeyondthesignmarked“MaskOn”atalltimes

2. OnlyequipmentprovidedbyARCGwillbeused

BysigningbelowIacknowledgethatIunderstandtherulesandrequirementsofARCG’sPaintballCourse.I

agreetofollowtheaforementionedrules.Ifplayerisundertheageof18aparentorguardianmustsign

belowstatingthattheyhavereviewedthisdocumentwiththeminortheyaresigningfor.

Pleaseprint

Nameofgroup______________________________________________________________

Playername(pleaseprint)_____________________________________________________

Signature___________________________________________Date___________________

Alliance Redwoods Conference Grounds, 6250 Bohemian Hwy, Occidental, CA. 95465 (707)874-3507, Fax (707)874-2509

ParticipantAgreement

Sonoma Canopy Tours is designed for participants in reasonably good health. Due to the nature of the tour, we reserve the right to refuse participation to anyone. The Sonoma Canopy Tour is an isolated environment; immediate medical attention may not be available. We cannot be responsible for any valuables dropped from the tour or left in your vehicle. You must sign the Voluntary Participation Agreement Form prior to participation.

Please review the following regulations:

• You must weigh at least 70 pounds, and not more than 250 pounds. • Youth under age 18 must have a parent or legal guardian

sign the Voluntary Participation Agreement Form.

• You must wear sturdy, closed-toe shoes that secures to the ankle.

Attire and preparation:

• Please wear comfortable clothing that protects your torso from rubbing caused by the seat and chest harnesses.

• Please no revealing clothing, dresses or skirts. • Please remove loose or dangling jewelry and body piercings. • Please tie back and secure long hair. • Please remove all valuables including rings,

necklaces, bracelets, and personal electronics. • Cameras are welcome on the tour, however you are

solely responsible for it’s transport and condition.

If you have any of the following medical conditions we STRONGLY recommend you consult your physician prior to participation, and discuss any concerns with your guide:

• Heart disease or any cardiac condition that may require immediate medical attention.

• Hemophilia. • Take any blood thinning medications. • Epilepsy. • Asthma. • Diabetes. • Insulin dependent. • Severe allergic reactions.

• Severe recent, reoccurring or existing injuries.

You cannot participate in the canopy tour if you are:

• Pregnant or think you may be pregnant. • Under the influence or consumed alcohol prior to the tour, illegal drugs, or legal drugs that we consider will impair you in any way.

Voluntary Participation Agreement Please read this document carefully. It must be signed by all participants prior to going on the Sonoma Canopy Tour. If the participant is a minor, at least one parent or guardian must also sign as evidence of their agreement to these terms and conditions on their own behalf and on behalf of the minor.

1. I, the undersigned participant, acknowledge that I have voluntarily applied to participate in the Sonoma Canopy Tour operated by Alliance Redwoods Conference Grounds (ARCG), which is a physically demanding and hazardous activity. I do not have any medical condition which might create an unsafe risk to me or others who are participating in this activity with me. I have also read and understand the participant requirements form.

2. Acknowledgement of Risks I understand that the Sonoma Canopy Tour at Alliance Redwoods may expose participants to certain risks. The activities require moderate physical exertion and are conducted at heights up to 200 feet. Among the hazards and risks of the activities and use of the premises and equipment are the following: falls; collisions; abrupt and possibly harmful contact with structures, objects and persons; anxieties and fears associated with heights; close contact with other people; coordination and misjudgments on the part of participants; the failure of structures or equipment; and the unpredictable forces of nature.

Participants may experience increased heart rate and other symptoms of anxiety and stress due to physical exertion, reliance on other participants, a fear of height, or of unprotected falling, loss of balance, coordination and misjudgments, including failure to follow procedures and instructions, physical or mental or psychological stress, fatigue, chill and /or dizziness which may diminish reaction time and increase the risk of an accident. Injuries associated with participation may include breaks, sprains, bruises, and in extreme cases, emotional upset, anxiety and even death.

Participants acknowledge that the description of risks is not complete and that other unknown or unanticipated risks may result in injury, illness or death. Participants acknowledge that this activity is purely voluntary, and participate with full knowledge of the inherent risks in such activity.

info@sonomacanopytours.com 1-888-494-7868 lastrevised7/9/12

3. Assumption of Risks I understand that the Sonoma Canopy Tour is a hazardous activity. I am voluntarily participating in this activity with knowledge of the danger involved. I hereby accept any and all risks of injury or death to myself or any minor children for which I am responsible, arising out of or in any way connected with the use of the Sonoma Canopy Tour, the Alliance Redwoods facilities, and/or any one of affiliated activities of Alliance Redwoods Conference Grounds.

4. Release and Indemnity As consideration for being permitted to participate in the Sonoma Canopy Tour, I hereby agree that I, my assignees, heirs, and/or as the parent/ guardian of a minor participant, will release and hold harmless and not bring any claim or legal suit against Alliance Redwoods Conference Grounds, its directors, managers, officers, agents, employees and volunteers or its affiliated organizations or the supplier of any of the equipment used in the activity (“Released Parties”), for any and all claims of injury, disability, death or other loss or damage to person or property suffered by me or my minor child arising in whole or in part from participation in this activity, both foreseeable or unforeseeable. I hereby waive the provisions of Civil Code 1542 for future unknown claims which are as follows:

“A GENERAL RELEASE DOES NOT EXTEND TO CLAIMS WHICH CREDITOR DOES NOT KNOW OR SUSPECT TO EXIST IN HIS FAVOR AT THE TIME OF EXECUTING THE RELEASE, WHICH, IF KNOWN BY HIM MUST HAVE MATERIALLY AFFECTED HIS SETTLEMENT WITH THE DEBTOR.”

In addition, I agree TO INDEMNIFY (that is, defend and satisfy by payment or reimbursement, including costs and attorney’s fees) Released Parties from any claim of loss, injury or death, brought on by myself or my child against another co-participant. These agreements of release and indemnity include loss or damage caused or claimed in whole or in part by the negligence of a Released Party, but not intentional wrongs or the gross negligence of a Released Party.

5. Severability If any provision of this agreement is held to be void or otherwise unenforceable by a court of competent jurisdiction, the remaining provisions shall nevertheless be fully enforceable, unimpaired by such holding.

6. Additional Provisions I, an adult participant or the parent/guardian of a minor participant, authorize Alliance Redwoods Conference Grounds to provide or obtain for me such medical care as it considers necessary and appropriate, and I agree to pay all costs associated with such care and transportation.

Any dispute between a Released Party and participant or parent/guardian will be governed by the laws of the State of California, and any mediation or suit shall take place only in that State in the County of Sonoma.

I, on behalf of myself and any minor child, hereby give my permission and consent to the taking of photographs, video, or other media and agree that such material may be published and otherwise used by Alliance Redwoods Conference Grounds for purposes it deems appropriate without compensation to me or the child.

I HAVE CAREFULLY READ THIS VOLUNTARY PARTICIPATION AGREEMENT FORM AND PARTICIPANT REQUIREMENTS AND FULLY UNDERSTAND ITS CONTENTS. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY IN WHICH I AM GIVING UP IMPORTANT LEGAL RIGHTS AND A CONTRACT BETWEEN MYSELF AND ALLIANCE REDWOODS CONFERENCE GROUNDS AND/OR ITS AFFILIATED ORGANIZATIONS, AND SIGN IT OF MY OWN FREE WILL.

Participant Tour Time

Name

Relevant medical conditions / Allergic reactions_

Signature

Date of Birth / /

Weight

Date / /

E-Mail Address Check here if you do not want to be included in our mailing list

Parent or Guardian (if participant is under age 18)

Parent or Guardian Phone Number

Signature Date / /

Emergency Contact Name ___________________________________________ Relation _____________________________ Phone Number _____________________________________

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