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Young Marines Adjutant’s Manual

Rev2016Apr Page 1 Adjutant’ Manual V.2

Introduction Adjutant – One of the most important positions in the Young Marines unit is the position of Adjutant. The Adjutant is responsible for ensuring that the administration is correct and up-to-date. In the Young Marines (YM), the Adjutant is the person usually responsible for most database entries and record keeping. The Adjutant needs complete access to the Young Marines Database System (YMDBS). This system is the mainstay of the unit’s Young Marine (YM) and Registered Adult (RA) records. It is the system that reports the activities of Young Marines, records their pertinent information, and registers and re-registers the unit and all of its members. It is through the Adjutant’s knowledge and implementation of the Young Marines administration that ensures newly registered Young Marines receive their YM National Headquarters basic issue - YM Basic Guidebook, T-shirt, cover, belt and buckle, patches, DDR deck of cards, and blousing bands. The Adjutant must make sure that information documented in the database is accurate and timely. Without that information, the unit might miss out on Esprit magazines or important correspondence and Young Marines might miss out on important opportunities. The position is vital to the successful management of the unit. It is the Adjutant’s work and understanding of the database that allows Young Marines National Headquarters (YMNHQ) to make sure YMs and RAs receive YM insurance coverage. Additionally, YMNHQ is able to get a complete overview of Young Marines the unit has and their breakdown by age, rank and gender, plus the distribution of units throughout the country. The role the Adjutant fills is critical and one of the most important positions in the YM unit. The YMNHQ staff will assist with answering questions via phone (800-717-0060), email, via the unit’s command elements (Battalion, Regiment, Division) and via Unit Management Courses (UMC), conducted locally, plus the Adult Leaders Conference (ALC) annually. Thank you for becoming a team member of the best youth program in the United States!



Administration Proper administration is a measure of the health and wellbeing of a unit. It is, generally, the first indication of whether a unit is well led and well managed. The Unit Commander (UC) must maintain accurate and organized administrative records of all members within the unit. The Adjutant is responsible to and appointed by the UC for all matters pertaining to administration of the unit.

The Adjutant:

• Registers new Young Marine recruits • Submits Adult Volunteer Applications • Annually re-registers all Young Marines and Registered Adults • Maintains and updates Young Marines’ Record Books (YMRB); both Young Marines Database

System (YMDBS) and hardcopy, plus safeguards the hardcopies of the Young Marines’ Record Books (YMRB).* o Keeps track of YM’s non-YM and YM awards o Completion of Performance Objectives (PO) and Enabling Objectives (EO)

(may be input by TO or ATO**) o Community Service hours o Training Subjects o DDR hours

• Maintains and updates the Registered Adult Record Book in the Young Marines Database System (YMDBS). o Updating personal information, address and email o Community service hours (all hours an RA works with/for YMs are community service hours) o Attendance o Event registration

• Maintains master file of all Young Marines National Headquarters (YMNHQ) blank forms & documents, unit correspondence, unit policies, awards and promotions, discharges and bylaws.

• Prepares award certificates, promotion warrants, discharges, minutes of staff meetings and elections, unit rosters and special events forms.

• As circumstances dictate, manage unit’s inventory account and ribbons & devices inventory (May be performed by the Executive Officer (XO).

• SPACES registrations and applications for YMs and RAs • Communications between RA’s, YM’s, parents, and community • Communicates schedule / calendar to all parties • Other duties that may be assigned: recording of YM/RA attendance, entering ribbon awards,

promotions, etc. *See page 10 **Note: it is recommended that the Training Officer (TO) or Assistant Training Officer (ATO) should be trained to assist in order to enter PFT scores and training related entries such as Performance Objectives. Unit Commander (UC) or Executive Officer (XO) may take responsibility to enter other items such as attendance, awards, etc. in order to stay informed of YM accomplishments and needed requirements to meet goals.



Authorized Users in the YMDBS The Unit Commander (UC) determines the authorized users in the unit’s database. Authorized Users may include, but is not limited to, the Unit Commander, Executive Officer, and Adjutant. New units – Unit Commander will be sent their username and password in the New Unit Welcome Package.

Getting Started with the YMDBS

Step 1. Navigate to https://www.ymdbs.org to login. If using members.youngmarines.com , click on Login. Using the Authorized User login, enter the user ID and password, and then click on YMDBS to enter the database. The system is secure and cannot be entered without a user ID and password. Step 2. Once in the system, the user may change their password by clicking on the User Profile button.

Step 3. The UC, XO, and Adjutant can Add authorized users, with the UC’s approval, by doing the following:

• Click on the Unit Management / Authorized Users under the Main Menu • Click on the Add New User link in blue • Fill-in the blank fields (See FAQ: What are the YMDBS Access Levels?) • Click on the Save button

Registration Adults and youth may not actively participate in any Young Marines meeting, activity, or event until they are registered. Youth may participate once they are inputted into the YMDBS and the invoice has been issued. Adults must be registered with YM National Headquarters and placed on the “active” roster in the YMDBS by YMNHQ prior to working with the youth.

Adults Adult Volunteers are critical components in the Young Marines program. Units must have one registered adult for every ten Young Marines. Units must have male and female adults on staff. Effort should be made to recruit adult volunteers who will participate consistently.

• Adult Volunteer Application – 2 step process:

o YM Adult Volunteer Application (https://www.youngmarines.com/YM_UPLOADS/LibraryDownloads/Volunteer%20Registered%20Adult%20App_V9.pdf)

o Background Check https://www.youngmarines.com/YM_UPLOADS/LibraryDownloads/Application%20and%20BG%20Check%20Pro_V3.pdf

o See Background Check County Fees in YM library: https://www.youngmarines.com/YM_UPLOADS/LibraryDownloads/Background%20Check%20County%20_V1.pdf

• Any adult who desires to be a registered adult in the Young Marine program will fill out, in its

entirety, an Adult Volunteer Application and must include:

o Full “legal” name including middle name. Any aliases including maiden names should be noted. (Please note if there is no middle name)

o Date of Birth (MMDDYYYY)

o Color photo

https://www.ymdbs.org/

http://www.youngmarines.com/

https://www.youngmarines.com/YM_UPLOADS/LibraryDownloads/Volunteer%20Registered%20Adult%20App_V9.pdf

https://www.youngmarines.com/YM_UPLOADS/LibraryDownloads/Application%20and%20BG%20Check%20Pro_V3.pdf

https://www.youngmarines.com/YM_UPLOADS/LibraryDownloads/Background%20Check%20County%20_V1.pdf



• Additional paperwork: o 3 Letters of character reference: Reference is written by an adult other than the applicant, a relative, or Young

Marine Registered Adult. Reference must know the individual for at least 1 year. Reference must include name, address and phone number and original signature. References must be signed and dated within 6 months of the Application. Letter should be a narrative of how they know and why they recommend the

applicant. Form letters will not be accepted.

o Copy of DD214 to include type of discharge and re-enlistment code. If the discharge is

anything other than honorable, a letter of explanation must be included.

o Active duty military should include a Statement of Service from Officer In Charge (OIC). *Photocopying of U.S. government identification cards is a federal offence and will not be accepted.

• Unit Commander’s Review and Authorization of Adult Volunteer Application:

o Ensure Adult Volunteer Application is completed in its entirety. Review all information and attachments using UC’s checklist provided with application.

(This form is the last page of the application.) UC’s recommendation (If the UC does NOT recommend the adult for approval, a

Letter of Explanation must be included and application mailed to YMNHQ). Unit commander’s signature on application.

• Pay for application to be processed:

o Include a unit check payable to the Young Marines National Headquarters for current registration fees per registrant.

o One check per Adult Volunteer Application package must be submitted to prevent delays in the registration of adults.

o Include their name in the memo field. o Make sure you have two signatures on the check. o Fees may also be paid online in YMDBS with a Unit Debit Card.

• Make one copy of the Adult Volunteer Application and attachments to be kept with unit

records.

• Submit the original directly to YM National Headquarters. • Background Check Self Registration.

o Provide each applicant the letter of instruction available online in the YMDBS Library. https://www.youngmarines.com/YM_UPLOADS/LibraryDownloads/Background%20Check%20Le_V1.pdf

o Applicants are responsible for performing and paying for background checks. o YMNHQ will be contacted directly by NCSI upon completion of the screening. o Do not include any background screening information with the adult application.

• Mail the completed Adult Volunteer Application package and unit check for each adult to:

Young Marines National Headquarters P.O. 70735 Southwest Station Washington, DC 20024-0735.

https://www.youngmarines.com/YM_UPLOADS/LibraryDownloads/Background%20Check%20Le_V1.pdf



• The registration packet will be returned to the unit for correction, if it is incomplete or inaccurate.

• Once the information is received, the adult will be added into the YMDBS by YMNHQ. You may check the status of the adult’s application by selecting Record Maintenance then select Registered Adult in the database. Only when the status shows “Approved,” is the adult allowed to work with the Young Marines.

o If the package is not approved, a letter of disapproval will be mailed to the applicant along with the original application. Notification will be sent to the UC along with the unit check. The reason of denial will only be given to the applicant.

• The National Executive Director or a Deputy Director must approve all adult volunteers registering with YMNHQ.

Youth One of our Guiding Principles is that “…We will never forget that this program is for our youth.”

• The steps for completing the youth registration are listed below:

o Download and print the Young Marine Recruit Enrollment Package for the YMRB.

o Completing the enrollment portion:

Have the parent or legal guardian fill out the enrollment portion of the forms (These forms remain at the unit level in the Young Marine’s record book.)

o *YMFORM1 – Personal Information o *YMFORM2 – Emergency Contact and Medical Insurance Information o YMFORM3 & YMFORM3A – Young Marine Contract and Obligation – The

Young Marine must read and sign these forms. o YMFORM4 – Photo/ Video Release o *YMMEDFORM1 – Authorization for Medical Treatment o *YMMEDFORM2 – Permission to dispense Prescription Drugs o *YMMEDFORM3 – Health History (Ensure date of last tetanus shot is

noted) o *YMMEDFORM4 – Physical Examination Form – To be completed by

Family Doctor. (A copy of a current school or sports physical may be substituted, if done during current school year. A copy must be kept on file in the YMRB)

o *These forms must be updated annually.

o Parent is required to provide a copy of:

Medical Insurance Cards (front and back) Tricare users can request a proof of coverage letter at

http://tricare.mil/plans/eligibility/deers/milconnect/proof.aspx

Immunization Exemption Request Form, if applicable.

Social Security cards and birth certificates are to be viewed for verification purposes only, and then returned to parent/guardian. Copies will not be kept on file.

http://tricare.mil/plans/eligibility/deers/milconnect/proof.aspx



Register the Young Marine in the Database System

• 1. Click on the Registration button under main menu. • 2. Fill in all required fields denoted by check marks.

Ensure all information is correct. (Please do not type it in all CAPS)

• 3. Click on the appropriate t-shirt and cover size. • 4. Click on the Save button. • Click on Next Registration button and repeat numbers 2, 3, and 4 to add additional

registrants. • To complete the registration of the Recruits, click the Registration Roster button. When you

are ready to transmit records to the YMDBS, click Submit. • Click on Invoice link in blue (you will need Microsoft Excel to see the Invoice. If you do not

have Excel, download Excel Viewer from http://office.microsoft.com/downloads/2000/xlviewer.aspx

• Payment options:

o Pay with unit check payable to YM National HQ and send with invoice to YMNHQ. o Pay with unit debit card written on invoice and mail in to YMNHQ.

Mail to: Young Marines National Headquarters P.O. Box 70735 Southwest Station, Washington, DC 20024-0735

o Pay invoice online in YMDBS with a unit debit card and mail nothing to YMNHQ.

Transfer or Re-Register a Young Marine

• Click the CHECK button to view if the Young Marine is entered into the database.

• A pop-up box will appear with the following image. Enter any or all of the requested information. Click the Find button.

• Another pop-up box will appear with your search results. Follow the directions that appear in the box.

http://office.microsoft.com/downloads/2000/xlviewer.aspx



Registration Fees The YMNHQ requires a set registration fee per Young Marine and Registered Adult Volunteer.

• Registration Fees are currently $20.00 per person (fee is subject to change)

• Paid by unit check with dual signature or money order and paid to the order of YOUNG MARINES NATIONAL HEADQUARTERS.

• Registration Invoices may also be paid online with a Unit Debit Card.

• Personal checks for registration will not be accepted. However, this is waived for new units in the starter kit phase.

Social Security Numbers Due to the YMs receiving federal funds, registrants may not register without providing a legitimate Social Security Number, Alien Registration Number (A-number), or Tax Identification Number (TIN).

• Members must be legal residents of the United States. • It is the only means by which to uniquely identify every adult and youth in the Young Marines

program. • The YMDBS is a secured site, protected by the same system that protects several banks. • Special circumstance registrants cannot be registered on-line. For special circumstances please

call YM National Headquarters (800-717-0060) and provide the following information:

o If the registrant is a foreign national, please provide a copy of the Alien Registration Card (A-number or “Green Card”) or Tax Identification Number (TIN).

The Adjutant is responsible to the UC for information security and shall assure the Registered Adults, parents and legal guardians that the unit:

• Safeguards and limits access to private information contained in unit files to include the Young Marine Record Book (YMRB)

• Personal information in the YMRB is password protected and secured with access limited to key staff members authorized by the Unit Commander and National Headquarters.

Unit Inventory List The YMDBS will not allow completion of the Annual Re-registration until unit inventory is updated. All unit assets must be listed on the unit inventory list to include any asset(s) listed on last report, but no longer in the possession of the unit because item(s) was disposed of, lost or stolen. Provide the applicable information in the table of the report. Assets are any durable item of value owned by the unit, such as:

• Office Equipment—Computers, typewriters, telephones, FAX machines, copiers, etc.

• Other Equipment—Flag sets, harnesses, flag stands, refrigerators, generators, microwave ovens, drill rifles, musical instruments, televisions, cameras, etc.

• Vehicles—Buses, vans, automobiles, boats, trailers, etc.

• Camping Gear—Tents, sleeping bags, packs, canteens, etc.



Re-registration Every Young Marine unit must re-register each year online through the database.

• The unit re-registration period is from 1 August to 30 September.

• Units may not re-register unless they are in good standing and current with all monthly financial reporting requirements (Monthly reporting information can be found in the Paymaster Manual).

• Unit re-registration must be completed no later than 30 September. If a unit fails to meet the re-registration deadline, the unit’s charter is automatically suspended without notice.

• Delinquent units are prohibited from conducting or participating in any activity or event involving Young Marines until the unit is properly re-registered.

How to complete the unit’s re-registration: • Select the Registration menu item.

• Verify and update Unit Demographic Information.

• Verify and update Unit Inventory.

• Review the names of all Registered Adults and Young Marines in your unit.

• Carefully select those individuals who will be re-registering and those who will be discharged. (Once the selections are submitted, no adjustments will be made to the invoice.)

• Click the SUBMIT button.

• Click INVOICE and print. The Group Exemption form will print with the invoice.

• Click on Registered Adult Agreement Form and print. A pre-populated Registered Adult Agreement form will print for each adult in the unit. Each RA must sign their agreement form. o Adults refusing to sign and submit the form will be discharged from the Young Marines.

Completing re-registration: Mail the following to: Young Marines National Headquarters, P.O. Box 70735 Southwest Station Washington, DC 20024-0735:

� Copy of the Invoice

� All (signed) Registered Adult Agreement Forms (If an adult is deployed, write “Deployed” on the signature line, UC initial and date)

� Signed Unit Group Exemption Form

� Payment methods for invoice: o Completed unit check with exact invoice amount made payable to Young

Marines National Headquarters. o Unit debit card information provided on the invoice. o Or, the invoice may be paid on in YMDBS with a unit debit card. Include

copy of receipt with the package.



Young Marine Record Book (YMRB) Proper and accurate record keeping is a fundamental requirement for a Young Marines unit. This can impact a Young Marine receiving credit for an achievement that may be required for a promotion or award or attendance to one of National Headquarters’ Summer Programs of Adventures, Challenges, Encampments, and Schools (SPACES).

• An YMRB is opened on each Young Marine starting with enrollment into the program. • It is the Young Marines’ official hardcopy record for all personal information and their

achievements as a Young Marine. • It is a standard letter-size tabbed file folder containing all official documents required in the

program. o The Young Marine’s name is written on the tab with black ink—last name, first name,

and middle initial. o When the folder is opened the Young Marine’s personal information forms are placed

on the left interior side of the opened file folder. o The report for the Young Marine’s online record book and documentation for awards

are placed on the right interior side of the opened file folder.

• Left Interior Side of the YMRB. � Young Marines Enrollment Form (YMFORM 1) � Young Marines Emergency Contact and Medical Consent Form (YMFORM2) � Young Marines Contract and Obligation (YMFORMs 3 and 3A) � Young Marines Photo Release Form (YMFORM 4) � Authorization for Medical Treatment (YMMEDFORM1) � Permission to dispense prescription drugs (YMMEDFORM2) � Health History (YMMEDFORM3) � Immunization Exemption Request Form, if applicable � Physical Examination Form (YMMEDFORM4) � Sick Bay Log (YMMEDFORM5) � Medication Incident Report (YMMEDFORM6) � Injury Report Form (YMMEDFORM7) � Attending Physician’s Statement (YMMEDFORM8)

• Right Interior Side of the YMRB

� Young Marines Administrative Remarks Form (YMFORM5) � Non-YM: Recognitions, Awards, Certificates, Certifications, School Report

Cards, etc. NOTE: Former requirement no longer necessary

� Printed copy of YM Record book from YMDBS (Must be updated quarterly in hardcopy, old copy to be given to Young Marine or disposed of by shredding.)

Safeguarding the YMRB The Adjutant is responsible for safeguarding record books. It is very important to safeguard the YMRB because Young Marines and their families provide confidential information for the benefit of the UC. Personal privacy and information given in confidence must never be breached. Keep record books in a secure place such as a locking file box or cabinet. When the record book is not in a secure place, it must be in the possession of the Adjutant, unless requested by the UC or XO in the performance of their duties. Record books must be on hand (physical copy or electronic access to YMDBS) at every drill or YM activity.



YMRB Management. Keep record books up to date.

• Interview Young Marines regularly and review the YMRB to ensure that changes are properly recorded.

• The Adjutant must anticipate what activities and events on the unit-training schedule will require documentation in the YMRB.

• Ensure paper copies of any documentation (i.e. report cards, sport certificates, etc…) turned in by Young Marines are kept in the YMRB and if applicable inputted into the YMRB online.

• Check documentation submitted with the Awards Manual to see if a ribbon is warranted. Surrendering the YMRB. The YMRB is the property of the Young Marine parent/legal guardian, not the unit. In the event the Young Marine moves or transfers to another Young Marine unit, the UC will surrender the YMRB, in its entirety, to the Young Marine’s parent or legal guardian. A copy of the YMRB with the most up to date database record book information must be kept for a two-year period. Then the file is properly disposed of; preferably by shredding or burning. Maintaining Young Marines Record Books (YMRB) On-Line.

• All YMRB forms can be created, updated, and printed from the Young Marines Database System. Once the Young Marine’s information is placed in the system, the unit can update individual Young Marine’s personal and performance information in the YMDBS.

• Units may also print Young Marine identification cards and certificates. • If a Young Marine attends a Leadership School it is the unit’s responsibility to enter the PFT

scores. What Goes Where in the Record Book? Is it community service or unit activity? What is a non-YM award? What is a non-YM activity? Below are definitions and examples that fall in each category. Definitions

• Unit Activity – Any organized activity that is not considered Community Service. o Drill o Encampment o Fund Raiser o Weekend Activity o Summer Trips o Study Night

• Community Service - Services volunteered by individuals or an organization to benefit a

community or its institutions. o Parades o Park Clean-up o Color Guard outside the Unit o Veterans Assistance

• Non-YM Activities (Formerly - Outside Activities) – any activity the Young Marine participates in

outside of the Young Marine. o Sports o Youth Group o JROTC o Sea Cadets o Scouts o Clubs



• Non-YM Award (formerly Personal Awards) – Any award given to a Young Marine outside the Young Marine program o National Honor Society o Presidential Volunteer Service Award o Unit Created Awards o School Awards

Unit Management

• Unit Awards: YM Unit Awards are entered by the issuing authority; National, Division, Regiment or Battalion. Community/Non-YM Unit Awards are entered by the Unit.

• Authorized Users – Those Registered Adults determined by the UC to have access to the YMDBS. Unit Commander, Unit XO, Unit Adjutant and Unit Paymaster must be identified and position title added to their profile page.

• Demographics: Vital unit information must be kept updated.

o Unit Commander and Executive Officer elections and changes. o Contact Information, Shipping, Mailing and Meeting Addresses o Point of Contact information for the youngmarines.com Unit’s Contact Us page and Unit

Locator.

• Inventory: Every unit has inventory.

o The unit’s initial gear issue of flags, flag poles, etc., must be entered. o Refer to “Unit Inventory List”: Office and other equipment (especially serialized numbered

equipment, list serial number), vehicles, camping gear, etc. o When updating inventory to show items that have been distributed or disposed of, follow these

steps: Click EDIT next to the item you are updating. Change the quantity to show the correct number still in inventory, In the notes field state whether the item was:

� Disposed of because it was unserviceable or broken. Note: It is a good idea to upload photos of items to show damage if recording a disposal.

� Distributed – fundraiser/auction item � Distributed – issued to YM or RA � Lost/stolen

Once documented, click the SAVE button.

• Invoice History: Displays all current and paid invoices.

• Rust Insurance Agency: Electronic Special Event Questionnaire required for any unit or YM activity taking place outside of the Unit’s regular drill location as listed in Unit Demographics.

Step-by-step YMDBS tutorials are available in the Admin folder of the Library.



Record Maintenance

• Select Registered Adult

Landing Page: Individual adult records can be viewed and maintained.

• Select Young Marine

Landing Page: Individual Young Marine records can be viewed and maintained.

Data Entry Almost all activities will be entered using this menu item. The data types available are:

• Unit Activity • Community Service (Public Color Guards are entered here) • Drug Demand Reduction • Swim Qualification • Training Subjects • Gear • Non-YM Awards • Non-YM Activities • Leadership Assignments • Leadership Schools (Entered by National Headquarters) • Guidebook Completion Exam • Rank • Adult Awards



PFT’s and PFT Imports - Every Young Marine is required to take the Physical Fitness Test at least twice per year; once between January 1 and June 30 and once between July 1 and December 31. Scores may be entered individually in “PFT’s” or using the uploadable PFT Import sheet.

• Minimum passing score is 200 for YM Recruit, Private, Private First Class and Lance Corporal. • Minimum passing score is 250 for YM-Corporal and above. • Every passing score qualifies for the Physical Fitness Ribbon Award with appropriate device. • Use of Excused Events is for medical reasons only.

o Do not use if YM misses a PFT due to absence.

YM Award & Batch Entry - See Awards Manual for all award qualifications.

• YM Award enables individual awards to be entered. • YM Award Batch Entry allows one award entry for multiple Young Marines.

YM Status Matrix - Helps to track the three most perishable items in a YM’s record book.

• Drug Demand Reduction (DDR) Hours • Physical Fitness Tests (PFT) • Community Service Hours

YM Promotion Matrix – Helps track the Young Marines’ progress toward their next promotion using:

• Billets (Leadership Assignments) • Awards • Leadership Schools • Guidebook Completion Exams • Guidebook Completions • Performance Objectives (Training Subjects) • PFT Scores

Discharge a Young Marine (RAM Ch. 9.9)

Types of Discharges. There are two types of discharges, a Young Marine Discharge and a Young Marine Retirement. The Young Marines in attendance at the 2011 Young Marines Symposium recommended there be discharges for Young Marines who fall into one of the two categories explained below. The National Executive Director agreed and thus the following discharge criteria are to be followed when a Young Marine leaves the organization. REGISTERED ADULT MANUAL (Revised 5/2013) Pages 9-5 and 9-6.

a) Young Marine Discharge. Young Marines are authorized to be presented the official discharge certificate from the organization upon fulfilling the following;

i. The Young Marine has more than one (1) complete year but less than five (5) years in the organization.

ii. The Young Marine has no serious disciplinary infractions since joining the organization. b) Young Marine Retirement. Young Marines are authorized to be presented the official discharge

certificate along with the official retirement certificate from the organization upon fulfilling the following;

i. The Young Marine has at least five (5) years of consecutive service. ii. The Young Marine has earned at least two (2) Good Conduct Awards. iii. The Young Marine has earned the Drug Demand Reduction (DDR) Ribbon appropriate to

the rank they hold. iv. The Young Marine has no serious disciplinary infractions since joining the organization.



c) Requests for discharges are made to the Unit Adjutant who will verify the years of service as well as the other requirements as listed above. The unit shall award these certificates in a manner that is typical of celebration. Preferably the discharge should be awarded in front of the Young Marine’s peers in formation. A short biography of the Young Marine’s time in the organization could be read and any awards due the Young Marine should be presented as well. For retirements, the unit could add a cake following the formation or other celebratory items/events. In either case, these proceedings should be indicative of the Young Marine’s career. This is also a good time to turn over the hard copy of this Young Marine’s record book to the YM (if 18) or the parents.

d) The Young Marine Discharge and the Young Marine Retirement certificates are located in the YMDBS under the Forms/Reports menu item.

Young Marines who do not qualify for a Discharge or Retirement shall be placed in Inactive Status until Re-Registration removes them from the unit roster.

To Discharge a Young Marine in the Database:

1. Select Record Maintenance.

2. Select the Landing Page of the Young Marine to be discharged.

3. Select Discharge Young Marine from the Profile Actions.

4. Select the Reason for the discharge from the dropdown.



5. Enter Notes regarding the discharge. Select Save.

NOTE: This action is final once Save is selected. If a discharge is mistakenly entered, please contact Young Marines National Headquarters for assistance. Forms

Adjutants are required to keep on file an original of all National Headquarters forms. All forms are available in the Library located in the YMDBS or youngmarines.com. The forms are:

• Federal Tax Identification and 501(c)3 letter • Adult Application and Background Check Procedure • Background Check Self Registration Letter • Adult Volunteer Application • YM Recruit Enrollment Package

o YMFORM1 – Personal Information o YMFORM2- Emergency Contact Information o YMFORM3 & YMFORM3A– Young Marine Contract and Obligation o YMFORM4 – Photo/Video/Film Release o YMFORM5 – Administrative Remarks Log o YMMEDFORM1 & YMMEDFORM2 – Authorization for Medical Treatment o YMMEDFORM3 – Health History o YMMEDFORM4 – Physical Examination (To be completed by physician) o YMMEDFORM5 – Sick Bay Log o YMMEDFORM5A – Sick Bay Medication Log o YMMEDFORM6 – Medication Incident Report o YMMEDFORM7 – Injury Report o YMMEDFORM8 – Attending Physician’s Statement

• YMFORM6 – Incident Report • YMFORM6A – Incident Report Follow Up • YMFORM6B – Incident Report Statement • Change of Command Notice • Official Termination of Unit Form • Unit Transfer Request Form • Rust Insurance Policy and Forms • Standard Activity and Training Form (for use at higher HQ events) • Young Marines National Headquarters Directory

*Additional forms are located in the Library.



The following forms must be updated annually or as required by change in information to include updating the information in the YMDBS:

• YMFORM1 – As required by change of information • YMFORM2 – As required by change of information • YMMEDFORM1 – Must be updated annually • YMMEDFORM2 – Must be updated annually • YMMEDFORM3 – Must be updated annually • YMMEDFORM4 – Physical Examination – Should be updated annually on or about physical exam

anniversary date. • Medical Insurance Card – (Copy of front and back of card) – as required by change of information

SPACES Process Slots fill quickly – Communicate information to all in the unit, plan, and Register Early! Much of the success of SPACES depends on the Young Marines unit staff communicating with the Young Marines and their parents/guardians prior to registration to ensure YMs are qualified for the event desired. Suggested unit steps for announcing SPACES events:

• When the SPACES catalog comes out in October share the link and information with the Young Marines and have a parent/guardian meeting to tell them about SPACES.

o EXPLAIN to Young Marines and parents/guardians: • The descriptions of each event and dates. • The minimum qualifications (age, rank, time in program (TIP), PFT, and other

requirements) • The application fee.

EXPLAIN the application fee includes transportation (airfare, but not unaccompanied minor fees, baggage, and food while traveling), lodging, and meals!

Just an FYI….. YMNHQ’s gets numerous phone calls and emails asking, “When do we need to pay for the airplane ticket?” Of course the answer is: “You don’t! The airfare is included in the application fee!”

• When it is time for registration for SPACES: o Make sure the Young Marines are able to attend the entire event – check and re-check

dates! Check dates to make sure they don’t conflict with family vacations or mandatory school functions!

The last thing YM National Headquarters wants is for a Young Marine’s parent to call YMNHQ in a panic when they get their child’s itinerary email and they have to CANCEL because they didn’t “realize” that they won’t be in town because they have a vacation planned, or there is a mandatory school function. Since that parent has decided to cancel…. That just took a spot away from another Young Marine because there isn’t time to fill that vacancy in the SPACES event!



Be prepared for the registration process before January. Visit the website members.youngmarines.com for instructions, events, descriptions and requirements.

• Mouse over PROGRAMS in the top menu bar to get the drop-down menu.

• Then, click on SPACES

• You will be brought to the screen below:

• Clicking on the SPACES logo will bring you to the current SPACES document containing all the registration and application procedures, event descriptions, costs, timelines and packing lists.

• Once in the document, you will “Click Here” next to How do I apply? You will be brought to the “SPACES Application Process.” Follow the directions to register the unit’s Young Marines and Registered Adults for SPACES events.

• Prior to starting the application process ensure the online

record books are up to date.

o Please refer to the SPACES Manual for qualification requirement including: Enrollment date - Must have one year in YM program by start of the SPACES

event Rank – Record book must show that the Young Marine has met all requirements

for the ranks they have held and currently hold Leadership Schools PFT scores Required quarterly DDR training Required billets for each rank held Any additional requirements listed in event descriptions (i.e., age, swim

qualification, etc.) Use the YM Status Matrix and YM Promotion Matrix in the database



• After registration, Young Marine is set to PENDING - What comes next:

o After registration and the Young Marine is set to pending… Their name and the event will be posted on the Unit’s dashboard in the YMDBS. This is where the paperwork will be available to download (the paperwork cannot be filled out online). This paperwork needs to be emailed to the parent/guardian.

• Directions need to be read and followed. • Everything is filled out on the computer – NOTHING is handwritten, except for the

occasional signature which in most cases can also be digital! • The Unit Commander and Adjutant need to MAKE SURE the paperwork is filled

out correctly and completely! • The unit staff needs to be available for parents to answer their questions. If the

staff doesn’t know the answer… then the staff will need to ask HQ.

• After the paperwork and Young Marine is CONFIRMED – What comes next:

o Explain to parents/guardians that they will be receiving an email from CONCUR TRAVEL with their Young Marine’s Travel Itinerary. The email they listed on the Travel Profile will be where the itinerary is sent.

o Since these reservations are made months before the actual event there are sometimes changes. Anytime there is a change – flight number, arrival time, departure time an email will be sent from AMERICAN EXPRESS GLOBAL BUSINESS TRAVEL. Parents must be conscientious of this and make sure they have the most current itinerary when it is time for the Young Marine’s departure.

o Sometimes flights are cancelled. There is no need to panic. YMNHQ will get the same email and will take of rescheduling the flight and a new itinerary will be sent.

o At this point… If the parent/guardian has questions about the itinerary, unaccompanied minors, etc.…. They can email the HQ’s staff member that made the reservation (included on email of itinerary).

o Once a Young Marine is ticketed they cannot be canceled. If the Young Marine cancels from the event at this point the unit will be responsible for reimbursing National Headquarters for the airfare.

o Explain to parents/guardians that the non-refundable application fee includes airline flights, lodging and meals. Parents/guardians are responsible for any additional costs that may be charged at the ticket counter for unaccompanied minor fees and checked baggage fees imposed by the airlines. Unaccompanied minor fees must be paid round trip at the time of departure from home airport. It is the parent’s responsibility to make all unaccompanied minor arrangements with the airline. YMNHQ will provide the name of the adult picking up the Young Marine. Young Marines must have monies to pay for checked baggage for return flight. YMNHQ is not responsible for these charges.

NOTE - If a parent changes the Young Marine’s flight or the Young Marine leaves the event for any reason, this will be at the expense of the parent.



• Young Marines are ready to go… o The UC and/or RA’s make sure the Young Marines are prepared. o They have the SPACES Event’s Clothing and Equipment List and they have everything

they need. o If a Young Marine is flying, make sure they understand what to expect with checking in,

security and TSA (the no-go’s and restrictions), if they have connecting flights and a layover. Talk to the Young Marines if they have a layover…. Pay attention to announcements and gate changes, keep everything with them – do not leave anything lying around – EVER!

o IF a Young Marine misses their flight…. They are going to call their parent/guardian and then their parent/guardian can call the UC. The Young Marines will then call their contact from the event or call the contact number they have for YMNHQ. So HQ can help coordinate

Again…. This is only being mentioned because it has happened! Young Marines sitting at their gate but they miss their connecting flight because they weren’t paying attention and the flight was moved to a different gate. Young Marines miss their flight because they think they have plenty of time and decide to stop and sit down somewhere for lunch… and they miss their flight.

• That’s it... Almost. “Repeat” the same policies for flying home. Finally, parents/guardians will pick up their Young Marines after their summer’s adventure, challenge, or academy and hear about all the wonderful memories that were made! As a courtesy … Communicate that the Young Marine is home! The Young Marines will be given direction in regards to who to contact and how (phone, email, text).

Procedure for when a Young Marine misses their flight? What do we want them to do?



YOUNG MARINES NATIONAL HEADQUARTERS STAFF CONTACTS:

• Unit Administration, National Awards, and Command (Div 1, 2, 3) o Joe Venable o National Hq’s Deputy Director o [email protected] o 800-717-0060 x207

• Drug Demand Reduction, DEA Awards, Unit Administration and Command (Div 4, 5, 6) o Joe Lusignan o Deputy Director-West, Drug Demand Reduction Officer (DDRO) o [email protected] o 509-440-0778

• Special Events and National Director’s Special Programs o Robert Borka o Director of Operations o [email protected] o 800-717-0060 x200

• Adjutant Duties and Responsibilities and Database Administration o Patricia Borka o Director of Administration o [email protected] o 800-717-0060 x204

• Training, DOM Awards, Awards Manual, YM Guidebooks, and SPACES o Michael Guiles o Director of Training o [email protected] o 800-717-0060 x203

Alvin Hendricks Training Coordinator [email protected] 800-717-0060 x202

• Young Marines University o Stephanie Guiles o Director of Education o [email protected] o 800-717-0060 x201

• Invoices, Payments o Mike Tracy o Director of Finance o [email protected] o 800-717-0060 x205

mailto:[email protected]










Young Marine Forms Catalog

• Federal Tax Identification and 501(c)3 letter

• Adult Application and Background Check Procedure

• Background Check Self Registration Letter

• Adult Volunteer Application

• YM Recruit Enrollment Package

o YMFORM1 – Personal Information

o YMFORM2- Emergency Contact Information

o YMFORM3 & YMFORM3A– Young Marine Contract and Obligation

o YMFORM4 – Photo/Video/Film Release

o YMFORM5 – Administrative Remarks Log

o YMMEDFORM1 & YMMEDFORM2 – Authorization for Medical Treatment

o YMMEDFORM3 – Health History

o YMMEDFORM4 – Physical Examination (To be completed by physician)

o YMMEDFORM5 – Sick Bay Log

o YMMEDFORM5A – Sick Bay Medication Log

o YMMEDFORM6 – Medication Incident Report

o YMMEDFORM7 – Injury Report

o YMMEDFORM8 – Attending Physician’s Statement

• YMFORM6 – Incident Report

• YMFORM6A – Incident Report Follow Up

• YMFORM6B – Incident Report Statement

• Change of Command Notice

• Official Termination of Unit Form

• Unit Transfer Request Form

• Rust Insurance Policy and Forms

• Standard Activity and Training Form (for use at higher HQ events)

• National Young Marines Headquarters Directory

Registered Adult Volunteer Application and Background Check Procedures

NEW

APPLICATION: The most recent Volunteer Registered Adult Application is in the Adult Volunteers folder of the Library located in the database and youngmarines.com website. It can also be found on the Volunteer page of the website. This application is to be completed by the applicant and reviewed by the Unit Commander. Adult Volunteer Registration is $20.00 payable from UNIT FUNDS to Young Marines National Headquarters. Please ensure the application is complete before sending it to National HQ. The application MUST contain the following:

• Full Name (no nicknames) • Social Security Number • Phone Numbers • Correct and current email address • Military service information to include:

o Active duty: Statement of Service letter from current OIC o Former military: DD214 containing the Character of Service or Type of Discharge:

“Honorable” and/or the individual’s Reenlistment Code. • Former Young Marine information (if applicable) • ALL Reference information from the three letters • Payment type (please do not leave blank if paying through the database. Mark “Online”) • Approval Recommendation, Appointment, T-shirt and cover sizes • Photo

o Must be attached to the page o Must be COLOR o Please try to provide a CLEAR head and shoulders picture o DO NOT use photocopy of Driver’s License or Government ID

• Letters of Reference MUST contain: o Date o Referee’s information

Mailing Address Phone Number Name of Referee Signature

o Form letters will not be accepted. Letters must be written by the referee. Referees must not be a YM Registered Adult or family member of the applicant. Referee must have known the applicant for a period of one year or longer.

Please use the Unit Commander’s Checklist to review the application and include it with the application to HQ.

1 | RAV Application and BG Check PCB 2015Dec1


NEW

BACKGROUND CHECK: To comply with federal regulations, the volunteer application and background check process are to be kept separate. Once a completed application has been reviewed and accepted by the YM Unit Commander, the unit shall then give the Background Check Self Registration Letter to the applicant. This letter explains the process that must be followed to complete the mandatory background check. The letter can be found in the Library. The letter may be given electronically as it contains a hyperlink to the website. This will enable the applicant to copy the code, select the hyperlink into the system, then paste the code into the appropriate field.

Once the applicant has completed the input process on the National Center for Safety Initiatives website, they will pay NCSI directly for the background check. The price is $20.00 plus a $1.25 processing fee. Some applicants will be required to pay county “Pass-Through” fees. These fees are applied by the county of longest residence within the last 5 years. No applicant will be made to pay fees for more than one county. The Background Check County Fees list is posted in the Library.

Once an Adult Volunteer application is received by HQ and entered into the database, the pending RA will be placed in “Awaiting Application Review” status. Once the application has been reviewed and confirmed complete, the pending RA status will change to “Awaiting Background Check”. The background check process can take 10 days on average. NCSI will handle all aspects of the background check process including all adverse action notifications, verifications, and challenges. YM HQ will receive a “Red Light/Green Light” approval notification from NCSI based on their results. Once this approval is received, the status will be updated to “Awaiting Director Approval” if green lighted. Once approved, the status will change to “Approved”. Only then can the RA be involved with the Young Marines and Unit activities.

Frequently Asked Questions:

• Why did YM HQ change background check procedures? o YM HQ has changed the background check provider due to a rate increase and new

federal regulations. Checks from IntelliCorp were previously less than $2.00. After the increase, the cost average was around $35.00 after fees. All county pass-through fees were also added on to the cost. This cost was paid for by National Headquarters, over and above the $20.00 registration.

• Why National Center for Safety Initiatives? o It was found that the background checks provided were not done to the extent or

satisfaction required by a high-risk organization like ours. National Center for Safety Initiatives (NCSI) proved to offer the most in-depth and accurate search for the best price. NCSI specializes in volunteers who work with youth and at risk populations.

• Who needs to go through the NCSI background check? o All new applicants are now responsible for obtaining and paying for their background

check using the contracted provider NCSI. o Any Registered Adult who allows their registration to lapse for more than one year.



NEW

• Why are we paying more for our background checks?

o The increase in prices would have had to have been passed on to the applicants in some way, if not this than with an increase in the application fee.

• Can we use a different company for our background checks? o Background checks from other entities are not accepted by YM National HQ.

Background checks obtained through NCSI may be shared with other volunteer organizations.

• Do active military, Federal employees, police, firefighters, teachers, etc. have to do a background check?

o ALL applicants are required to do the background check, even active duty military.

The whole background check process is to further ensure the safety of our Young Marines, fellow Registered Adults, Units and the Young Marines as an institution.


Dear Registrant: Young Marines of the Marine Corps League welcomes you to background screening with National Center for Safety Initiatives (NCSI). Please follow the directions below to start the process. Simply go to www.ncsisafe.com and click on “Start Your Background Screening Now”. Complete three easy steps:

Step 1: Enter Self Registration Number: 44172687 Step 2: Enter Your Information as Requested Step 3: Provide Legal Authorization and Certification

It is important when entering your name, that you use your full legal name as written on your current ID (state driver’s license, passport or state ID with name and DOB). Please also verify that your social security number was typed correctly. Using nicknames or failing to type a correct social security number may delay or invalidate your background check. NCSI will contact you directly if there are any questions, problems or issues related to your specific information. An email address is required when completing the background check is our contact with you will largely be electronic. Please be sure to add ncsisafe.com to your list of acceptable domains in your email program to receive notifications from us. If you have any questions or problems submitting your information, please email [email protected] or call the NCSI at (440) 542-9833 or toll free (866) 833-7100. Once you have submitted your information you will receive a confirmation page with a 16-digit Applicant ID Number. The background check generally takes 10 business days to complete and you may check your status on our website under the "Check Your Background Screening Status" link at www.ncsisafe.com. Thank you for your cooperation in this important process.


Dear Applicant, On behalf of the thousands of Young Marines and registered adult volunteers, I would like to welcome you to the Young Marine family. Since our early beginnings, all we have tried to do is to provide a structured and disciplined environment for those youngsters who will eventually make up the nucleus of your organization. Our approach is a tried method that has been so successful that other countries have adopted our mission, goals and objectives, and guiding principles. And we do it the old fashion way, with firmness, fairness, dignity, and compassion. Our Young Marines have become so engaged in the activities of their communities that the communities have come to expect that they can count on their Young Marines wherever and whenever they need help. Similarly, we are there to lend encouragement and support to that element of our society that is most vulnerable, our youth. You will likely make a lasting impact on the lives of those Young Marines that you have the chance to lead and mentor. The National Headquarters staff is at your disposal to lend any and all assistance that we can to make your job just a little bit easier. We will offer periodic training opportunities in your area and, once a year host the Adult Leaders Conference. In addition, we have available to you on our web site at www.youngmarines.com our Registered Adult Manuals. The rewards will be numerous and will likely be reflected in the eyes of those with whom you have had a positive impact. Thank you in advance for your interest and time in helping with “Strengthening the lives of America’s Youth.” Semper Fidelis

http://www.youngmarines.com/

VOLUNTEER REGISTERED ADULT APPLICATION All parts of this form must be completed. Please use capital letters. Attachments required

are marked with a check √. The application will not be accepted without the required attachments.

FIRST NAME: MIDDLE NAME: LAST NAME: MAIDEN NAME: DATE OF BIRTH: MARITAL STATUS:

Single Married SOCIAL SECURITY NUMBER: Divorced Widowed HOME PHONE: CELL PHONE: WORK PHONE: EMAIL ADDRESS: CURRENT ADDRESS: CURRENT EMPLOYER: EMPLOYER PHONE: √If currently employed by the U.S. Military, please include a Statement of Service from your OIC. CIVILIAN SCHOOLS, COURSES AND YOUTH ACTIVITIES:

YES NO If YES, complete the following. √Please include a copy of most recent DD214 or equivalent showing the condition of discharge. BRANCH OF SERVICE: ENLISTMENT DATE: MILITARY SCHOOLS ATTENDED: MOS: HIGHEST RANK: DID YOU INSTRUCT? DATE OF DISCHARGE: YES NO COURSES INSTRUCTED:

FORMER YOUNG MARINE: FORMER UNIT(S): YES NO CURRENT CERTIFICATIONS AND/OR LICENSES: (example: EMT, Range Master, etc.) √Please include copy of all certifications and licenses.

PERSONAL INFORMATION

MILITARY SERVICE

ADDITIONAL INFORMATION

M M D D Y Y Y Y

REFERENCES √Attach a character letter of reference from each referee below. The names and information listed below should appear on each signed letter. Referees should not be a relative or Young Marine Registered Adult. Form letters will not be accepted.

√Attach a current color photo in the space provided below:

APPOINTMENT TYPE To be completed by the Unit Commander

PHOTO

$20 PAYMENT TYPE: REFERENCE 1 Unit Check Unit Debit Card Online Name, Address, Phone Number: Name on Card: Card Number: Expiration Date: UNIT: REFERENCE 2: Name, Address, Phone Number:

UNIT COMMANDER: (Print Name) RECOMMEND APPROVAL? YES NO √If NO, attach explanation.

SPECIFIC APPOINTMENT TYPE: UC Adjutant Unit Staff REFERENCE 3 XO Paymaster Support Staff Name, Address, Phone Number: APPLICANT COVER SIZE:

XXS XS S M L APPLICANT SHIRT SIZE: S M L XL XXL

Please Place Current Color Photo Here Head and Shoulder

(Please do not attach copy of Driver’s

License or Government ID)

Before signing this application form, the applicant must have received, read, accepted and understood the following conditions of membership: CONDITIONS I hereby certify that I have received, read, accepted and understood the Young Marines Registered Adult Manual and By-Laws. I have also read, accepted and understood the following Registered Adult’s Obligation and Registered Adult Code of Conduct. REGISTERED ADULT’S OBLIGATION I do solemnly swear or affirm to support and abide by the By-laws, rules and regulations that govern the Young Marines Program. I bear true faith and allegiance to the spirit and fundamental principles of the same. I understand that I am expected to always serve the greater good over my personal interests. I take this obligation freely and without mental reservation to the service for which I am about to enter, so help me God. REGISTERED ADULT CODE OF CONDUCT The Young Marines have a policy that physical force and verbal abuse are prohibited and defamatory remarks will never be used in the presence of Young Marines and Young Marine Recruits. Physical Force: Physical force is the physical touching, holding or striking of another with any object for the purpose of restraining and/or inflicting pain. Physical force shall never be used to instruct, correct, or discipline Young Marines or Young Marine Recruits. However, a minimum of physical force may be used under these conditions:

a. To break-up a physical altercation, b. To protect others, and c. To protect yourself.

Verbal Abuse: Verbal abuse is a direct or indirect expression by word of mouth, written communication, body language, or physical gesture from one person to another with expressed purpose to threaten, demean, denigrate, belittle, or harass. The use of profanity is considered a form of verbal abuse and shall never be used in the Presence of Young Marines or Young Marine Recruits. Defamatory Remarks: Defamatory remarks are generally offensive and intended to purposely disparage targeted individuals and groups of a racial, gender, religious, social, political, and ethnic nature. I certify that I have read and understand the Registered Adult Code of Conduct and agree to abide by said code. I also understand that it is the policy of this program to have a zero tolerance of any type of abuse of its members.

All of the above information is true to the best of my knowledge. I further understand that I may be denied association with the Young Marines program without explanation at any time.

Applicant Unit Commander National Executive Director or Deputy Director

Attachments:

3 Letters of Reference DD214 Statement of Service Letter Letter of Explanation

SPECIAL CONSIDERATIONS

STATEMENT

SIGNATURES AND DATES

Name Signature Date

Name Signature Date

Name Signature Date

Young Marines Unit

Applicant Name

Applicant: Fields marked “X” are not complete.

Please complete and return to Unit Commander for review. This form must accompany the Volunteer Registered Adult Application.

Payment Provided:

Unit Check #: ___________ Payment Amount: $ __________

Unit Debit Card Online Unit Debit Credit

1st attempt 2nd attempt

Page 1 Applicant provided their legal name including middle name on application.

Page 1 Date of birth and social security number have been verified.

Page 1 Applicant indicated military and Young Marine service. Page 2 The Unit Commander printed name, unit name, and checked yes or no for recommended approval.

Page 2 All 3 references (name, address, and phone number) are written in the reference area

Page 2 Appointment Type (specific position, t-shirt, and cover sizes)

Page 2 There is a color photo of the applicant attached to page two of the application. Page 3 The applicant printed, signed and dated the Date and Signature fields provided on page three of the application.

Page 3 The Unit Commander printed, signed and dated the Date and Signature fields on page three of the application.

Skip if applicant is not prior Military. The applicants’ DD Form 214 is attached. Skip if applicant is not Active Duty. Statement of Service is attached. Letter of Character Reference #1 has a date, mailing address, phone number and signature.

Letter of Character Reference #2 has a date, mailing address, phone number and signature.

Letter of Character Reference #3 has a date, mailing address, phone number and signature.

Copies of current certifications and/or licenses are attached.

UNIT COMMANDER’S CHECKLIST

Table of Contents

Select YMFORM to go to that page

Personal Information………………..……..……..……………YMFORM1

Emergency Contact…………………..……...……….………..YMFORM2

YM Contract and Obligation…………........……….………….YMFORM3

YM Code of Conduct…………………….………….………YMFORM3A

Photo/Video/Film Release………………….…….……………YMFORM4

Administrative Remarks Log………………………………….YMFORM5

Authorization for Medical Treatment………......………..YMMEDFORM1

Permission to dispense/Medication List…………………YMMEDFORM2

Health History……………………………………………YMMEDFORM3

Physical Examination…………….………………………YMMEDFORM4

Sick Bay Log………………………………………..……YMMEDFORM5

Sick Bay Medication Log……………………………....YMMEDFORM5A

Medication Incident Report………………………………YMMEDFORM6

Injury Report……………………………………….……..YMMEDFORM7

Attending Physicians Statement………………………….YMMEDFORM8

Young Marine Record Book

Personal Information Part I

Enrollment Date: ________________________ Rank: ____________

Last Name: ________________________ First Name: _________________ Middle Initial _____

Male/ Female: _______ Date of Birth: ______________ Social Security Number: ____________

Young Marine’s Email Address: ___________________________________

Home Street Address: ___________________________________________

City: ___________________ State: ____________ Zip Code: _________

Living with: _____Mother & Father _____Mother _____ Father _____Legal Guardian

Mother’s Information

Last Name: ______________________ First Name: _______________ Middle Initial ______

Home Street Address: _______________________________________________________

City: ________________________ State: _____________ Zip Code: _____________

Home Phone: (____)_____________________ Work Phone: (____)_______________

Cell Phone: (____)____________________ Email Address: _____________________________________

Father’s Information

Last Name: _______________________ First Name: _______________ Middle Initial _______

Home Street Address: _______________________________________________________

City: ______________________ State: ______________ Zip Code: _____________

Home Phone: (____)__________________ Work Phone: (____)____________________


Legal Guardian’s Information

Last Name: _________________________ First Name: ________________ Middle Initial: _____

Jurisdiction and Court Docket Number: _______________________________________

Home Street Address: _____________________________________________________

City: __________________________ State: _______________ Zip Code: ___________

Home Phone: (____)__________________ Work Phone: (____)___________________


(YMFORM1)

Primary Emergency Contact

(Check if applicable) Contact is the same as: ____Mother ____Father ____Legal Guardian

Last Name: _______________________ First Name: _______________ Middle Initial.: ______

Home Street Address: ______________________________________________________

State: ______________ Zip Code: ____________ City: ______________________

Home Phone: (____)__________________

Cell Phone: (____)___________________

Work Phone: (____)____________________

Email Address:______________________________________

Alternate Emergency Contact Information (Other than Parents/Guardian)

Alternate #1

Last Name: _______________________ First Name: _______________ Middle Initial: ______

Relationship: _______________________


City: ______________________ State: ______________ Zip Code: ____________



Alternate #2

Last Name: _______________________ First Name: _______________ Middle Initial.: ______

Relationship: _______________________


City: ______________________ State: ______________ Zip Code: ____________



Medical Insurance Information (Please provide copy of front & back of medical card)

Name of Medical Insurance Company: ________________________________________

Policy Number: __________________________________________________________

Contact Telephone Number: (____)________________________

(YMFORM2)

Tshirt and Cover Sizes

YM Tshirt Size: ____ YM ____YL ____S ____M ____L ____XL ____XXL ____3XL

YM Cover Size: ____XXS ____XS ____S ____M ____L

Young Marine Contract and Obligation

PLEASE COMPLETE, READ, AND SIGN

Last Name ___________________________First Name ____________________Middle Initial ______

UNDERSTANDING AND CONDITIONS

1. I understand that I am joining the Young Marines of my own free will and desire. I know that the training will be

challenging, but I will accept it and shall always try to do my best.

2. I understand that I am bound to obey all orders and instruction given from time to time by instructors, staff and Young

Marines appointed over me in accordance to the rules and regulation governing the discipline of the Young Marines.

3. I understand as a Young Marine in good standing I have the following rights:

• Attend scheduled meetings, events and activities that are purposeful, planned and organized.

• Meet in a safe, drug and tobacco-free environment under the supervision of Registered Adults.

• Be treated fairly with dignity and respect.

• Have opportunities to succeed and excel.

• Report any inappropriate action by other Young Marines or adults.

• Receive a copy of the Young Marines Esprit Magazine in the Fall, Winter, Spring, and Summer.

4. Young Marine - Core Values. Every United States Marine upholds the core values of Honor, Courage and

Commitment. These values give Marines their strength, regulate their behavior, and bond them together into a force, like no

other, capable of overcoming every obstacle and meeting any challenge. The Young Marines’ Core values are Discipline,

Leadership and Teamwork.

a. Discipline. Discipline requires that Young Marines show instant willingness and obedience to the rules of the Young

Marine program, their parent’s rules, and the laws of the land. Discipline also dictates a respect for authority. Young

Marines will:

1) Follow all rules and regulations set forth in the Young Marine Guidebooks and manuals.

2) Follow the rules of the home and of their parents, completing chores, obeying curfews, and assisting in the home

when needed.

3) Follow all laws of our government and have respect for our leaders, police and those in charge of us.

b. Leadership. Leadership is the ability to influence others. A good leader is able to effectively pass on from their

leaders all that is expected to be accomplished. A true leader leads by example. Young Marines will:

1) Aspire to positively influence the fellow Young Marines all the time.

2) Accomplish their mission by completing all tasks assigned by their leaders and those in charge of them from their

parents, teachers, coaches and Young Marine adult leaders.

c. Teamwork. Teamwork is co-operation between those working together on a task. To truly understand teamwork,

Young Marines must learn to listen to their leaders and peers, ask questions to ensure complete understanding,

persuade their team that they can accomplish the mission, respect those on their team and their suggestions, help those

on their team to accomplish the mission, share in the glory and the failures of the team, and participate in the task as a

member of the team. Young Marines will:

(YMFORM3)

1) Always work together to accomplish the mission..

2) Keep their team motivated at all times even when the mission or task is not a popular one.

3) Not grab all the glory for a team effort, but spread it amongst all team members.

5. Young Marines Code of Conduct.

a. Article I:

(1) I am an American youth, proud of my country and our way of life. I am prepared to dedicate myself to educating

others and myself in the history, traditions, and institutions thereof. I will do my best to live by the core values of

Honor, Courage and Commitment, Discipline, Leadership and Teamwork.

b. Article II:

(1) I will never let another Young Marine down of my own accord. If in-charge, I will do my best to ensure the

safety and well being of those for whom I am responsible. I will immediately report any suspicious activity or

behavior to a registered adult.

c. Article III:

(1) If I am offered drugs, alcohol, or tobacco products, I will politely resist and refuse. I will make every effort to

stay clear of situations involving gangs, drugs, alcohol, and tobacco. I will not get involved in the same. I will

also aid my friends and schoolmates to stay clear of similar situations.

d. Article IV:

(1) I will always be loyal to my fellow Young Marines. I will make no statements nor take part in any action that

may bring discredit to my God, country, family and Young Marines. If I am the senior Young Marine present, I

will take charge. If not, I will obey the lawful orders of those senior to me and support them in everyway.

e. Article V:

(1) When asked about the Young Marines Program, I will answer questions politely, respectfully and to the best of

my ability. If I am asked a question that I do not know the answer to, I will refer the person asking the question to

a registered adult. I will never give information that I am not certain of nor mislead those who are seeking

information about the Young Marines Program.

f. Article VI:

(1) I will never forget that I am an American Youth and therefore the future of America, privileged with the freedom

won and kept by the blood of those who fought to ensure our freedom. I am responsible for my actions, and

dedicated to the principles that made my country free.

YOUNG MARINES OBLIGATION

From this day forward, I sincerely promise, I will set an example for all other youth to follow and I shall never do anything

that would bring disgrace or dishonor upon my God, my Country and its flag, my parents, myself or the Young Marines.

These I will honor and respect in a manner that will reflect credit upon them and myself. Semper Fidelis.

Young Marine __________________________ Date __________

Parent/Legal Guardian ___________________________ Date __________

(YMFORM3A)

PHOTO/VIDEO/FILM RELEASE

The Young Marines may encounter the news media, video and film crews, or photographers hired by the Young

Marines for the purpose of taking promotional or publicity photographs, video or film. There is a possibility that

students and adults attending programs will be photographed. I give my consent to authorize the Young Marines of

the Marine Corps League, or any entity or person authorized or designated by them the use and reproduction of any

and all photographs, video or film taken of the person named as the subject of this application during Young Marine

training or related activities. I understand there will be no compensation to me. All negative and positives, together

with said prints, video or film are the property of the Young Marines of the Marine Corps League or the entity or

person authorized or designated by it, solely and completely. I also waive any right to inspect or approve any photo,

video or film taken during said training or related activities. I affirmatively release and discharge the Young

Marines of the Marine Corps League from responsibility for any distortion or manipulation, whether intentional or

otherwise, of photos, video or film taken of your child while a participant in the Young Marine Program.

PERMISSION & WAIVER

I/We, the undersign, do hereby certify that I/We have read and fully understand the attached release and waiver; that

I/We have fully consented to such release and waiver and expressly give this minor permission to participate in the

Young Marines Program. Furthermore, I/We certify that this application is complete, correct, and true to the best of

my/our knowledge.

(YMFORM4)

_____ I hereby agree with the above stated Photo/Video/Film Release

_____I DO NOT agree with the above Photo/Video/Film Release for the reason(s) of:_______________________

____________________________________________________________________________________________

Mother/Legal Guardian ________________________________ Date __________

Father/Legal Guardian _________________________________ Date __________

Mother/Legal Guardian ________________________________ Date __________

Father/Legal Guardian _________________________________ Date __________

Young Marines

Administrative Remarks Log

PLEASE COMPLETE AND SIGN

Last Name ___________________________First Name ____________________Middle Initial______

LOG ENTRIES

Date Remarks

Signature & Title________________________________

Signature & Title________________________________

Signature & Title________________________________

Signature & Title________________________________

Signature & Title________________________________

Signature & Title________________________________

(YMFORM5)

Authorization for Medical Treatment

PLEASE PRINT (Update for each event requiring medication)

Last Name ___________________First Name _________________Middle Initial______

Age ______ Date of Birth ___/____/____ Social Security Number _________________

Home Street Address _____________________________________________

City _______________ State___ Zip Code ______

Parent/Guardian Name ________________________________

Relationship _______________

Home Street Address ____________________________________________

City _______________ State___ Zip Code ______

Home Number (____)_____________ Work Number (____)_____________

Mobile Number (____)____________ Pager Number (____)_____________

Other Number (_____)____________

PART I: Medical Consent (Parent or Legal Guardian is required to complete)

I certify that I am the parent, legal guardian, or other person in legal control of the above identified child and

request and authorize that my child be administered appropriate first aid and/or taken to the nearest medical

facility for emergency treatment as necessary.

Parent or Legal Guardian _____________________________ Date ____________

PART II: Permission to Use Over-the-Counter Medication (If not completed, Young Marines will

not receive medication)

My child, ___________________________, has my permission to take any over-the-counter

medications in accordance with label instructions as needed with the exception of:

___________________________________________________________________________ while

attending Young Marine Activities.

Parent or Legal Guardian ______________________________ Date ___________

(YMMEDFORM1)

PART III: Permission to Dispense Prescription Medication (If not completed, Young Marines will not

receive medication)

I request and authorize that my child, ____________________________, be administered the following prescription

medication:

______________________________________________________________________________________________per the

medical doctor’s instructions on the original and un-expired pharmacy label. I certify that my child has a valid health reason

for taking the medication during the Young Marine Activities. This permission is valid from (beginning date) __________

to (ending date) __________.

Parent or Legal Guardian _______________________________ Date __________

PART IV: Medication Administration Record

Medication Name __________________________ Strength _____________

Form of Medication: ___ Liquid ____Tablet ___Aerosol ___Ointment ___ Other

Dosage & Time ___________________



Dosage & Time ___________________



Dosage & Time ___________________



Dosage & Time ___________________

(YMMEDFORM2)

Health History (Completed by Parent/Legal Guardian)

PLEASE PRINT (Update Annually)

Note: For the safety and well being of your child ensure all information is true and correct. Your child will NOT be disqualified from the program based on information provided here.

Last Name _________________________First Name _______________Middle Initial____

Age ______ Date of Birth ___/____/____ Social Security Number_________________

Parent/Guardian Name _____________________________________


Physician’s Name ________________________Date of Last Visit _____________

Dentist’s Name __________________________Date of Last Visit _____________

The Subject Young Marine: *Yes No Remarks (“Yes” require

remarks)

Wears Eye Glasses /Contact Lenses

Is on a restricted diet

Wears a hearing aid

Visited the Dentist in the last 6 months

Has known health problems (knee problems, migraines, etc.)

Is under a doctors care

Is on prescription medication

*Has Allergies

Food//Medication//Environmental (pollen, bee stings)

Has heart murmur

Suffered Rheumatic Fever

Had a family member under age 50 die of a heart problem

Suffers one or more of the following conditions:

Seizures, Diabetes, Asthma, Arthritis

Has had a history of head injury

Has been hospitalized or had surgery and dates

Had any injuries (no matter how minor) in the past year. (Sprains,

broken bones, ingrown toenails, stitches)

Date of last Tetanus Shot

I certify to the above to be complete, correct, and true to the best of my knowledge.

Parent/Legal Guardian ______________________________ Date ___________

(YMMEDFORM3)

PHYSICAL EXAMINATION (Must be completed by a Physician, PAC, or CRN)

(A current school or sports physical may substitute, if done during the current school year. A

photocopy must be included in YMRB.)

Height _______ Weight ___________ BP _________ Vision Screen ____________

Hearing ______________________________ Lungs ________________________

Heart Rate _______________ Rhythm ______________ Hernia ______________

Neurological Examination ____________________

Are there any restrictions or accommodations needed for the following activities?

Activities Yes No Remarks (“Yes” require

remarks)

Competitive Sports

Physical Training

Swimming

Classroom

Other

I, certify that ____________________, is/ is not physically and medically fit to participate in the

Young Marines.

Please provide additional remarks or instructions, if participation in the Young Marines is

conditional due to any medical conditions not provided in the remarks above.

______________________________________________________________________________

______________________________________________________________________________

_____________________________________________

Examiner’s Signature ____________________________ Date of Exam _________

Print Examiner’s Name________________________ Title ____________________

Office Address ________________________________________

City _________________________State _______ Zip Code __________

Office Telephone Number (____)_________________

(YMMEDFORM4)

Sick Bay Log

Last Name _________________________________First ________________________Ml______

Date Time In Time Out Reason for visit Treatment AMO Signature

(YMMEDFORM5)

Sick Bay Medication Log Before dispensing any medication verify authorization from Parent (YMMEDFORM1 & YMMEDFORM2) and ensure correct dosage.

Last Name _______________________First Name ______________________ MI ___

(YMMEDFORM5A)

Date Name of Medication

Dosage

(ml)

Qty Time

Given

Reason if Over the counter

medication

AMO1 Initials AMO2 Initials

YOUNG MARINES Medication Incident Report

PLEASE PRINT (Complete and retain for unit records) PART I: Young Marine’s Personal Information Today’s Date _________


Age ______ Date of Birth ____/____/____Social Security Number_________________

Home Street Address _________________________ City _______________ State___ Zip Code ______ Parent/Guardian Name ____________________________________ Relationship _______________

Home Telephone Number (____)___________ Work Telephone Number (____)___________

PART II: Young Marine’s Unit Information

Young Marine Unit Name_____________________________________ Unit Commander Name ______________________________________________

Unit Commander’s Daytime Phone Number (____)_____________

PART III: The Incident and Surrounding Circumstances

Incident involved one or more of the following (Circle one): //Incorrect Dosage//

//Medication given at incorrect time (>1/2-hr) //Dosage missed //Incorrect Medication given//

Date of the Incident __________ Approximate Time of the Incident ___________________

Location of the incident ______________________________________________________

Provide a short description of how the incident occurred: (Include name of drug, dose, and any reaction. Use the back of this form to

complete the description).

____________________________________________________________________________________________________________

____________________________________________________________________________________________________________

________________________________________________________________________________________________

Was the parent or legal guardian notified of the incident? Yes //No (circle one) If yes, by whom?

Name ____________________________ Status ________________

Was hospital/emergency care required? Yes // No (circle one) If yes, submit Young Marine Injury Report, Attending Physician’s

Statement, other medical documents to Young Marines National Headquarters.

PART IV: Unit Commander or Registered Adult in-Charge Certification

I certify this incident occurred during a scheduled Young Marine activity and under the supervision of Registered Adults designated

by me to act as the Activities Medical Officers. They were acting in accordance with the Standard Operating Procedures established

in Appendix D of the Registered Adult Manual. To the best of my knowledge the information provided is correct and true.

UC/RAC Signature_________________________________ Date ___________ Contact Number (____)_____________

(YMMEDFORM6)

YOUNG MARINES Injury Report (PLEASE PRINT) (Complete and mail to Young Marine National Headquarters, P.O. Box 70735 Southwest Station, Washington DC 20024-

0735)

PART I: Injured Person’s Personal Information Today’s Date _________


Age ______ Date of Birth ___/____/____Social Security Number_________________

Home Street Address _______________________________________________________________

City _____________________________________State_____ Zip Code ______________

Parent/Guardian Name ____________________________________ Relationship _______________

Home Telephone Number (____)_________ Work Telephone Number (____)________

Was the parent or legal guardian notified of the injury? Yes No (circle one)

Was hospital/emergency care required? Yes No (circle one) if yes, please attach documents.

PART II: Young Marine Unit Information

Young Marine Unit Name_____________________________________

Unit Commander’s Name ______________________________________________

Unit Commander’s Daytime Phone Number (____)________

PART III: Describe the Injury & Circumstances Surrounding the Injury

Provide a short description of the injury or injuries: (use additional pages as needed.)

________________________________________________________________________________________________________

__________________________________________________________________________________

Date of the Injury __________ Approximate Time of the Injury ________

Location of where injury occurred ________________________________________________________

Provide a short description of how the injury occurred: (who, what, why, and how). Use back of this form or additional

pages as needed.

________________________________________________________________________________________________________

________________________________________________________________________________________________________

____________________________________________

PART IV: Unit Commander or Registered Adult in-Charge Certification

I certify this injury occurred during a scheduled Young Marine activity and that the injury was not pre-existing and the

activities did not involve undue risk outside the scope of the Young Marines Accident and Liability Insurance coverage. To the

best of my knowledge the information provided is correct and true. UC/RAC

Signature______________________________________________ Date ________________

UC/RAC Contact Telephone Number (____)______________

PART V: NHQ Review and Processing

Date Report was Received ______________ Proof of Claim (Accident Medical Expense Form) attached? Yes No (circle one)

Medical Bills attached? Yes No (circle one)

Date Claim forwarded to Insurance Company ___________

Date of Follow-up: ____________ Remarks ______________________________________________

Date of Follow-up: ____________ Remarks ______________________________________________

(YMMEDFORM7)

YOUNG MARINES

Attending Physician’s Statement PLEASE PRINT

(Please complete and mail to Young Marine National Headquarters, P.O. Box 70735 Southwest Station, Washington DC

20024-0735)

PART I: Patient’s Personal Information (To be completed by Young Marine Unit)


Age ______ Date of Birth ___/____/____Social Security Number_________________

Home Address ___________________________ City _______________ State___ Zip Code _______

Parent/Guardian Name ____________________________________ Relationship _______________

Home Telephone Number (____)_________ Work Telephone Number (____)________

PART II: Authorization (To be Completed by Attending Physician)

I hereby authorize NATIONAL ACCIDENT INSURANCE UNDERWRITERS, INC. or its representatives to inspect all x-ray pictures, clinical

records and to obtain full information, including etiology, diagnosis and prognosis, or other data that may be in your possession or under your control, and to make copies of the same or any portion, thereof, pertaining to the subject patient.

Date ____________ Signed ____________________________________________(Attending Physician) (Degree)

PART III: Questionnaire for Attending Physician

1. Diagnosis (describe nature of illness or injury):

__________________________________________________________________________________

_______________________________________________________________________________________________________

________________________________________________________________________________

_____________________

2. Is condition the result of ____illness/ ____injury? (Check appropriate blank)

What date did the illness commence or injury occurred? _______________

3. Has the patient had treatment for the same or related condition before? ____Yes ___No ___ Unknown (Check appropriate

blank) If yes, when and why?

________________________________________________________________________________________________________

__________________________________________________________________________________

4. On what date were you first consulted for this condition? __________

Give dates of treatment(s): In Office _________________________ At Home _____________________________

5. If hospitalized, give name and address of hospital and dates of in-patient care. Name of

Hospital____________________________________ Dates: (From/To) ________________

Hospital Address ______________________________________ City_________________State _______Zip Code _________

Hospital Telephone Number (____)_____________

6. If surgery was performed, please describe:

________________________________________________________________________________________________________

__________________________________________________________________________________

7. Prognosis:

________________________________________________________________________________________________________

________________________________________________________________________________

Date: _________________ Signed: ______________________________________ (Attending Physician) (Degree)

(YMMEDFORM8)

YOUNG MARINES INCIDENT REPORT

PRIMARY DETAILS Page ______of_______ Date of incident:_____________________ Type of incident:___________________________________________

(example; theft, fight, assault, accident, missing property, damaged property, discipline, etc.) Address/Location of incident: ___________________________________________________________________________________________ Young Marine Activity: ___________________________________________________________________________________________

PRIMARY PARTICIPANTS Name: ________________________ Role: ______________________ (Victim, Witness, Offender, Parent, etc.) Date of Birth: __________________ Male/Female_______ Address: __________________________________________________________________________________________ Telephone number: _____________________ Email address: ______________________________________ Name: ________________________ Role: ______________________ (Victim, Witness, Offender, Parent, etc.) Date of Birth: __________________ Male/Female_______ Address: __________________________________________________________________________________________ Telephone number: _____________________ Email address: ______________________________________ Name: ________________________ Role: ______________________ (Victim, Witness, Offender, Parent, etc.) Date of Birth: __________________ Male/Female_______ Address: __________________________________________________________________________________________ Telephone number: _____________________ Email address: ______________________________________ SUMMARY OF FACTS: ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Continued on back: Yes / No Person submitting report_________________________________ Date submitted________________________ Signature______________________________________________

YMFORM6 Incident Report 2015Aug04


ADDITIONAL PERSONS Page ______of_______ Name: ________________________ Role: ______________________ (Victim, Witness, Offender, Parent, etc.) Date of Birth: __________________ Male/Female_______ Address: __________________________________________________________________________________________ Telephone number: _____________________ Email address: ______________________________________ Name: ________________________ Role: ______________________ (Victim, Witness, Offender, Parent, etc.) Date of Birth: __________________ Male/Female_______ Address: __________________________________________________________________________________________ Telephone number: _____________________ Email address: ______________________________________ Name: ________________________ Role: ______________________ (Victim, Witness, Offender, Parent, etc.) Date of Birth: __________________ Male/Female_______ Address: __________________________________________________________________________________________ Telephone number: _____________________ Email address: ______________________________________

PROPERTY Type of Action 1. Stolen 4. Lost 7. Destroyed/damaged/vandalized 2. Recovered 5. Found 8. Safekeeping 3. Evidence 6. Seized 9. Other No._____ Item _________________________________ Brand/model___________________________________

Action#______ Description_____________________________________________________________________

Value: $_______________

No._____ Item _________________________________ Brand/model___________________________________


Value: $_______________



Value: $_______________



Value: $_______________



VEHICLE Page ______of_______ Vehicle Code: __Stolen __Located __Damaged __Other

No._______ License#___________ State___________ Vin_________________________________

Year_______ Make_____________ Model_______________ Style__________________________

Color__________ Special features__________________________

Registered Owner_________________________________________

R/O Address ______________________________________________________________________________

Damage estimate $___________________

Vehicle Code: __Stolen __Located __Damaged __Other

No._______ License#___________ State___________ Vin_________________________________

Year_______ Make_____________ Model_______________ Style__________________________

Color__________ Special features__________________________

Registered Owner_________________________________________

R/O Address ______________________________________________________________________________

Damage Estimate $____________________

ADMINISTRATIVE NOTES:

_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

CONCLUDING REMARKS:

__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________



ADDITIONAL NARRATIVE/ FOLLOW UP Page ______of_______ Incident Classification___________________________ Date originally reported__________________________ Name________________________________________ Role__________________________________________ Address______________________________________________ Phone number________________________ Email address_________________________________________ Date of follow up______________________ Narrative______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ The above statement is given without any threats or promises and is true and correct to the best of my knowledge. Signature___________________________________________________ Date____________________________ ADMINISTRATIVE NOTES ___________________________________________________________________________________________ ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

YMFORM6A Incident Narrative/Follow Up 2015Aug04


STATEMENT FORM Page ______of_______ Name________________________________________________ Date of Birth______/______/________ Address_______________________________________________ Phone___________________________ ______________________________________________ Email____________________________ Statement: ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ The above statement is given without any threats or promises and is true and correct to the best of my knowledge. Signature___________________________________________________ Date____________________________ ADMINISTRATIVE NOTES _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

YMFORM6B Incident YM Statement 2015Aug04

Election/Change Form – Unit Commander

Change of Command_Unit_V3 Revised Apr 2016

Unit Name: ______________________________ Location: __________________________________

Prior Unit Commander: _______________________________________________________________

New Unit Commander: _______________________________________________________________

Shipping Address: ___________________________________________________________________

Home Phone: ___________________________ Work Phone: ______________________________

Cell Phone: ________________________ Email: ________________________________________

I, ____________________________________ assumed the position of Unit Commander of the _________________________ Young Marines Unit on _______________. The election results of Unit Commander are from a regularly scheduled or special election (or vacated UC position) held on _______________ where _______ of the ________ Unit Commanders voted. I assume the role of Unit Commander. *This form must be completed even if the same UC is elected.

Elected as Unit XO: Name: __________________________________________________________

I have updated all Unit information in the Young Marines Database System including the Unit’s shipping address, phone number, email and Contact Us information. I have also verified my home address, phone numbers and email address are current.

Please sign the statement below:

I, ______________________________________ accept the position of Unit Commander of the ________________________________ Young Marines unit located in ________________________.

I understand that it is my responsibility to follow all policies and regulations of the Young Marines National Headquarters. I have read the newest edition of the Registered Adult Manual (posted on-line in the Library) and I am familiar with all policies.

I understand it is my responsibility to ensure: all adults and children working with my unit are registered with Young Marines National Headquarters in the YMDBS, turn in monthly financial reports to Ambassador Accounting on time every month, re-register every year by the deadline established by YMNHQ, record book of all Young Marines remain updated, keep a well-organized staff, and most important… ensure the safety of the children.

This form must be received at the Young Marines National Headquarters with 10 days of election.

______________________________________________ _____________________ Unit Commander Signature Date

Email, Mail or Fax this form to: Young Marines National Headquarters P.O. Box 70735, Southwest Station Washington, DC 20024-0735 [email protected] Fax 202-889-0502

Intent to Close Young Marine Unit

(Please type or print)

Name of Unit: _________________________________________________________________

Name of Current Unit Commander: _________________________________________________

Mailing Address: _______________________________________________________________

_____________________________________________________________________________

Phone Numbers: (H)_________________ (W)_________________ (Cell)___________________

Email: _______________________________________________________________________

Reason for Termination: __________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

PLEASE INITIAL EACH ITEM WHEN COMPLETED

All inventory items have been transferred to the next higher headquarters and or given to other Young Marine units.

All appropriate actions have been taken to close out bank accounts and submit a final financial report to Ambassador Accounting showing a zero balance.

Check from funds has been sent to National Headquarters.

All physical YMRB’s have been given to the Young Marines.

US Flag, Unit Flag and Guidon have been mailed to YMNHQ

By signing this form, the Unit Commander acknowledges that the unit listed above is no longer an active unit within the Young Marine program. This form also serves as an official notice that the unit is no longer meeting or holding any sort of activities.

Any questions or concerns please contact National Headquarters at 1-800-717-0060.

Unit Commander Signature: ____________________________________ Date: ______________

Please mail this form to: Young Marines National Headquarters

P.O. Box 70735 Southwest Station

Washington, DC 20024-0735

Official Termination of Unit: Headquarters Use Only

National Deputy Director: __________________________________________ Date: ______________

Vanguard Ambassador Accounting XMM Email Copy of Check

Registered Adult Unit Transfer Request

Registered Adult Reques ng Transfer: _______________________________________ (Please Print Name)

Registered Adult Signature: ________________________________________________ Date: ______________

Mail or fax this form to: Young Marines Na onal Headquarters

P.O. Box 70735 SW Sta on Washington, DC 20024-0735

Fax 202-889-0502 A scanned copy may also be emailed to [email protected]

*Requires approval and signatures from both Commanders to complete transfer.

From Unit: _______________________________ Unit Commander: _________________________________ (Please Print) (Please Print)

*Commander’s Signature: _________________________________________________ Date: _____________

Recommend Approval Yes _______ No _______ (Please a ach explana on)

To Unit: _______________________________ Unit Commander: _________________________________ (Please Print) (Please Print)

*Commander’s Signature: _________________________________________________ Date: _____________

Recommend Approval Yes _______ No _______ (Please a ach explana on)

YOUNG MARINES Injury Report Form

Young Marine Unit Name Today’s Date

Commanding Officer Date of Injury

Injured Person: Date of Birth: (Last Name, First Name, Middle Initial) Address: Soc. Sec. No.: Telephone: Location/Address where injury occurred: Type of Injury: Was more than one person injured? YES NO Hospital or Medical Facility where injury was treated: Name and Address of Attending Physician: Description of how injury occurred (use additional pages, if necessary): Name, Address and Telephone of Adult Supervisor who was with person when the injury occurred: Witnesses (both Young Marines and Adults). Use additional pages, if necessary Name Address Telephone Will additional hospital/doctor visits be required? YES NO If yes, please explain: Are you conducting an investigation of the accident? YES NO If yes, please explain: Do you feel an investigation by higher authority is warranted? YES NO If yes, please explain: Additional Comments: Proof of Claim (Accident Medical Expense Form) attached? YES NO Medical Bills attached? YES NO Signature of Unit Commanding Officer Date

10/2014

Standard Activity and Training Form (For use when attending multi-unit events or higher HQ events)

1

Event: _______________________ Div: ____ Unit: ________________________

A. Young Marine Information

Last Name: ________________________ First Name: _____________________ M.I. _____

Age: ____ Date of Birth: ___________ Gender: _____ Date of H.S. Graduation: ______

Home Address: ____________________________________

City: ____________________ State: ______ Zip Code: ______________

Email Address: ________________________________ Phone number: _________________

------------------------------------------------------------------------------------------------------------------

B. Parent/Guardian Information

Parent/Guardian Name: _____________________________ Relationship: _______________

Home Address: _____________________________________________

City: ___________________ State: _____ Zip Code: ___________

Email Address: ______________________________ Phone Number: _________________

Cell Phone Number: ____________________ Work Number: __________________

--------------------------------------------------------------------------------------------------------------------

C. Emergency Contact Information (other than parent/guardian)

In the event I cannot be reached during an emergency please contact the following person:

Emergency contact name: ____________________________ Relationship: _______________

Email Address: ______________________________ Phone Number: _________________

Cell Phone Number: ____________________ Work Number: __________________

--------------------------------------------------------------------------------------------------------------------

D. Permission of attendance

__________________________ has my permission to attend ____________________________. Young Marine’s name Event

Location: __________________________

Dates of event: ______________________

X Parent/Guardian Signature: __________________________________ Date: _____________ --------------------------------------------------------------------------------------------------------------------


2

E. Photo/Video/ Film Release ____ I give my consent to authorize the Young Marines National Headquarters or any entity or person

designated by them use and reproduction of any and all photographs, video or film taken of the person

named above during the program training activities and related activities. I understand there will be no

compensation to me. All negatives and positives with said prints, video or film are the property of the

Young Marines National Headquarters or the entity or person authorized or designated by it, solely and

completely. I also waive any right to inspect or approve any photo, video or film taken during my visit. I

affirmatively release and or otherwise, of photos video, or film taken of me during this event.

____ I do not give my consent.

X _______________________________ X ___________________________ Signature of attendee Signature of Parent/Guardian

--------------------------------------------------------------------------------------------------------------------

F. Medical Consent

I certify that I am the parent, legal guardian or other person in legal control of the above

identified child and request that my child be administered appropriate first aid and/or taken to the nearest medical facility for emergency treatment as necessary.

X Parent/Legal Guardian: _____________________________ Date: _______________

------------------------------------------------------------------------------------------------------------------

G. Permission to Use Over-the-Counter Medication (if not completed the Young Marine will not

receive medication)

My child, _______________________, has my permission to take any over-the-counter

medication in accordance with label instructions as needed with the exception of: ____________ _____________________________________ while attending Young Marine Activities.

X Parent/Legal Guardian: ____________________________ Date: ________________ ------------------------------------------------------------------------------------------------------------------

H. Permission to Dispense Prescription Medication (If not completed the Young Marine will not

receive medication)

I, request and authorize that my child, __________________________, be administered the

following prescription medication(s) _____________________________________________ ___________________________________________________________________________

per the medical doctor’s instruction on the original and unexpired pharmacy label. I certify that

my child has a valid health reason for taking the medication during Young Marine activities. This permission form is valid from (beginning date) ____________to (ending date) ______________.

X Parent/Legal Guardian: ___________________________ Date: ____________________ -----------------------------------------------------------------------------------------------------------------

I. Medical Insurance Information

Name of Medical Insurance Company: _______________________________

Policy Number: _____________________ Group Number: _______________

Contact telephone number: ______________________________

Must provide a copy of front & back of medical card.

----------------------------------------------------------------------------------------------------------------


3

Health History (Completed by Parent/Legal Guardian)

PLEASE PRINT (Update Annually)

Note: For the safety and well being of your child ensure all information is true and correct. Your child will NOT

be disqualified from the program based on information provided here.

Last Name _________________________First Name _______________Middle Initial____

Age ______ Date of Birth ___/____/____ Social Security Number_________________

Parent/Guardian Name _____________________________________


Physician’s Name ________________________Date of Last Visit _____________

Dentist’s Name __________________________Date of Last Visit _____________

The Subject Young Marine: *Yes No Remarks (“Yes” require

remarks)

Wears Eye Glasses /Contact Lenses

Is on a restricted diet

Wears a hearing aid

Visited the Dentist in the last 6 months

Has known health problems (knee problems, migraines, etc.)

Is under a doctors care

Is on prescription medication

*Has Allergies Food//Medication//Environmental (pollen, bee stings)

Has heart murmur

Suffered Rheumatic Fever

Had a family member under age 50 die of a heart problem

Suffers one or more of the following conditions:

Seizures, Diabetes, Asthma, Arthritis

Has had a history of head injury

Has been hospitalized or had surgery and dates

Had injuries (no matter how minor) in the past year. (Sprains, broken bones, ingrown toenails, stitches)

Date of last Tetanus Shot

I certify the above to be complete, correct, and true to the best of my knowledge.

X Parent/Legal Guardian ______________________________ Date ___________


4

Unit Commander’s Endorsement

I have personally interviewed the applicant and reviewed the applicant’s record. I attest that the applicant:

a. Is eligible and meets all of the qualification requirements for the selected program. ___.

b. Has taken the PFT on (mm/dd/yy) ____/____/____ and passed with an overall score of _________.

c. Has attained his/her present rank on (mm/dd/yy) ____/____/____.

I attest that:

d. I have enclosed one unit check (no. _______) in the amount of $_______.00 as part of the application fee (non-refundable), if applicable.

e. Below is a current photo of applicant.

___________________________________ _________

Unit Commander’s Signature Date

Daytime Telephone No. (____) ______________

Attach

Young Marine’s

Head & Shoulder

Photograph

in this box

Young Marines National Headquarters P.O. Box 70735, SW Station

Washington, DC 20024-0735

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