weekly resources april 27, 2012
DESCRIPTION
events, training and informationTRANSCRIPT
The contents of this binder are strictly for informational purposes and does not imply endorsement of any private or commercial organization by the 65th EN BN, 8th TSC,
USARPAC or the Department of the Army.
65th EN BN BLANKET ORDER FORM OHANA FEST/EARTH DAY CELEBRATION
GROW HAWAIIAN FESTIVAL KA’ENA POINT RESTORATION
CAMP ERDMAN OFFERING 2 SUMMER ADVENTURE CAMPS HAWAIIAN LUAU LUNCH BUFFET
CHILDREN’S MENTAL HEALTH AWARENESS DAY AFTB LEVEL 1
SURF ACADEMY MOM’S BOWL FREE
MOTHER’S DAY BRUNCH W/SHOW AT ALA MOANA HOTEL 65th ENGINEER BATTALION QUARTERLY FRG MEETING
130th ENGINEER BRIGADE TOWN HALL MILITARY BALL ETIQUETTE CLASS
DRESS SWAP HAWAII ENGINEER REGIMENTAL BALL
65th EN BN Weekly Resources APRIL 27, 2012
6 5 t h En g in e e r Ba t t a lio n
BLANKET ORDER
Company:________________________ Purchaser: ________________________ FRG Leader: ________________________ Phone #: ________________________ Address: ________________________ ________________________ Email: ________________________ Qty Item Unit Price
Checks Payable To: Subtotal
65th Engineer Battalion Shipping (Checks must be written out exactly as stated) TOTAL
• Blankets are minimum $50 donation • Dimensions: 48” x 68” – 100% woven blanket (cotton) • Blankets can be shipped via Flat Rate Box ($14.00) to mainland addresses. • Deadline for order forms: ONGOING
*Forward order form & payment to: Tiffany Suchomski, 3435 Gustin St, Wahiawa HI 96786. For additional inquiries contact Tiffany at email: [email protected]
Send To Address(s): _____________________ ________________________ ________________________ ________________________
________________________ ________________________ ________________________
Saturday, April 28, 2012 Fort Shafter Flats Parade Field
10:00 A.M.—2:00 P.M. FREE EVENT FOR THE ENTIRE FAMILY
Learn about environmental sustainability through exciting interactive exhibits provided by TSG Environmental Division, USAG-HI, IPC and dozens of community organizations that have teamed up to raise awareness about pollution prevention and the importance of con-serving our natural resources. Take the Earth Day Passport Challenge! Kids that complete their passport receive a commemorative pair of sunglasses made from recycled materials. Visit the Synergy Booth for more details.
Join us for an OhanaFest/Earth Day Celebration!!
Enjoy dozens of cool exhibits from Department of Land and Natural Resources, Blue Planet Foundation, Solar City and more! **Bounce House **Face Painting **Shave Ice and Cotton Candy **Hot Dogs **PA’I’AI (Poi pounding) Demonstration from Mana’ai **Live Music from Zach Shimizu **Movies and Popcorn Bring a tank top from home (used is okay) and turn it into a one-of-a-kind tank top tote. Visit the Up-cycling booth for great take-home projects made from recycled materials.
Pride of the Pacific!
Don’t forget to visit our Trash-Formation Recycled Art exhibit. Entry forms for Art Contest can be found at the Fort Shafter Library or call 438-1600 Ext. 3307.
1557
1555
1550
1554 1
2 3
4 Solar Trailer w/panels
facing south
EXHIBITORS:
1. Synergy Kids (1)
2. Clean Water Branch (3)
3. DPW/IPC
4. DPW (Cultural Resources) (2)
5. DPW (Natural Resources) (2)
6. USAG-HI - UPCYCLING
7. DPW/TSG – Energy (2)
8. Solar City (2) corner
9. Tetra tech (2)
10. Trash-formation Display (AH)
11. SOLAR Oven Display
12. Blue Planet Foundation
13. City and County of Honolulu
Storm Water Branch
14. Leilehua High School Project
15. Enviro-babies Endangered
Hawaiian Monk Seal - Info
16. DES
17. Story time with Aunty Sheryl
18. FACE PAINTING
19. PA’I’AI Demonstration
20. Pure Water Hawaii
1 2
3
4
1
2
3
4
5
7 8 9
12 13
14
15
17
18
20
19
Recycle Station
6 Upcycling booth will be underneath the pavilion.
10
Trash-formation will be inside the Assembly Hall as well as movie theatre.
11 Solar Oven Display adjacent from Synergy Passport booth.
16 DES – Military Police will be across from the bounce houses.
VENDOR TENTS 1) NATURAL /CULTURAL RESOURCES 2) VARIOUS 3) VARIOUS 4) FACE PAINTING
SYNERGY TENT: KIDS WILL PICK UP THEIR PASSPORTS AND THEIR SUNGLASSES AT THIS LOCATION
VOUCHER TENT: ATTENDEES WILL SIGN AND PICK UP THEIR VOUCHERS FOR ALL FOOD GOODS. THIS BOOTH WILL BE MANNED BY THE TSG FRG
DES (ARMY POLICE) WILL HAVE AN OBSTACLE COURSE SET UP FOR THE KIDS.
BOUNCE HOUSE FOR WEE ONES 3-5
BOUNCE HOUSE FOR WEE ONES 6-12, LIKE AGES IN AT A TIME. DES WILL CHAPERONE BOUNCE HOUSES
HYDROGEN CELL VEHICLE UNDER PAVILLION, TO CHARGE POPCORN HOT DOGS AND COTTON CANDY MACHINE. AS WELL AS UPCYCLING BOOTH
SOLAR OVEN DISPLAY - JOHN GRANDINETTI
UPCYCLING BOOTH. MAKE & TAKE HOME PROJECTS MADE FROM RECYCLING MATERIALS. POWERED BY HYDROGEN FUEL CELL VEHICLE.
COTTON CANDY, HOT DOGS, POPCORN PICK-UP. POWERED BY HYDROGEN FUEL CELL VEHICLE.
RESTROOMS OPEN IN BUILDINGS 1554 AND 1550. POLICE BATHROOMS EVER HOUR FOR AMPLE SUPPLIES.
SHAVE ICE WILL BE SERVED NEAR DOORWAY OF ASSEMBLY HALL DUE TO KITCHEN. SIDE DOOR WILL BE OPEN, KITCHEN SIDE.
ENVIRONMENTAL DIVISION GREETERS; PROGRAM HANDOUT AND INFO.
U.S. Army Reserve Center
Building 1557
Room 236
ARIM/DCSENG
Fort Shafter
Main Post
DIRECTIONS FOR MOANALUA
FREEWAY HEADING WEST
Use right lane, take Fort Shafter Exit,
turn left at traffic light, stay in left
lane, cross Fort Shafter Overpass,
turn left at bridge, then follow road to
left and take right turn on Loop Road.
DIRECTIONS FOR MOANALUA FREEWAY
HEADING EAST (TOWARDS DIAMOND HEAD)
Use right lane, take Fort Shafter Exit, turn right at
traffic light, turn left at bridge, then follow road to
left and take right turn on Loop Road.
Bridge
Fort Shafter
Flats
Fort Shafter Main Gate
Ballfields
Family Housing
U.S. Army Reserve Center
Parking Area
E hele mai! Join us in restoring one of Oahu’s most beautiful treasures! Located at the northwest tip of Oahu, Ka‘ena Point
is a popular location for fishing, hiking, bicycling, and other recreational and educational activities. It’s also home to
nesting seabirds, monk seals, and other native coastal species. As community members, let’s all come together and lend a
hand to restore the beauty of this special place.
(Āhea) When: Saturday, April 28, 2012; 8:30 AM to 1:00 PM (Ma Hea) Where: Kaena Point State Park Reserve -
End of Farrington Highway (Highway 930)
(‘O Wai) Who: Soldiers, Hawaiian community &
Environmental community (Aha) What: Volunteers will be divided into
groups to assist with picking up of trash and marine debris or provide support in lining/marking the main and shoreline road alignments.
To RSVP or for more information, please contact the USAG-HI Native Hawaiian
Liaison Office at (808) 655-9694, or email [email protected]
This project is an initiative under the Army’s Covenant with Native Hawaiians, a promise which lays the path for a meaningful partnership between both communities.
Dear OMK Team Members and Military Partners: We now have permission to announce and recruit participants for the two Hawaii Adventure Camps that will be held at Camp Erdman this summer. Camp dates are June 25-28 and July 9-12 and both camps are open to any military teen in Hawaii or the Pacific Rim, 14-18 years old. Each camp will offer a unique outdoor experience that will allow campers to build leadership, self-confidence, and teamwork skills while participating in activities like hiking, surfing and archery. Mindfulness activities are planned at the camp to help youth develop skills to deal with stress. (*Mindfulness is the ability to focus on the present moment with acceptance, which resonates with aloha literally means "presence in the breath"). Participation in the Hawaii Adventure Camp will enhance problem solving, self-responsibility and decision making skills, as well as provide youth with an opportunity to form strong connections with other military youth from the Pacific Rim region. Both camps will have a maximum of 40 teens. To reserve a spot, teens must complete an application with all of the required information and documents plus send in a $25 deposit. This is on a first come first served basis. Funding for Military Teen Adventure Camps has been made available through a partnership between the Department of Defense, Office of Military Community & Family Policy and the United States Department of Agriculture/National Institute of Food & Agriculture. Besides covering registration and activity fees for all campers, there is also funding to cover transportation costs for military youth in the pacific rim and on the neighbor islands of Hawaii. (Teens from the Pacific Rim will be designated for up to $1000 travel stipend to cover fare. Grant funds will cover travel costs for neighbor island participants up to $250.) Ground transportation to Camp Erdman will be provided for all campers. Applications and all other required forms are due 4 weeks before the camp start date. Applications for the Hawaii camps should be sent to:
Dr. Thao N. Le Department of Family and Consumer Sciences College of Tropical Agriculture
and Human Resources 2515 Campus Rd, Miller Hall 201
Honolulu, HI 96822
For more information on the Hawaii Adventure Camp, call 956-2256 or email [email protected] http://hawaiiadventurecamp.webs.com/ Please also note: 11 other states have been selected to offer Adventure Camps as well which are being offered between April 2012 through March 2013. For more information about these opportunities, check out http://www.extension.purdue.edu/Adventure_camps/campshome.html
Military Adventure Camps
Camp Dates From April 2012 – March 2013 Would you like to spend time with other military teens…
• Whitewater rafting? • Hiking? • Rock climbing? • Mountain biking? • Running ropes course? • Paddle boarding/Surfing? • And more?
Camp locations available in: • Alaska • California • Colorado • Florida • Georgia • Hawaii • Kentucky • Maine • Montana • New Hampshire • Ohio • South Carolina • Washington
If you want to join in the fun
• Go to the site URL to find out more about each camp location
• Go to the link for the camp of your choice for specific registration information
https://www.extension.purdue.edu/Adventure_camps/campshome.html
UHM Hawaii Adventure Camp for Military Youth at Camp Erdman, HI
Summer 2012 Youth Application
Thank you for your interest in attending the Hawaii Adventure Camp (HAC) for Military Youth at Camp Erdman! Camp Erdman is located on the beautiful North Shore of Oahu, Hawaii. We look forward to spending four days in Summer 2012 with your youth. Please use the handy checklist below to ensure you have completed all of the required application. If you have any questions, please contact Aurora Lemke, HAC Assistant Organizer at [email protected] or 808-956-2256. Application Checklist This checklist is for your use to ensure all required forms are completed and returned correctly. For those in Hawaii, completed forms must be postmarked/sent in at least two weeks before the first day of camp. For those coming from outside of Hawaii, completed forms must be postmarked/sent in at least four weeks before your youth’s first day of camp (by May 28th or June 11th). This is to allow for time to make the plane reservation. Packets that are mailed to us without all of the forms completed entirely will impact your child’s ability to attend camp. Camp spots are on a first come, first serve basis. Youth/Guardian Information Form (1 page)
o This form asks for participant’s and parent’s/guardian’s general information. Youth Cabin Placement (1 page)
o This form asks for any information that would be useful in placing your youth in the correct cabin.
Youth Contract Form (1 page) o This form asks your youth to comply with YMCA Camp Erdman rules.
Refundable Check Information Form (1 page) o Explanation of the refundable check needed to hold your youth’s placement in a camp.
Medical Background Information Form (2 pages) o This form asks about your youth’s general medical information.
Assumption of Risk and Release Form (1 page) o In signing this form, you understand that the University of Hawaii is not liable for any injuries
involving your youth during the four days at camp. Please read the form carefully before signing.
Medical Consent Form (1 page) o In signing this form, you understand that UH and its affiliates may not be held liable for any
claims connected to medical treatment or care. Photo Release Form & Publicity Release (1 page)
o In signing the Photo Release form, you allow your picture to be taken and for photos to be posted on the HAC website (www.HawaiiAdventurecamp.webs.com). As we cannot print out the photos that will be taken during the four-day camp to give to your youth, we will put the photos online for your use. In signing the Publicity Release form, you allow the forms of media (pictures, video etc.) to be taken for publicity for UHM and its affiliates.
Camp Erdman Odyssey Release form o In signing this form, you understand that YMCA Camp Erdman is not liable for any injuries
involving your youth during the four days at camp. Please read the form carefully before signing.
Sunset Suratt Surf Academy Release of Liability Form o In signing this form, you understand that Sunset Suratt Surf School is not liable for any
injuries involving your youth. Please read the form carefully before signing.
Youth Name: ________________________________ Camp Session: _______________________________
Parent/Guardian FAQ
1. A welcome packet with more specific information about the camp will be mailed to you after we receive your completed 2012 Youth Application.
2. There is limited cell phone and Internet coverage at Camp Erdman. However, there are outlets in the cabins for charging of electrical equipment. In any emergency, campers will be able to use the campsite’s office phone.
3. A list of the necessary gear to bring will be included in your welcome packet. 4. This camp was made possible through funding from the Department of Defense, Office
of Family Policy, Children & Youth and USDA/NIFA, in partnership with Purdue University and the University of Hawaii at Manoa.
Youth Name: ________________________________ Camp Session: _______________________________
Youth and Guardian Information Form Youth’s Name: Youth’s Age: Gender: _____________________________ Parent or Guardian(s) Names: Parent or Guardian(s) Phone Numbers: Cell Phone:
Home Phone:
Parent or Guardian(s) email: Home Address: City, State, Zip: Parent or Guardian or Immediate Family Member’s Military Branch (circle one): Army Navy Marine Air Force Coast Guard Air/Army National Guard Reserves (Reserve: ________________) Is this individual currently active duty or retired? ____ Active Duty ____ Retired Which Camp do you want to attend? • Please note, your youth can only attend one of the camps. • Rank according to your preference 1(most desired camp attendance dates) or 2(second
desired camp attendance dates). • Leave blank if you CANNOT attend a certain week.
. June 25-28 . July 9-12 .
Youth Name: ________________________________ Camp Session: _______________________________
Youth Cabin Placement
All youth will be housed in the cabins equipped with bunk beds and an indoor toilet/shower. The youth will be separated by age and gender and supervised by their respective camp counselors who will also be sleeping in the cabins. For more information on the Cabins at YMCA Camp Erdman, please visit: http://www.ymcahonolulu.org/camp_erdman/about/facilities To help us make the best sleeping placement for your youth at Hawaii Adventure Camp for Military Youth at Camp Erdman please let us know any information that you believe to be important about your youth (i.e. sleep walking, hearing impaired, etc.):
Youth Name: ________________________________ Camp Session: _______________________________
YOUTH CONTRACT FOR HAWAII ADVENTURE CAMP
This contract is an agreement between me (print first and last name) , my camp counselor, and the Hawaii Adventure Camp staff. While participating in this camp, I agree to keep myself safe, cooperate with the program guidelines and instructions given by my camp counselor, treat other campers respectfully, and consent to learning. While attending the Hawaii Adventure Camp, it is expected that I will:
1. Arrive on time to all camp activities.
2. Remain with the group or a counselor at all times.
3. Know, understand, and obey rules throughout the camp activities and during free time.
4. Follow safety rules regarding activities and at the camp.
5. Remain drug and alcohol free.
6. Respect all camp equipment.
7. Attend and participate in all scheduled activities.
8. Respect all people and wildlife/sealife I come in contact with when in group and out of group.
9. Only use my IPOD or other electrical devices on the bus to and from camp.
10. Not engage in any inappropriate or disrespectful behavior.
*I understand that not following these rules or insubordination could put me, other people, and wildlife/sealife in an unsafe situation and might result in me having to leave the program. *Hawaii Adventure Camp staff has the authority to expel campers who pose a risk to the health and safety of others and to themselves , as well as insubordination. Parents/guardians will be notified to pick up their camper or be charged for a change in flight fee by the airlines company, and any other additional costs.
Youth Signature Date
Guardian Signature Date
Hawaii Adventure Camp Staff Signature Date *The staff member will sign this upon receiving the entire, correctly completed application.
Youth Name: ________________________________ Camp Session: _______________________________
Refundable Check Information Form Your camp placement will not be saved until payment is received. Please enclose a check with this application for $25 made payable to RCUH. Please send the completed application with the refundable check to: Attention: Thao N. Le Department of Family and Consumer Sciences College of Tropical Agriculture and Human Resources 2515 Campus Road, Miller Hall 201, Honolulu, HI 96822 Your check will be refunded to you if:
1. Your youth arrives at the pick-up location at the correct time and boards the bus. 2. You decide not to send your youth to HAC for Military Youth at Camp Erdman after
completing and returning this application. However, you must let Aurora Lemke, HAC Assistant Organizer, know two weeks in advance of the camp start date that your youth will not be attending.
Your check will not be refunded to you if:
1. Your youth does not cancel within two weeks of the camp start date and/or does not show up at the pick-up location on time.
Please also be aware that a travel scholarship/stipend is being reserved and provided to offset your child’s travel expenses to the camp. If for some reason your child is unable to fulfill commitment to attend, we will expect reimbursement of the travel expenses. If you have any questions about this refundable check, please contact: Aurora Lemke, HAC Assistant Organizer Email: [email protected] Office Phone: 808-956-2256
Youth Name: ________________________________ Camp Session: _______________________________
Medical Background Information Form Today's DateParents, please complete as fully as possible. Please print clearly. This information is confidential and will not be released outside of the University of Hawaii at Manoa Hawaii Adventure Camp for Military Youth at Camp Erdman without your permission.
____
Youth’s Personal Information: Name (Last) (First) (MI) Youth’s Age Birth Date Male/Female Height (feet/inches) Weight (lbs) In Case of Emergency Notify: Parent or Guardian Name (first contact) Phone number
: ___________________________________________________________________
Parent or Guardian Name (second contact) Phone number(s) Physician to contact_______________________________________________________________ Physician phone number___________________________________________________________ Medical information: Please note that withholding or falsifying medical information can jeopardize your child’s safety and the safety of others. Do you have medical insurance? Yes No Medical Insurance Company Does your child have any disabilities that may impact his/her participation such that you are seeking a reasonable accommodation? Yes No Please explain Has your child had a recent operation that might affect his/her participation? Yes No____ Please explain List any medications your child is currently taking: List any allergies to medications, insects, or foods:
Youth Name: ________________________________ Camp Session: _______________________________
Special Instructions
Prescription Medication: Must be furnished in the original pharmacy labeled container. The camper’s name, name of the medicine, dosage, name of prescribing health care provider (who is required to furnish Health Care Provider Authorization and Directions above), date prescription was filled, and expiration date must be printed on the medicine container’s pharmacy label.
Nonprescription Medication: Must be furnished in the original container labeled by the pharmaceutical company or other commercial distributor of the medicine.
Parent/Guardian Request, Permission and Release to Administer Medication I hereby request and give my permission for the nurse at Camp Erdman and/or Hawaii Adventure Camp Counselor to administer to my child the medicine named above, as specified by the health care provider. In connection with my request, I hereby authorize the health care provider to provide information to the nurse at Camp Erdman and/or Hawaii Adventure Camp Counselor who may be involved in administering the medicine to my child. If my request is granted, I hereby release and hold harmless Camp Erdman and University of Hawaii at Manoa and their board members, employees and agents from any and all liability, claims, causes of action, damages and demands of any kind whatsoever (except willful and wanton acts or omissions) that may be brought by my child or on my child’s behalf for any and all damages, including personal injury to my child, arising out of or in connection with the administering of medicine to my child as provided above. Signature of Parent/Guardian Date Please mention any activities that your child should not participate in and/or any potential problems your child might encounter and/or with strenuous exercise. Please rate your child’s personal fitness level (circle one): (low) 1 2 3 4 5 (high) List any concerns you or your child might have about the experience:
Youth Name: ________________________________ Camp Session: _______________________________
ASSUMPTION OF RISK, RELEASE, AND INDEMNIFICATION AGREEMENT
Activity: Hawaii Adventure Camp for Military Youth Location:
YMCA Camp Erdman
[NOTE: For the purposes of this Agreement, the term “I” refers to both Parent/Legal Guardian and Participant.] I, _______________________________________, understand that I will be participating in the
(Print Participant’s name) above-described activity on ____________ at ________________________. I understand that there are inherent dangers and risks involved with participation in this activity including, but not limited to: sprains, strains, dislocations, amputations, cuts, bruises, breaks, teeth (loosened/broken/knocked out), head injuries, paralysis, exposure to outdoor elements resulting injury, risks associated with hiking, paddle boarding, swimming, surfing, ropes course, snorkeling and outdoor recreation activities, and death. I am fully aware that there are inherent risks of injury that include, but are not limited to, illness, personal injury, or death. I certify that I am in good physical health and am able to participate in all activities of the above named activity. I understand that I should be covered during the dates of the activity by a private medical and liability policy; and that the University of Hawai‘i does not provide health insurance or otherwise indemnify individuals with respect to injuries or other liabilities arising out of participation in the Activity. In consideration of Participant being permitted to participate in the Activity:
I agree, for myself, my heirs, personal representatives and assigns, to hereby RELEASE, WAIVE, DISCHARGE AND COVENANT NOT TO SUE the University of Hawai‘i, its Board of Regents, officers, employees and agents from any and all claims, including, but not limited to, claims for property damage, personal injury, illness, or death, arising from my involvement or participation in the Activity. I also agree to DEFEND, INDEMNIFY AND HOLD HARMLESS the University of Hawai‘i, its Board of Regents, officers, agents and employees from and against any and all claims, demands, actions or causes of action, on account of any loss, including damage to personal property, or personal injury or death, which arise out of my involvement or participation in the Activity. I also agree that this Agreement shall be construed in accordance with the laws of the State of Hawai‘i. I further agree that if any portion is held invalid, the remainder will continue in full legal force and effect.
I have read this Assumption of Risk, Release and Indemnity Agreement and I understand that I am giving up substantial rights, including the right to sue. I acknowledge that I am signing this Agreement freely and voluntarily. STUDENT ACKNOWLEDGEMENT (Co-signature of parent/guardian required if under 18 years of age) _________________________________________ Student Signature Date _________________________________________ Print Name
PARENT/LEGAL GUARDIAN ACKNOWLEDGEMENT _______________________________________ Parent/Legal Guardian Signature Date _______________________________________ Print Name
Youth Name: ________________________________ Camp Session: _______________________________
Medical Consent Form Your child is planning to participate in activities, which have inherent risks (see the Assumption of Risk and Release Form for complete details). In addition to those risks is the possibility that professional medical assistance and/or professional evacuation may be hours away should a medical emergency arise. By reading and signing this form you agree to hold harmless Camp Erdman and the University of Hawaii, as well as its employees and assigns, from any and all liability for injuries that are incurred or that may be incurred by you or your property as a result of delay in receiving professional medical attention. Furthermore, you agree to inform the staff on your child trip of any medical condition, which your child now have, that might create a medical problem while on the trip. I/We, the undersigned, consent to and authorize any medical professional and others working under their supervision to treat the above individual for any injury or illness arising from or related to my participation in the above named program. I/We further agree to pay any and all medial expenses, costs and other charges and to release and discharge and hold harmless the University of Hawaii, State of Hawaii, its officers, employees, agents, and assigns from and against any liability or any claims or demands arising from or connected with such medical treatment or care. _________________________________________________________ _________________ Signature of Parent(s)/Guardian(s) Date _________________________________________________________ _________________ Print Name(s) of Parent(s)/Guardian(s) Date
Youth Name: ________________________________ Camp Session: _______________________________
Photo Release Form I, (Guardian’s first and last name printed), allow my youth to have appropriate pictures taken of her/him while she/he is attending the Hawaii Adventure Camp. I allow these pictures to be posted on the HAC website (www.HawaiiAdventureCamp.webs.com). In addition, by indication of signature below, I authorize the University of Hawaii College of Tropical Agriculture and Human Resources (CTAHR), and DOD/USDA-NIFA unlimited permissions to use, publish, and republish these pictures for purposes of advertising, public relations, or any lawful use but no personal information will be added to the pictures. The pictures will be posted to the HAC website to allow you and your family to download and print the pictures to remember your youth’s time at the camp. Individuals with knowledge of the HAC camp website will be able to view the photos. Youth’s Signature Date Parent or Guardian’s Signature Date HAC Staff Member Date *The staff member will sign this upon receiving the entire, correctly completed application.
(1/2)
YMCA CAMP ERDMAN 69-385 Farrington Hwy., Waialua, HI 96791 P (808) 637-4615 F (808) 637-8874
ODYSSEY COURSE, ALPINE TOWER, TEAM DEVELOPMENT COURSE PARTICIPANT ASSUMPTION OF RISK, RELEASE, AND AGREEMENT In consideration of the services of YMCA of Honolulu, their agents, owners, officers, volunteers, participants, employees, and all
other persons or entities acting in any capacity on their behalf (hereinafter collectively referred to as YMCA), I hereby agree to release, indemnify, and discharge YMCA, on behalf of myself, my children, my parents, my heirs, assigns, personal representative and estate as follows: 1. I acknowledge that me participation in ropes course activities entails known and unanticipated risks, which could result in
physical of emotional injury, paralysis, death, or damage to myself, to property, or to third parties. I understand that such risks simply cannot be eliminated without jeopardizing the essential qualities of the activity. YMCA programs are based on the "challenge by choice" principle. At any time you and / or your group are free to withdraw from
participation in ropes course activities. The Risks include, among other things, the potential for: slips, fall and falling; rope burns; pinches, scrapes, twists and jolts that could result in scratches, bruises, sprains, lacerations, fractures, concussions, or even more severe life threatening hazards. During an activity there may be contact with plants, animals or insects that could create hazards such as stings, allergies, and associated disease. Furthermore, YMCA instructors have difficult jobs to perform. They seek safety, but they are not infallible. They might be
unaware of a participant's fitness or abilities, they might misjudge the weather. 2. I expressly agree and promise to accept and assume all of the risks existing in the activity. My participation in this activity is
purely voluntary, and I elect to participate in spite of the risks. 3. I hereby voluntarily release, forever discharge, and agree to indemnify and hole harmless YMCA from any and all claims,
demands, or causes of action, which are in any way connected with my participation in the activity of my use of YMCA equipment of facilities, including any such Claims which allege negligent acts or omissions of YMCA. 4. Should YMCA or anyone acting on their behalf, be required to incur attorney's fee and costs to enforce this agreement, I agree
to indemnify and hold them harmless for such fees and costs. 5. I certify that I have adequate insurance to cover any injury or damage I may cause or suffer while participating, or else I agree
to bear the cost of such injury or damage myself. I further certify that I am willing to assume the risk of any medical or physical condition I may have. 6. In the event that I file a lawsuit against the YMCA, I agree to do so solely in the state of Hawaii, and I further agree that the
substantive law of that state shall apply in that action without regard to the conflict of law rules of that state. I agree that if any portion of this agreement is found to be void or unenforceable, the remaining portions shall remain in full force and effect. By signing this document, I acknowledge that if anyone is hurt or property is damaged during my participation in
this activity, I may be found by a court of law to have waived my right to maintain a lawsuit against YMCA on the basis of any claim form which I have released the herein. I have had sufficient opportunity to read this entire document. I have read and understood it, and agree to be bound by its terms. Last Name:
First Name:
Signature & Date:
Mailing Address:
City:
State:
Zip:
Home Phone:
Cell Phone:
Email:
PHOTOGRAPH / VIDEO RELEASE I, the undersigned, consent for all purposes to reproduce, sell, and / or use of photographs or videos of the undersigned (with or
without the use of the individual's name), by the YMCA of Honolulu and by any nominee or designee of the YMCA of Honolulu (including any agency, client, or periodical or other publication) in all forms and media and in all manners, including trade, display, advertising, editorial, art and exhibition. In giving this consent I release the YMCA of Honolulu and their nominees and designees for liability for any violation of any
personal and / or proprietary right I may have in connection with such sale, reproduction or use. Last Name:
First Name:
Signature & Date:
PARENT�’S OR GUARDIAN�’S ADDITIONAL INDEMNIFICATION (Must be completed for participants under the age of 18)
In consideration of (print minor's name)("Minor") being permitted by YMCA to participate in its activities and to use its equipments and facilities, I further agree to indemnify and hole harmless YMCA for any and all Claims which are brought by, or on behalf of Minor, and which are in any way connected with such use of participation by Minor.
Parent/Guardian First & Last Name:
Parent/Guardian Signature & Date:
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YMCA CAMP ERDMAN 69-385 Farrington Hwy., Waialua, HI 96791 P (808) 637-4615 F (808) 637-8874
ODYSSEY COURSE, ALPINE TOWER, TEAM DEVELOPMENT COURSE YMCA OF HONOLULU �– HEALTH DISCLOSURE FORM
Participant Last Name:
Participant First Name:
Birthday (mm/dd/yy): Age at Camp:
Name of Organization / Program / Family Camp:
PLEASE READ: This information is intended to remind staff and participants of the seriousness of attempting adventure activities with at pre-existing condition. This information is to be confidential.
QUESTIONS RESPONSE �– Please CHECK answer
Any pre-existing medical conditions? If yes, please explain: YES NO
Are you currently taking any prescription or non-prescription medication? If yes, please explain: YES NO
Do you have any heart condition? YES NO
Do you have any high blood pressure? YES NO
Do you have any allergies (food, bees, insects, or medicines)? YES NO
Do you foresee any problems participating in the upcoming Alpine Tower, Odyssey Challenge Course activity due to lack of physical exercise? YES NO
Do you have a disability? YES NO
If yes, please indicate the functional implications and any concerns about participation related to the disability:
Describe your current level of physical activity:
IN CASE OF EMERGANCY
Last Name:
First Name:
Relationship to Participant:
Home Phone:
Cell Phone:
MEDICAL INFORMATION - Is the participant covered by family medical/hospital insurance? YES NO
Carrier or Plan Name: Group #: ID#:
PARTICIPANT – please read and sign
I have honestly disclosed to the staff any medical, physical, or personal information relating to my health. I will remember that a Challenge by Choice© atmosphere exists at all times, and I should not feel pressure to participate.
Last Name:
First Name:
Signature & Date:
PARENT/GUARDIAN – if participant is a minor, please sign below.
Last Name:
First Name:
Signature & Date:
LUNtrH BUFFET11:00am to 1:00pm
The tradition continues... Hawaiian Luau Lunch Buffet - $12.95. Come and
enjoy local cuisine every last Friday of the month !*
For more information, call 438-1974 for Hale lkena or 655-4466 for Nehelani.
*Not available in November or December.
Come join us as we recognize
Children’s Mental Health Awareness Day
May 9, 2012 Hawaii State Capitol 3:00-‐4:30pm Sign-‐Waving (Beretania St. near flagpole) 4:30-‐5:30pm Lei of Friendship For more information contact Donna: Hawaii Families As Allies (HFAA) 487-8785 or [email protected]
Brought to you by the Children’s Mental Health Matters Campaign Committee (CMHMCC)
Rally for Mental
Wellness
Army Family Team Building Presents:
AFTB Level I: Learn AFTB Level I is the basics to learning everyday life in the Army. It will
assist you in obtaining the skills necessary to navigate your way
through the military environment.
AFTB instructors will help you to:
Understand your benefits and entitlements
Learn your community resources
Solve basic problems
Understand military lingo, customs and courtesies
Develop a budget and savings plan
Classes are scheduled for May 7-8, 1730-2100 hrs
LT Brostrum Community Center, Austin Road,
Fort Shafter, Hawaii
LEARN. GROW. LEAD.
Call Ferne @ 655-0671 To Sign Up!
Name(s ) ____________________ _______________________ Rental _____ Lesson _____ Participants (minors) ___________________________ ___________________________
_______________________ ________________________ ________________________
Telephone _________________________ Emergency #______________________________
Date ____________ Signature(s) _______________________________________________
I have read, understand and approve the Sunset Suratt Surf School Release of Liability.
I agree to indemnify, hold harmless and release from all liability, Sunset Suratt Surf School, Bryan Suratt (owner), hired helpers or volunteers, the cities and counties of Hawaii, it’s elected and appointed officials, agents, employees, and volunteers, from any and all lawsuits, damages, claims, judgements, losses, liability or expenses arising our of (1) the death or personal injury or personal damage to myself, my child or my ward, which may be sustained while taking
a surf lesson with Sunset Suratt Surf School or renting or using a surfboard or other property owned or under control of Sunset Suratt Surf School, or (2) any death or injury which results or increases by any action taken to medically treat me, my child, or my ward.
All of the terms above shall apply whether or not causes by the alleged negligence, whether active or passive, or any acts or omissions of Sunset Suratt Surf School, Bryan Suratt, the cities or counties of Hawaii, or any of it’s elected or appointed officers, agents, employees, or volunteers. I have read, understand and approve this release of Liability. If the participant(s) is a minor, the undersigned parent or legal guardian warrants and represents that this release, it’s significance and the assumption of risk has been explained to and understood by my minor or ward. I hereby declare, under penalty of perjury, that I am the parent or legal guardian of the participant.
WWW.SURFNORTHSHORE.COM 808-783-8657
Release of Liability
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Sunofay, May (3, 2o{2
Af Scrtofietldforf Shofter Bowling Cenfers
timif 3 fi,eegame:' per^ hrunch purthase,
Sp."iul is offered pro"ided l"r'.u "r. uuuilubl-.
lnfo: 655-0573 or 438-6733
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040412-2
ALA MOANA HOTEL * CATERING * 410 ATKINSON DRIVE * HONOLULU, HI 96814 * PH. 808.944.4333 * F. 808.944.6837
Salads: Panzanella Salad with Green Beans & Sweet Red Onions
Assortment of Sliced Fresh Fruits in Season
Marlin & New Potato Salad with a Creamy Dill Dressing
Orzo Pasta Salad with Roasted Peppers
Tomato & Mozzarella Caprese with Grilled Vegetables
Soup: Creamy Chicken Soup
Carved Entree: Herb Roasted Prime Rib
Au Jus & Horseradish
Hot Entrees: Seafood Cioppino with Fennel
Turmeric & Yogurt Grilled Chicken
Balsamic Glazed Pork Belly & Calamata Olives over Mushroom Risotto
Brioche French Toast with Cinnamon & Almonds
Mediterranean Eggs Benedict with Pulled Pork & an Herbed Hollandaise
Bacon
Scrambled Eggs
Accompaniments: Steamed White Rice
Paprika Roasted Potatoes with Caramelized Onions
Asparagus & Summer Squash Medley with Balsamic & Garlic
Freshly Baked Rolls & Butter
Desserts: Assorted Desserts Station
Freshly Brewed Lion Coffee, Decaffeinated Coffee, Hot or Iced Tea
$55 - Adults
$30 - Children, ages 4-11 years
Mother’s Day Brunch Buffet & Show
with Augie T. & A Touch of Gold May 13, 2012
Hibiscus Ballroom
Doors Open at 9:30am * Show Time: 10:30am - 12:30pm
FOR: MOTHER’S DAY BRUNCH BUFFET /SHOW
In order to protect both you and us, we require that you provide us with written, signed authorization to make charges to your credit card in your name. Please complete this form and fax to: (808) 944-6837,
or mail to: Ala Moana Hotel – 410 Atkinson Drive, Honolulu, HI 96814 I, the undersigned, hereby authorize ‘Ala Moana Hotel ‘ and its subsidiaries to charge my credit card,
the amount of $ .
as payment for Brunch Buffet/Show Tickets: _______ Seats @ $55.00, per Adult / _______ Seats @ $30.00, per child 4-11yrs.
_______ Total Number of Seats; and _______ Number of Infants (no charge)
Hold Reservations under (name if other than cardholder’s):
Event Date: Sunday, May 13, 2012
(Please Print)
Name of Card Holder (As it appears on the credit card)
Billing Address: Apt #:
City State Zip Code
Telephone Number ( ) Fax Number ( )
Email Address (Optional)
Credit Card Type (Please Check One):
MasterCard Visa Discover American Express Diners JCB
Credit Card Number Expiration Date
Date:
Signature of Credit Card Holder
INTERNAL USE ONLY
Date Charged Amt Charge Approval Code
Initial Batch No.
Revised 4/4/12
Ala Moana Hotel CREDIT CARD AUTHORIZATION FORM
ADVANCE PAYMENT (NON-REFUNDABLE)
65th Engineer Battalion Quarterly FRG Meeting
Tuesday May 22, 2012 @1700
SGT Smith Theatre
130th Engineer Brigade Town Hall
Hallll Hall
@1800 FREE CHILDCARE! Registration Deadline: May 16, 2012 Email 65th FRSA [email protected] Or 84th FRSA [email protected] Childcare request must include the child’s name, age, special needs/allergies and sponsors name with contact information.
Childcare site: New CDC 1875 Lyman Rd Drop off time: 545pm
Etiquette
Military
Ball
From Social Hour to the Retiring of Colors
Learn the Dos & Don’ts
Open to all 130th, 84th and 65th Families
Thursday, June 14th
5 to 6:30pm, 84th EN BN Classrooms
175 Sutton Street, Bldg 867
Topics:
Appropriate Ball Attire
Receiving Line
Seating and Eating
And much more…
Bring your Ball Attire or a picture and see if it passes the critique!
Meet others that will be attending the ball!
To register call or email:
Shannan Kalili, 8086558547, [email protected] OR
Bridget Shioshita, 8086556559, [email protected]
DRESS SWAP
65th Engineer Battalion
Do you have a gently worn ball gown? Wanna swap it for another dress?
SIGN UP TODAY! EVENT DATE: June 21
@1700-1830
65th EN BN Classroom
Participation will determine success of event and gown selections available.
Already have a dress and still wanna donate a gown for a great cause ? Drop-off donations or contact the 65th EN BN FRSA
[email protected] or #655-6559
Participate in the DRESS SWAP & SAVE MONEY!
Army service uniform or mess dress for military personnel & civilian formal attire .
To purchase tickets, contact your company representative. $85/per person unless otherwise indicated as a result of individual
company fundraising efforts.
All Hawaii Engineers, Soldiers & Spouses are cordially invited to the formal ball
Cocktails commence @1700
Hilton Hawaiian Village July 27, 2012
@1800 Cocktails commence @1700
For more information, please contact the 130th Engineer Brigade S2 #655-8867/6224, or email [email protected]