Read RKTC-2%20MO%202011.pdf text version

RANGER KIDS TRAINING CONFERENCE REGISTRATION INFORMATION

To insure successful registration for this training event, please keep the following items in mind:

All information requested on the application, such as your daytime contact information and complete date or birth, must be provided. The health history must be completed and sent with your application. All information requested on the health history, including insurance information, must be completed and the form must be signed and dated by the applicant. Incomplete forms will delay registration. Payment in full or the $50.00 pre-registration fee must be sent with the application to secure your place at the event. Checks or money orders should be made out to ROYAL RANGERS. Please do not send cash. We also accept Visa, MasterCard, American Express or Discover credit/debit cards. If using this method of payment, the cardholder's name as it appears on the card, signature, and billing address/phone number must be provided in the space along with the card number, expiration date and the amount to be charged. Applications may be mailed or faxed to the Royal Rangers training office. We NEVER recommend emailing credit card information! Applications received without payment may not confirm registration unless approved by the national Royal Rangers office. Contact the training office for details. Any balance due will be collected onsite at the event registration. Registration questions can be directed to the training department. Our contact information is listed below. All sessions must be attended in order to receive credit for this training. Payment confirmation and additional seminar information will be sent by either email or post when the application is processed.

Royal Rangers, 1445 N. Boonville Ave. Springfield, MO 65802-1894 Training office phone: 417.862.2781 x4179 Email: [email protected]

2011 RANGER KIDS TRAINING CONFERENCE APPLICATION TWO-SATURDAY OPTION

FOR OFFICE USE POSTMARKED: PAID: BAL. DUE: FOP:

PLEASE PRINT NAME _____________________________________ SPOUSE'S NAME ___________________________________ HOME ADDRESS ______________________________________________________________________________ CITY, STATE, ZIP _____________________________________________________________________________ PREFERRED PHONE (____) _____________________ ALTERNATE PHONE (____) ___________________________ EMAIL __________________________________________________ DATE OF BIRTH

REGISTER YOU FOR THIS TRAINING EVENT.

//

PLEASE FILL IN ALL BLANKS. WE MUST HAVE YOUR COMPLETE DATE OF BIRTH IN ORDER TO

DISTRICT _______________________________ OUTPOST # ________ CHARTERED? (PLEASE CIRCLE ONE) YES NO CHURCH NAME __________________________ CHURCH OFFICE PHONE ( _____ ) _________________________ REQUIREMENTS YOU MUST BE 18 YEARS OR OLDER IN ORDER TO REGISTER FOR THIS TRAINING EVENT. THE HEALTH HISTORY FORM MUST ACCOMPANY THIS APPLICATION. EVENT LOCATION 02 [ ] BOLIVAR, MO EVENT DATES AUG. 6, Pt. 1 AUG. 27, Pt. 2 REGISTRATION FEES

CHARTERED OUTPOST $125.00 CHARTERED OUTPOST EARLY REGISTRATION** $100.00 NON-CHARTERED OUTPOST $148.00 NON-CHARTERED OUTPOST EARLY REGISTRATION** $123.00

EARLY REGISTRATION DEADLINE** JULY 6

**Applies if application is postmarked/faxed/emailed by EARLY REGISTRATION DEADLINE DATE.

(FOR CREDIT/DEBIT CARD PAYMENT ONLY)

CARD NUMBER:

EXP. DATE: /

(PLEASE PRINT)

__________________________________________________________

CARDHOLDER'S NAME AS IT APPEARS ON CARD

__________________________________________________________

SIGNATURE OF CARDHOLDER

$________

AMOUNT ($50.00 MINIMUM)

__________________________________________________________

BILLING ADDRESS (IF DIFFERENT THAN ABOVE)

__________________________________________________________

BILLING TELEPHONE NUMBER (IF DIFFERENT THAN ABOVE)

FOR UP-TO-DATE TRAINING CAMP STATUS INFORMATION, PLEASE VISIT THE ROYAL RANGERS WEBSITE ATROYALRANGERS.AG.ORG/TRAINING/SCHEDULE/ . Mail form to: Royal Rangers, 1445 N. Boonville Avenue, Springfield, MO 65802-1894 Fax form to: 417.831.8230 Please make checks payable to ROYAL RANGERS.

HEALTH HISTORY FORM NATIONAL ROYAL RANGER TRAINING EVENTS

THIS ENTIRE FORM MUST BE COMPLETED AND SENT IN WITH THE APPLICATION. THE NATIONAL ROYAL RANGERS MINISTRIES OFFICE HAS THE PREROGATIVE TO DENY APPLICANTS BASED UPON THE INFORMATION PROVIDED. Applicant's Name: Birth Date: (Please Print.) (mm/dd/yyyy) Height: Weight: Occupation: HEALTH HISTORY

QUESTION/CONDITION Hearing Difficulties? Lung Condition? High Blood Pressure? Heart Problems? Asthma/Allergies? Fainting/Dizziness? Shortness of Breath? Vision Problems? Contact Lens Wearer? Skin Infections or Problems?

Please check YES or NO to the following and briefly explain any YES answers in the space provided below. Use the back of this form, if necessary.

YES NO QUESTION/CONDITION Have you had medical treatment in the last 12 months? Have you had surgery in the last 12 months? Have you been exposed to infectious diseases in the last 3 weeks? Have you been exposed to Hepatitis in the last 6 months? Do you have any disorders that would prevent strenuous activity? Are you taking any prescription medications? Have you had any allergic reactions to any types of drugs or medications? Sinus Condition? Food Allergy? YES NO

PLEASE USE THE SPACE BELOW TO EXPLAIN ANY "YES" ANSWERS: _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ _____________________________________________________________________________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ _____________________________________________________________________________________________________ If you are currently taking medication, please complete the section below.

MEDICATION DOSAGE FREQUENCY

GIVE THE LATEST DATE OF INOCULATION OR VACCINATION AGAINST THE FOLLOWING: Inoculation Date DISEASE (Month/Year) TETANUS / MEASLES / DIPHTHERIA / SMALL POX / POLIO / TYPHOID /

INSURANCE INFORMATION

Please provide the following information regarding your health insurance coverage.

INSURANCE COMPANY'S NAME: INSURANCE COMPANY'S PHONE NUMBER: ( POLICY NUMBER: CERTIFICATE/GROUP NUMBER: EFFECTIVE DATE OF COVERAGE: POLICY HOLDER'S NAME: **EMERGENCY CONTACT**

)

NAME _________________________________________ RELATIONSHIP ______________________________________ DAYTIME PHONE (____) _____________________________ EVENING PHONE (____) _____________________________

I, the undersigned, hereby acknowledge that to the best of my knowledge, I qualify for participation in this event and do hereby agree to abide by the rules and standards established for this event by its appointed leadership. I acknowledge that the information provided on my Health History is true and correct and I consent to the administration of emergency medical treatment at the discretion of the event leadership. I further acknowledge my understanding that media footage, including audio, video, and photographs may be recorded at this event for future promotional use and hereby consent to the use of such items containing images of me in any form and relinquish all rights of ownership or compensation.

Applicant's Signature ___________________________________________________ Date _______________

Revised 9/17/10

RKTC SCHEDULE

(Two-Saturday Option)

ALL SESSIONS MUST BE COMPLETED IN ORDER TO RECEIVE CREDIT FOR THIS TRAINING.

First Saturday

7:30 Registration & Continental Breakfast 9:00 Orientation/Instructions 9:30 Rotating Class Sessions -- 30 Minutes (+5 for rotation)

Second Saturday

7:30 Check-In, Patrol Work & Continental Breakfast 8:30 Opening (Formations) 9:15 Rotating Class Sessions ­ 30 Minutes (+5 for rotation)

Visual Aids Outdoor Safety Games 10:00 Break ­ 20 Minutes

Bible Stories/Storytelling Trip Planning Counseling Boys Classroom Management 9:45 Break ­ 20 Minutes

11:40 Lunch 12:30 Rotating Class Sessions ­ 30 Minutes (+5 for rotation)

11:45 Lunch 12:30 Puppet Shows/Critiques 1:30 Day Camping 2:10 Break ­ 20 Minutes 2:30 Model Day Camp 3:30 Advancements 4:00 Council of Achievement Class 4:30 Council Fire 5:15 Dinner 6:00 RKTC Council of Achievement 6:30 Adjournment

Music Nature Crafts Soul Winning

2:10 Break ­ 20 Minutes 2:30 Puppet Making 3:15 Model Outpost Meeting 4:30 Council Fires 5:00 Working Dinner ­ Patrol Work Assignments 5:45 Old West Council Fire 6:30 Adjournment

RANGER KIDS TRAINING CONFERENCE PERSONAL EQUIPMENT CHECKLIST (Two-Saturday Option)

CLOTHING Complete Class B Ranger Kids uniform or Girls' Ministries uniform OR Minimum of ONE of the following uniform options: UTILITY (RR utility shirt and blue jeans with brown or black belt or tact pants with black belt) SPECIAL (RR t-shirt or RR sports jersey/polo with blue jeans and brown or black belt or tact pants with black belt) DRESS (Khaki shirt and pants, tan webbed belt, appropriate footwear) Windbreaker-style Jacket (Royal Ranger one if you own one.) Royal Rangers sweatshirt (for colder areas only) Pair army fatigue trousers, jeans, or other work-type trousers for casual wear Royal Rangers T-shirts (May be substituted with Ranger Kids t-shirts.) Extra uniforms or clothing for fresh change Pair shoes or boots for outdoor activities Socks Poncho or raincoat with hood Underclothing and handkerchiefs Pajamas Please note: No cap or hat is needed. A special ball cap will be issued. Please remove all collar insignia, and all items pinned to your uniform. All other patches may remain on your uniform. PERSONAL ITEMS Pen and pencil Small Bible Water Bottle Pocket Knife Personal first aid kit Optional Uniforms Khaki long sleeve or short sleeve shirt Khaki pants or shorts Khaki skirts or culottes for women Khaki belt with brass buckle Blue Awards vest

OPTIONAL ITEMS Ranger Kids Leaders Guide Ranger Kids Handbook Ranger Kids Workbook

Sunscreen lotion Sunglasses Extra materials to add to a patrol flag o Beads, feathers o Acrylic Paints and brushes o Miscellaneous items

Directions to : Bolivar Assembly of God Church 1320 S. Springfield Ave. Bolivar, MO 65613 From Kansas Expressway and I-44, Springfield, MO Take KANSAS EXPY/ MO-13 North approximately 23 miles Take the Business 13/ MO-83 toward BOLIVAR Turn RIGHT onto Business 13/ MO-83 (Same as Springfield Ave.) The church is on the right, across from Southwest Baptist University From St. Louis Take I-44 West to Springfield, MO Take the Hwy 13 exit North toward Bolivar and follow the directions above From Oklahoma City Take I-44 East to Springfield, MO Take the Hwy 13 exit North toward Bolivar and follow the directions above From Kansas City, MO Take 71 Hwy South Just past Harrisonville, take Hwy 7 toward Clinton In Clinton, take Hwy 13 South, to Bolivar Take the second Bolivar Exit (Aldrich Road) East to Springfield Ave. Turn left on Springfield Ave. The church is the next drive on the right. 71 S From KC 7 Hwy South

Aldrich Rd.

Church

Hwy 83/Springfield Ave

I44 West from St. Louis

I44 East from Oklahoma City

Hwy 13N from Springfield

Information

2005

6 pages

Find more like this

Report File (DMCA)

Our content is added by our users. We aim to remove reported files within 1 working day. Please use this link to notify us:

Report this file as copyright or inappropriate

1074958


You might also be interested in

BETA
10k of most popular keywords
Microsoft Word - Program