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Kathy Rodgers at 703-866-7864

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					                                                                                                          March 27-29, 2009




                                                                          January 26, 2009


         Keene Mill GT Center Families:

         Each Spring, the parents of children in the Keene Mill GT Center who are in the 4th, 5th and 6th grade
         sponsor a Spring Campout called “Al Fresco.” Al Fresco consists of two nights and three days of
         structured fun and learning in the casual atmosphere of a local camp.

         Schedule - Friday evening includes a Campfire Sing-A-Long and Soc-Hop/Games Tournament.
         Workshops are held throughout the day on Saturday. Examples of workshops are: Marshmallow
         Blasters, Low and High Ropes, Horseback Riding, and How to Make Practical Jokes. These
         workshops are limited only by the imagination of the volunteers. The ever-popular Talent Show is
         held on Saturday evening. Sunday culminates with the presentation of the Al Fresco Cup Award to
         the cabin with the highest challenge points earned over the entire weekend.

         History - This program was originally begun by the school GT Center itself, but eventually became
         the casualty of budget cuts. Recognizing that this was an activity that was too important to let go by
         the wayside, parents took on the responsibility of organizing and managing the campout totally
         independent of the school. So again this year, about 100 students and 40 adults will pack up and
         have some fun while creating life long memories – ask any kid who’s been before.

         Location - We have again selected Camp Letts on the Rhode River in Edgewater, Maryland as
                                                   th    th        th
         our locale. We have reserved March 27 , 28 , and 29 as our camping dates. The drive is
         approximately 60 minutes from Springfield. The waterfront setting is beautiful and most civilized.
         We will be camping in heated dormitory style cabins that house approximately 24 students and four
         adults. There are private bathrooms and showers in every cabin. In the event of rain the indoor
         facilities are exceptional. There are basketball and tennis courts as well as open athletic fields for
         soccer and/or baseball. This is a wonderful opportunity for the children in the GT Center to mix
         outside of classes and between grades and to benefit from our very talented and enthusiastic
         parents.

         Payment - The weekend cost is $155 for the first student in each family. Each additional student is
         $130. The cost for volunteers who spend the night is $120. These costs cover food, site rental,
         insurance, transportation (for students), teaching supplies and printing/mailing costs. When class,
         bus, and dorm assignments have been made, you will receive a final mailing with further details. If
         your child is planning to attend Al Fresco Spring Campout 2009 please fill out the Registration
         Forms (8 pages) and return them by February 15th with your payment to:

                                   Al Fresco Spring Campout
                                   c/o Kathy Rodgers
                                   6824 Wild Rose Ct.
                                   Springfield, VA 22152
                     Forms may either be mailed or dropped off at the above address
                           Forms and payment are due no later than Sunday February 15th.

                         For more information please visit our web site: http:// kmalfresco.org or
                                        email to kmalfresco@yahoo.com or call:
                                           Kathy Rodgers at 703-866-7864




Al Fresco Spring Campout 2009 - Registration Packet                                                    Page 1 of 16
THIS IS NOT A FAIRFAX COUNTY PUBLIC SCHOOL or KEENE MILL PTA SPONSORED ACTIVITY
                                                                                              March 27-29, 2009




Registration Information includes:

      Camp Rules Agreement – family copy to keep
      Sample Camp Schedule
      Workshop Descriptions

   Registration Packet to be Returned – please print out pages 7-16 from the web site,
   complete and mail with payment to:
    Al Fresco Spring Campout, c/o Kathy Rodgers, 6824 Wild Rose Ct, Springfield, VA 22152
           1. Registration Form
           2. Payment Form
           3. Medical/Health Form
           4. Medical Authorization and Consent Form
           5. Transportation Information
           6. Workshop Choices
           Students should review the workshop descriptions to help them choose activities they will
           enjoy given their interests; parents must sign this form approving choices.
           7. Camp Rules Agreement
           Please review Camp Rules with your student, then both of you need to sign and return the
           agreement with your registration.
           8. AMATEUR MINOR ATHELTIC WAIVER AND RELEASE OF LIABILITY*
           9. AMATEUR ADULT ATHELTIC WAIVER AND RELEASE OF LIABILITY*: complete
               only if you are volunteering during the campout
           10. Individual Volunteer Form (do not complete if you have already turned one in)
               See where you can help make Al Fresco a wonderful experience for everyone involved.

 We must receive the Registration Packet by Sunday, February 15, 200. Please fill out these
forms now and return them as soon as possible. If the forms are late, the student will be assigned
workshops and cabin space after all other camper plans have been determined.


* Required for insurance




Al Fresco Spring Campout 2009 - Registration Packet                                         Page 2 of 16
THIS IS NOT A FAIRFAX COUNTY PUBLIC SCHOOL or KEENE MILL PTA SPONSORED ACTIVITY
                                                                                       March 27-29, 2009




                                      Camp Rules Agreement
                                     Family Copy - Please keep handy

       The following Camp Rules have been established by Camp Letts and Al Fresco
       organizers. Please read and sign below indicating that both the parent and the student
       understand and agree to abide by these rules. Parents will be required to pick up
       anyone not abiding by the rules.

   1. Show consideration and respect for parent volunteers and other campers.
   2. Stay with the adult and group to which you are assigned.
   3. Leave the group only with a partner and with permission of the adult in charge.
   4. Stay on marked trails.
   5. Respect animal’s homes and food supply.
   6. Enjoy the flowers without picking them.
   7. Do not litter. Pick up any litter that you find.
   8. Obey lights out and quiet time (11 p.m. to 7 a.m.)
   9. Do not climb trees, wade or swim without adult supervision.
   10. Do not go near the river unless accompanied by an adult.
   11. Be sure to go to assigned activities and remain there until the adult dismisses you.
   12. Do not throw anything except a ball or Frisbee.
   13. Do not move the furniture.
   14. After meals clean up the area where you ate.
   15. Leave the campsite as clean as or cleaner than when we arrived.
   16. Bring only those items listed on the packing list or exceptions that are approved by Al
       Fresco organizers.
   17. Do not go into any cabin but your own.
   18. Remain in the cabin after 11 p.m. and before 7 a.m. unless accompanied by an adult.
   19. Shoes must be worn at all times in and around the water.
   20. All “practical jokes” must be approved by Mr. Tragakis, the camp director, IN
       ADVANCE!
   21. No Vaseline or shaving cream on any furniture or building.
   22. Appropriate dress is required. If you can’t wear it to school (spaghetti straps, midriff
       bearing shirts, short shorts, etc.), you can’t wear it at camp.
   23. NO ELECTRONIC DEVICES ARE ALLOWED either on the buses or at camp. All
       radios, CD players, MP3 players, gameboys or any other battery operated device which
       is not medically necessary will be confiscated until the end of the weekend.




Al Fresco Spring Campout 2009 - Registration Packet                                  Page 3 of 16
THIS IS NOT A FAIRFAX COUNTY PUBLIC SCHOOL or KEENE MILL PTA SPONSORED ACTIVITY
                                                                                                        March 27-29, 2009

                                            Al Fresco 2009 Schedule
                                                      (Revised 1-14-09)
Friday:
9am                    Meet at West Springfield Government Center
9:30                   Depart for Camp Letts
10:30                  Arrive at Camp, stow gear, cabin orientation, rule review
11:30                  Assembly, review general rules, review Al Fresco Cup
12pm                   Lunch
1:00                   Al Fresco Cup Challenge Field Games
3:00                   Cabin Time (Mascot Brainstorming)
4:00 – 4:50            Activity 1: (basketball, dodge ball, soccer, volleyball, nukem, softball, hike-camp orientation)
5:00 – 5:45            Activity 2: (basketball, dodge ball, soccer, volleyball, nukem, softball, hike-camp orientation)
5:50                   Camp Assembly
6:00                   Dinner
7:00                   Cabin time (Mascot Construction)
7:30                   Campfire
8:30                   Soc Hop & Games Tournament
9:30                   Quiet time in cabins
10:30                  Lights out

Saturday:
6:30                   Optional early quiet activity (hiking, sunrise photography, fishing, etc.)
7:50                   Assembly
8:00                   Breakfast
9:00 – 10:20           Workshop Session 1
10:30- 11:50           Workshop Session 2
12:00                  Assembly
12:15                  Lunch
1:00 – 2:20            Workshop Session 3
2:30 – 3:50            Workshop Session 4
4:00                   Talent show rehearsal or sports/game/craft/hike break or cabin time
4:50                   Assembly
5:00                   Dinner
6:00                   Talent show rehearsal or sports/game/craft/hike break or cabin time
7:30                   Talent show
10:30                  Quiet time in cabins or 6th grade party
11:00                  Lights out

Sunday:
7:50                   Assembly
8:00                   Breakfast
9:00                   Sports break/Game break/Canoeing and Cabin clean-up                    .
11:45                  Assembly/Mascot Judging
12:15                  Lunch
1:00                   Camp Photo, Cabins empty, Departure Head count and Al Fresco Cup Awards
2:00                   Load busses and leave for return to West Springfield Government Center
3:30                   Arrive at West Springfield Government Center


Al Fresco Spring Campout 2009 - Registration Packet                                                   Page 4 of 16
THIS IS NOT A FAIRFAX COUNTY PUBLIC SCHOOL or KEENE MILL PTA SPONSORED ACTIVITY
                                                                                                        March 27-29, 2009

                    Descriptions of Workshops for Al Fresco 2008
                    Name/Activity                               Workshop Description
              1. Balloon                 Ever wonder how clowns make those balloon creations? You’ll learn in
                                         this fun class.
              Animals**
              2. Volleyball**            That sand pit isn’t just for Nuke-em! Come learn how to set, spike and
                                         volley!
              3. Fishing**               Learn fishing basics and try you hand at catching JAWS, the renowned
                                         mega-fish of Camp Al Fresco! DO NOT BRING HOOKS! Bring your
                                         own rod if you’d like but it’s not required.
              4. I Scream for Ice        Cold and creamy and made in a can? We’ll show you how!
              Cream****
              5. Marshmallow             How far will your confection fly?
              Blasters
              6. What’s the              Never held a racket? Need to work on your backhand? Come practice
                                         and learn to rule the court!
              Racket (Tennis
              that is!)
              7. Dodgeball               Run off the great Alfresco treats while playing this favorite game.

              8. Soccer                  Is there a David Beckham or Mia Hamm among us? Come play a little
                                         footie and find out!
              9. Fire Building**         Learn how to build, start and extinguish fires properly. Marshmallows
                                         may be required!
              10. Archery*               Bulls eye! Work on your skills and maybe you’ll get one.

              11. Fireside               Anyone hungry? Let the coals smolder while we cook up sweets and
                                         savories in a dutch oven.
              Cooking
              12. Potato                 Everyone’s favorite spud adventure game! Design and camouflage your
                                         own potato then join your teammates in a game of tuber hide-and-seek!
              camouflage
              13. Backyard               Backyard rocket science – how to turn newspaper and other household
                                         items into launch vehicles!
              Blastoff
              14. Capture the            Organize your team, stake your territory, protect your flag and strategize
                                         to capture your opponents’ flag!
              Flag****
              15. Nature Walk**          Take a walk on the wild side. Is that plant edible? What kinds of
                                         animals made those tracks? Don’t touch that plant – it’s poisonous!
              16. Basketball             Dribble? Shoot? Lay-up? How do you do those things in a court? Come
                                         see!
              17. Yoga**                 Camel? Eagle? Downward dog? It’s not the zoo… it’s yoga! Stretching
                                         and relaxation all in one!
              18. Fun with Clay          Enjoy making something to remember your weekend with that is also art!

              19. Al Fresco              Cooperative and challenging activities to test your teamwork skills in the
                                         great outdoors. Discover strengths you never knew you had!
              Obstacle Course
              20. High ropes*            Adventure course to test your physical and mental skills – can you
                                         master the zip line? High wire climbing includes full safety gear and is
                                                                                                           th      th
                                         supervised by certified YMCA staff. This workshop is only for 5 and 6
                                         graders.
              21. Horseback              First the safety lesson, then the trail ride! Riders must wear long pants
                                         and closed toe shoes. Helmets provided. (weather permitting)
              Riding*

Al Fresco Spring Campout 2009 - Registration Packet                                                   Page 5 of 16
THIS IS NOT A FAIRFAX COUNTY PUBLIC SCHOOL or KEENE MILL PTA SPONSORED ACTIVITY
                                                                                                     March 27-29, 2009
                    Name/Activity                                  Workshop Description
              22. Confidence             Teambuilding exercises meant to foster self discovery, confidence,
                                         teamwork and communication. See how mentally and physically tough
              Course*                                                          th     th
                                         you are! This workshop is only for 5 and 6 graders.
              23. Practical              Freak out, gross out, and confound friends, family, and complete
                                         strangers. We'll learn practical jokes you can pull just about anywhere
              Jokes                      with very little set-up.

              Canoe*                     If you would like to Canoe on Sunday please let us know. This
                                         does not count as one of your workshop options.




Workshops marked with an asterisk (*) are led by YMCA staff at Camp Letts. All others are led by parent
volunteers. Both rope course are not open to fourth graders

Workshops marked with two asterisks(**) need workshop leaders.

Workshops marked with four asterisks (****) need workshop leaders and are usually very popular.

Note to Parents: Workshop placements are based on the availability of instructors and
student requests. Priority is based on grade.




Al Fresco Spring Campout 2009 - Registration Packet                                               Page 6 of 16
THIS IS NOT A FAIRFAX COUNTY PUBLIC SCHOOL or KEENE MILL PTA SPONSORED ACTIVITY
                                                                                              March 27-29, 2009

                                        1. Registration Form
Student’s Name:                                            Gender: ___ Male ___ Female

Teacher:                                                   Keene Mill Grade:

Name of Parent(s)/Guardian(s) #1:                          Parent(s)/Guardian(s) #2:


Address:                                                   Address (if different):


Home Phone:                                                Home Phone (if different):

Cell Phone:                                                Cell Phone (if different):

Most correspondences are through e-mail so please provide us with the best email address to contact
your family:



                                        PHOTO CONSENT/RELEASE

I understand and give my full consent for my picture (or my child’s picture for children under age 18) to be
posted on the Al Fresco website and/or used in Al Fresco promotional materials. I understand that there will be
no person’s name associated with the picture(s) but that it will be clear that the persons in the picture are
participating in the Al Fresco Spring Campout.

Please sign by one choice only                              Signature                             Date
YES, I grant permission
NO, I do not grant permission

Comments:




Al Fresco Spring Campout 2009 - Registration Packet                                         Page 7 of 16
THIS IS NOT A FAIRFAX COUNTY PUBLIC SCHOOL or KEENE MILL PTA SPONSORED ACTIVITY
                                                                                                                                 March 27-29, 2009

                                                         2. Payment Form
                                                                                           Student Name:_______________________

The weekend cost is $155 per student. Each additional student (sibling) is $130. The cost for volunteers who
spend one or two nights is $120. These costs cover all meals, site rental, insurance, transportation (for
students) teaching supplies and printing/mailing costs. When class bus, and dorm assignments have been
made, you will receive a camp confirmation with further details. Full payment is due with registration.
Send Check and Registration Packet by February 15th to:
                                                  Al Fresco Spring Campout
                                                  c/o Kathy Rodgers
                                                  6824 Wild Rose Ct.
                                                  Springfield, VA 22152

Overnight Camper Fees**:                                                                                                     Your Amount
1st Student name:________________________________________                                         $155.00                       $

2nd Student (Sibling) name:________________________________                                        $130.00                      $
Adult Volunteer Camper Name:______________________________ m / f                                   $120.00                      $
Adult Volunteer Camper Name:______________________________ m / f                                   $120.00                      $

Non-camper, Day Visitor Meals: Order and pay for visitor meals below.
Meals are served buffet style, vegetarian options available with prior notice.

Friday Lunch (12:15 pm) $10.00/person                Vegetarian #___            How many? ___ X            $11.00 =                  $



Friday Dinner       (6 pm) $13.00/person                Vegetarian #___            How many? ___ X $13.00                =           $


Saturday Breakfast (8 am) $9.50/person                Vegetarian #___           How many? ___ X            $9.50     =               $



Saturday Lunch (12:15 pm) $11.00/person                  Vegetarian #___        How many? ___ X            $11.00 =                  $


Saturday Dinner (5 pm) $13.00/person                   Vegetarian #___          How many? ___ X $13.00               =               $



Sunday Breakfast (8 am) $9.50/person                    Vegetarian #___         How many? ___ X            $9.50     =               $



Sunday Lunch (12:15 pm) $11.00/person                Vegetarian #___            How many? ___ X            $11.00 =                  $



            Additional cash contributions to support the campout are greatly appreciated                                             $


                                                            Total Amount of Check Enclosed                                      $
                                        (Make checks payable to: Al Fresco Spring Campout)
** Financial aid is available for students who meet certain requirements. Please contact Kathy Rodgers at 703-866-7864 or via email at
kmalfresco@yahoo.com with questions or inquiries.


Al Fresco Spring Campout 2009 - Registration Packet                                                                          Page 8 of 16
THIS IS NOT A FAIRFAX COUNTY PUBLIC SCHOOL or KEENE MILL PTA SPONSORED ACTIVITY
                                                                                                            March 27-29, 2009

                                         3. Medical/Health Form
General Health Information:
STUDENT’S NAME:

DATE OF LAST TETANUS SHOT:
Note: We must have an actual date – “up to date” is not sufficient” -- or your child cannot go to camp!
FOOD ALLERGIES/DIETARY RESTRICTIONS:



ALLERGIES TO MEDICATIONS:


OTHER ALLERGIES:


MEDICINES YOUR CHILD MAY/WILL NEED TO TAKE DURING CAMP:



On Friday morning, please provide (to the Al Fresco volunteers) medicine in a labeled prescription
bottle/container with the patient’s name and administering requirements (dosage, time and frequency). Pick
up medications after camp from medical volunteers at school on Sunday. It will be your child’s
responsibility to request the medication from the camp volunteers. The camp volunteers will assist in
locating and recording the administration of medications or treatments.
PHYSICAL IMPAIRMENTS:



OTHER PERTINENT FACTS OR MEDICAL CONDITIONS:




Health Insurance Information:
INSURANCE COMPANY:                                                  POLICY #
POLICY HOLDER’S NAME:                                               ID #:


Emergency Contact Information (available by phone during camp weekend):
PRIMARY GUARDIAN NAME:                                OTHER GUARDIAN NAME:

DAY PHONE:                                            DAY PHONE:

EMAIL ADDRESS:                                        EMAIL ADDRESS:

CELL PHONE:                                           CELL PHONE:

ALTERNATE EMERGENCY CONTACT:                          PHONE1:

                                                      PHONE2:

NAME OF PHYSICIAN:                                    PHONE:



Al Fresco Spring Campout 2009 - Registration Packet                                                       Page 9 of 16
THIS IS NOT A FAIRFAX COUNTY PUBLIC SCHOOL or KEENE MILL PTA SPONSORED ACTIVITY
                                                                                          March 27-29, 2009

                          4. Medical Authorization and Consent

I am the parent/guardian of ________________________________. Subject to conditions set forth
below, I consent for my child to receive such medical treatment and/or surgical procedures as are
deemed necessary in the even of an emergency and assume liability for any medical expenses
incurred. This authorization extends to my child’s participation in any activity sponsored by the Al
Fresco Spring Campout 2009.

I recognize the risk of illness and injury by participating in a campout and hereby waive, release, and
hold harmless Al Fresco Spring Campout 2009 volunteers from liability arising from an
accident/illness resulting form participation in the campout activities.

I understand the person(s) at Al Fresco Spring Campout 2009 who will administer medication and any
first aid treatment may be inexperienced and untrained in this requested service and state. Without
reservation, I will not hold them responsible in any way for any harm or injury that may be
experienced by my child as a result of this service. I have read all of the information on this form and
fully understand its content. All information on this form is correct to the best of my knowledge.

Should a medical emergency arise during my child’s participation in an Al Fresco Spring Campout
2009 activity, I understand that reasonable efforts will be made to contact me or my designated
alternate at the phone numbers listed on this form. If it is believed my child’s life or health may be
adversely affected by the delay that an attempt to contact me or my designated alternate would
cause, I consent to:

         (i)   The administration of medical treatment and/or surgical procedures deemed necessary
               by the medical doctor and/or medical facility chose by the Al Fresco Spring Campout
               2009 staff, and
        (ii)   Immediate administration of life-sustaining measures deemed necessary under the
               circumstance.


Parent/ Guardian signature __________________________________ Date _________




Al Fresco Spring Campout 2009 - Registration Packet                                     Page 10 of 16
THIS IS NOT A FAIRFAX COUNTY PUBLIC SCHOOL or KEENE MILL PTA SPONSORED ACTIVITY
                                                                                            March 27-29, 2009




                                 5. Transportation Information
                                                  Student name:____________________________
Charter busses have been hired to transport student campers and a few bus chaperones. Adult
campers who are not bus chaperones will need to arrange transportation for themselves. Car
pools are very popular among adult campers. If your child is not taking the bus you are
responsible for transportation.

Student Transportation: Please check one

                       ___   My child will be taking the bus on Friday and Sunday
                       ___   My child will only be taking the bus on Friday (Please see below)
                       ___   My child will only be taking the bus on Sunday (Please see below)
                       ___   My child will not be taking the bus (Please see below)

The buses are equipped with video equipment and bus drivers usually play a movie during the drive
to and from camp. Please check one:

                       ___ My child is allowed to watch a movie rated PG
                       ___ My child is only allowed to watch movies rated G

Prior Approval for Authorized Drivers:

If someone other than the guardian noted on the registration form is driving your child to or from
camp, we need to have prior approval to release your child.

The following adults are pre-authorized to drive my child: (name/address/phone)

________________________________________________________________________________

________________________________________________________________________________



Special Family Pick-up or Drop-off Plans:

If you have prearranged times when you know your camper will be coming or going from camp, for
instance, for a sporting activity Saturday afternoon, it is helpful for us to have that information before
camp. This does not mean that you must have prior approval to pick up your child, it just makes our
security a little easier.

Family plans to pick up or drop off camper from camp during the weekend:



________________________________________________________________________________

Al Fresco Spring Campout 2009 - Registration Packet                                       Page 11 of 16
THIS IS NOT A FAIRFAX COUNTY PUBLIC SCHOOL or KEENE MILL PTA SPONSORED ACTIVITY
                                                                                             March 27-29, 2009

                                     6. Workshop Choices Form

__________________________________                           _____________________________________
      Parent Approval Signature                                         Student Name/grade

Students mark your top 8 choices in numerical order of preference. Every effort will be made to get
you in your top 4 choices, but that is not always possible.


 Choice
                 Workshop Name/Activity                         Choice
                                                                                Workshop Name/Activity
          1. Balloon Animals                                             13. Backyard Blastoff
          2. Volleyball                                                  14. Capture the Flag
          3. Fishing                                                     15. Nature Walk
          4. I Scream for Ice Cream                                      16. Basketball
          5. Marshmallow Blasters                                        17. Yoga
          6. What’s the Racket (Tennis that is!)                         18. Clay making
          7. Dodgeball                                                   19. Alfresco Obstacle Course
          7. Soccer                                                      20. High ropes*#
          9. Fire Building                                               21. Horseback Riding*
          10. Archery*                                                   22. Confidence Course*#
          11. Fireside Cooking                                           23. Practical Jokes
          12. Potato camouflage                                          Canoeing* (On Sunday) **

*Classes are taught by Camp Letts Staff
** Offered on Sunday – please check if you would like to go canoeing. This does
not count as a workshop choice
#Workshop is for 5th and 6th graders only

Note to Parents: Workshop placements are based on the availability of instructors
and student requests. Priority is based on grade.




Al Fresco Spring Campout 2009 - Registration Packet                                        Page 12 of 16
THIS IS NOT A FAIRFAX COUNTY PUBLIC SCHOOL or KEENE MILL PTA SPONSORED ACTIVITY
                                                                                          March 27-29, 2009




                                    7. Camp Rules Agreement
The following Camp Rules have been established by Camp Letts and Al Fresco organizers. Please
read and sign below indicating that both the parent and the student understand and agree to abide by
these rules. Parents will be required to pick up anyone not abiding by the rules.

   1. Show consideration and respect for parent volunteers and other campers.
   2. Stay with the adult and group to which you are assigned.
   3. Leave the group only with a partner and with permission of the adult in charge.
   4. Stay on marked trails.
   5. Respect animal’s homes and food supply.
   6. Enjoy the flowers without picking them.
   7. Do not litter. Pick up any litter that you find.
   8. Obey lights out and quiet time (11 p.m. to 7 a.m.)
   9. Do not climb trees, wade or swim without adult supervision.
   10. Do not go near the river unless accompanied by an adult.
   11. Be sure to go to assigned activities and remain there until the adult dismisses you.
   12. Do not throw anything except a ball or Frisbee.
   13. Do not move the furniture.
   14. After meals clean up the area where you ate.
   15. Leave the campsite as clean or cleaner than when we arrived.
   16. Bring only those items listed on the packing list or exceptions that are approved by Al Fresco
       organizers.
   17. Do not go into any cabin but your own.
   18. Remain in the cabin after 11 p.m. and before 7 a.m. unless accompanied by an adult.
   19. Shoes must be worn at all times in and around the water.
   20. All “practical jokes” must be approved by Mr. Tragakis, the camp director, IN ADVANCE!
   21. No Vaseline or shaving cream on any furniture or building.
   22. Appropriate dress is required. If you can’t wear it to school (spaghetti straps, midriff bearing
       shirts, short shorts, etc.), you can’t wear it at camp.
   23. NO ELECTRONI`C DEVICES ARE ALLOWED either on the buses or at camp. All radios, CD
       players, MP3 players, gameboys or any other battery operated device which is not medically
       necessary will be confiscated until we return to Keene Mill.


I promise to abide by the above rules and understand that if I fail to do so, my parents will need to
pick me up and take me home.


___________________________ / ___________________________ (Student name / signature)




__________________________________                    (Parent signature)

Al Fresco Spring Campout 2009 - Registration Packet                                    Page 13 of 16
THIS IS NOT A FAIRFAX COUNTY PUBLIC SCHOOL or KEENE MILL PTA SPONSORED ACTIVITY
                                                                                                 March 27-29, 2009

               8. AMATEUR MINOR ATHELTIC WAIVER AND RELEASE OF LIABILITY

In consideration of being allowed to participate in any way in ______________________
                                                                   (name of organization)
athletics/sports programs, and related events and activities, the undersigned:

   1. Agree that the parent(s) and/or legal guardian(s) will instruct the minor participant that prior to
      participating he or she should inspect the facilities and equipment to be used, and if the participant
      believes anything is unsafe, he or she should immediately advise his or her coach or supervisor of such
      condition(s) and refuse to participate.

   2. Acknowledge and fully understand that each participant will be engaging in activities that involve risk
      of serious injury, including permanent disability and death, and severe social and economic losses which
      may result not only from their actions, inactions, or negligence but the action, inaction, and negligence
      of others, or the condition of the premises or of any equipment used. Further that there may be other
      risks not know to us or not reasonable foreseeable at this time.

   3. Assume all the foregoing risks and accepts personal responsibility for the damages following such
      injury, permanent total disability or death.

   4. Release, waive, discharge and covenant not to sue ______________________
                                                                 (name of organization)
      its affiliated clubs, their respective administrators, directors, agents, and other employees of the
      organization, other members/participants, sponsoring agencies, sponsors, advertisers, and if applicable,
      owners and lessors or premises used to conduct the event, all of which are hereinafter referred to as
      “releases” from any kind of liability to each of the undersigned, his or her heirs, and next of kin for any
      and all claims, demands, losses, or damages on account of injury, including death and damage to
      property, caused or alleged to be caused in whole or in part by the negligence of the releases or
      otherwise

I HAVE READ THE ABOVE WAIVER AND RELEASE, UNDERSTAND THAT I HAVE BEEN
GIVEN UP SUBSTANIAL RIGHTS BY SIGNING IT AND SIGN IT VOLUNTARLY

Name of Participant (print) _________________________________________________

Name of Parent/Guardian (print) ______________________________Date___________

Signature of Parent/Guardian ________________________________________________

Address of Member/Participant ______________________________________________

Telephone Number of Parent/Guardian ________________________________________




Al Fresco Spring Campout 2009 - Registration Packet                                            Page 14 of 16
THIS IS NOT A FAIRFAX COUNTY PUBLIC SCHOOL or KEENE MILL PTA SPONSORED ACTIVITY
                                                                                                 March 27-29, 2009

               9. AMATEUR ADULT ATHELTIC WAIVER AND RELEASE OF LIABILITY

In consideration of being allowed to participate in any way in ______________________
                                                                   (name of organization)
athletics/sports programs, and related events and activities, the undersigned:

   4. Agree that the parent(s) and/or legal guardian(s) will instruct the minor participant that prior to
      participating he or she should inspect the facilities and equipment to be used, and if the participant
      believes anything is unsafe, he or she should immediately advise his or her coach or supervisor of such
      condition(s) and refuse to participate.

   5. Acknowledge and fully understand that each participant will be engaging in activities that involve risk
      of serious injury, including permanent disability and death, and severe social and economic losses which
      may result not only from their actions, inactions, or negligence but the action, inaction, and negligence
      of others, or the condition of the premises or of any equipment used. Further that there may be other
      risks not know to us or not reasonable foreseeable at this time.

   6. Assume all the foregoing risks and accepts personal responsibility for the damages following such
      injury, permanent total disability or death.

   4. Release, waive, discharge and covenant not to sue ______________________
                                                                 (name of organization)
      its affiliated clubs, their respective administrators, directors, agents, and other employees of the
      organization, other members/participants, sponsoring agencies, sponsors, advertisers, and if applicable,
      owners and lessors or premises used to conduct the event, all of which are hereinafter referred to as
      “releases” from any kind of liability to each of the undersigned, his or her heirs, and next of kin for any
      and all claims, demands, losses, or damages on account of injury, including death and damage to
      property, caused or alleged to be caused in whole or in part by the negligence of the releases or
      otherwise

I HAVE READ THE ABOVE WAIVER AND RELEASE, UNDERSTAND THAT I HAVE BEEN
GIVEN UP SUBSTANIAL RIGHTS BY SIGNING IT AND SIGN IT VOLUNTARLY

Name of Participant (print) _________________________________________________

Signature of Parent/Guardian ________________________________________________

Address of Member/Participant ______________________________________________

Telephone Number of Parent/Guardian ________________________________________




Al Fresco Spring Campout 2009 - Registration Packet                                            Page 15 of 16
THIS IS NOT A FAIRFAX COUNTY PUBLIC SCHOOL or KEENE MILL PTA SPONSORED ACTIVITY
                                                                                                                        March 27-29, 2009

                                                    10. Individual Volunteer Form
                                           (Only complete if you have not so already)
        We need about 70 volunteers – you will make a difference! One volunteer per form please
Let me tell you about myself:
Name: __________________________ m/f Email: ____________________________
Phone - Day: ______________________________                Evening: __________________________
Cell Phone #: ______________________________
Name/Grade/Teacher of Your Child(ren):______________________________________________

I would like to be a Key Volunteer:

Advance Team: Arrive before campers, set-up camp headquarters, post signs, post cabin lists inside
cabin, check with YMCA staff
Craft Coordinator: Supervise crafts during open times

During Camp, I can: (check all that apply)
Open (setup) and close (breakdown) camp                                    Be a bus chaperone
Help with first aid/medication                                             Help with Al Fresco cup cabin competition
Help with camp photography                                                 Be a cabin counselor
Be a lead cabin counselor                                                  Help with sports activities
Help with security at camp                                                 Help wherever you need me
Help with the soc hop (Friday pm)                                          Help with camp fire (Friday pm)
Help with early activities (6:30 am)                                       Help with talent show (Saturday pm)

You should know that I:
Plan to be an overnight camper                                    Have medical training (RN, LPN, EMT, etc)

Workshops
Workshops are 90 minute sessions during the day on Saturday and are meant to be a fun way to introduce the kids to lots of different
activities. Class sizes range from 4 to 20 students. Materials and supplies are available or purchase arrangements can be made.
I can lead (L) or assist (A) in a workshop about: note as many as you can, we’ll get back with you on details.
Basketball               (L/A)         Ice cream making (L/A)
Balloon Animals         (L/A)          Nature Walk       (L/A)
Capture the flag        (L/A)          Volleyball       (L/A)
Fire Building           (L/A)
Fishing                 (L/A)




Al Fresco Spring Campout 2009 - Registration Packet                                                                  Page 16 of 16
THIS IS NOT A FAIRFAX COUNTY PUBLIC SCHOOL or KEENE MILL PTA SPONSORED ACTIVITY

				
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