Mt he ae UAE VLC ‘soncone =1s0"2 aes? ‘As @ high school stucient you have undoubtedly been impacted by someone in yourlife. But have you thought about the legacy that you willbe leaving on others? You have reached the point in your fe where you see the horizon of high school graduation ‘approaching. You have obviouely undertaken activities to prepare yourself for life after high school. Outdoor Odyssey wants to show you how much additional potential you have in your own hands; the potential to change someone else's If. Te Sempsr Fi Fund le sponsoring a spacial camp in coorination with Outdoor Odyssey. These organizations are looking fora fw future laacors who want to make a aifaranco in cihers--specically children of injured Marines and Sailors siaioned in the Camp Lejeune ‘area, You wil em the fundementals of mentoring while geining a keen insight ilo your potential through introduction of Outdoor Odyssey's leadership curiculum, develooed by Outdoor assy Founder, Maior General. S. Jones, USMC ret). The motto of Outcoor (Odyssey is "growth through adlventure, "so expect new and excting adventures, clméing, rappeling, backpacking, caving, high and low ropes ard white-water rang ae but few of the experiences designed to show you your true potential. Every activity is undertaken as pert fa tear, conssing of mentors, juror mentors’ and campers sled, seasoned counselors ‘oversee all aspects ofthe adventure. ‘The Outdoor Oayssey Leadership Academy floated inthe Laue Highlands of scutrwestem Pennsylvania, Transportation from Camp Lefune and the entre week-long experience is being Neate sporsored by the Semper Fi Func the any cost to yous a deste to lear and the genuine ‘concer requledolmpact analn ased. The entre week puts you In an inspiring leacerstip Tho Leadership Academy cultivates your skills at a leader, while postion, withthe adventure an shared challenges ofthe week forging a BOND between you and ae eer eee ‘your team is fly expected tht this BOND wil provide rch vend to ainvaved inthe ‘eeventures and an opportuniey to Upcoming academic yaar wake @ difference Volunteer! Learn Leadership! Be a Mentor! Help Others Grow! July 10-16, 2011 ~ outdoorodyssey.orgI 42, Camp Semper Fi SEMPER FI FUND 760-725-3680 | info@semperfitund.org www.semperfifund.org Located at Outdoor Odyssey at Roaring Run 450 Boy Scout Road | Roswell, PA 15531 814-629-6516 | emall@outdoorodyssey.org | www.outdoorodyssey.org GENERAL INFORMATION FORM Please make sure to fill out EVERY form in its entirety. This includes providing ALL signatures and ALL dates. If a participant does not have all of his/her paperwork in, or if any of the paperwork is incomplete, that child will not be permitted to attend camp. ‘Camper's Name: Fes Date of Birth: School: Guidance Counselor: Full Name of Parent or Legal Guardian with Whom Child Resides: Address: City: Phone Numbers: State: Home (__). Cell (__), Parent Email: Name of Second Parent or Guardian if Applicable: Phone Numbers: Home (__). Cell (__). Parent Emall: Emergency Contact (other than parent/guardian}: Phone: Age: Gender: Grade Entering in Fall:__ ZIP Code: ‘Work (__}, Work (___). Relationship to Camper: Date: General Information Form> Camp Semper Fi 760-725-2680 |intoosemperttund.org SEMPER Fl www.semperffund.org FUND Located at Outdoor Odyssey at Roaring Run ‘450 Boy Scout Road | Roswell, PA 15531 814-629-6616 | emall@outdoorodyssey.org | www.outdoorodyssey.org AUTHORIZATION AGREEMENT 1 , hereby give my permission for my son/daughter, (Nave of Pari or Guard to participate in the Camp Semper Fi Youth Mentoring (Nam of Parpant Program at Outdoor Odyssey. Furthermore, I release Outdoor Odyssey at Roaring Run, Inc, its employees, and its volunteers of any and all Fabiliy for or on account of ary personal injury which my child may incur while my child i participating in Outdoor Odyssey's programmed activites. | further authorize Outdoor Odyssey and Camp Semper Fito photograph my child for use in promotional materials for the program. Additionally, | authorize my chld’s school to release information regarding my child's grades, attendance records, IEP, and behavioral updates, which willbe held strcty confidential by Outdoor Odyssey at Roaring Run, Inc., and willnotbe released without the written consent of the person/agency who authored the information or agency ‘who maintains responsibiliy for its consent. | give my permission for my child's mentor to meet with him/her during school hours when arranged with school personnel or before/after school hours with my express consent. understand that unless otherwise limited by state or federal regulation, and excepptto the extentthat action has been taken which was based on my consent, I may withdraw this consent at any ime by writing to Outdoor Odyssey atthe above address. Please identify any existing agencies that may currently assist your child. Working together helps strengthen the support for your child and helps us identify funding sources for your child’s experience. Check all that apply. Children and Youth Services co MWR 0 Focus Other (please list): (Name of Participant's Parent or Guardian) (Relationship to Participant) (Gignature of Participant's Parent or Guardian) (Date Signed) Authorization Agreement