HIGH SIERRA INTERNATIONAL RENDEZVOUS '98
SANTA CLARA COUNTY COUNCIL
BOY SCOUTS OF AMERICA
JULY 25 - AUGUST 01, 1998
I hereby attest that I have read, understand, approve and agree to all the terms and conditions of this application and certify its correctness. Further, I certify that this Applicant can meet the health and physical fitness requirements for High Adventure activities.
In consideration of the benefits to be derived from participation in HIGH SIERRA INTERNATIONAL RENDEZVOUS '98, any and all claims against the Boy Scouts of America and the Santa Clara County Council, or any of the officers, employees, agents or other representatives of either of them, or any other persons working under their direction or engaged in the conduct of their affairs, arising out of any accident, illness, injury, damage, or other loss or harm to or incurred or suffered by the applicant named on the application or to his property, in connection with or incidental to HIGH SIERRA INTERNATIONAL RENDEZVOUS '98, including preliminary training and travel, the encampment at Camp Hi Sierra, and all activities during Home Hospitality are expressly waived by the applicant and the applicant's family or guardians.
HOTLINE: | We have established (408) 280-5088, ext. 918 as a special phone line for ALL questions and comments. Call anytime, for any reason. We will return your call within 48 hours. |
E-MAIL: | [email protected] |
Name:________________________________________________________________ (FIRST NAME) (MIDDLE NAME) (LAST NAME)Address:_____________________________________________________________ (STREET & NUMBER) (CITY & ZIP CODE)Date of Birth:____/____/____ Place of Birth:_______________________Parents Name:________________________ Home Phone:(____) ____________Current Scout Ldrship Pos'n:____________________________ Unit #:_____Prev Scout Ldrship Pos'ns:___________________________________________Years in Scouting:___ Current Rank/Date Rec'd:_______________________Camping Experience: Years at Hi-Sierra _____ Other Scout Camps _______________________ Philmont or other High Adventure _________________________________ Junior Leader Training ___________________________________________ Order of the Arrow?___ Jamboree Experience _______________________School Attended:________________________ Grade Point Average:________School Activities:___________________________________________________Extracurricular Activities:__________________________________________Community Activities, including religious life: _________________________________________________________________Foreign Languages: Spoken?___________________ Studying:______________APPLICANT'S STATEMENT: Please tell why you want to attend the RENDEZVOUS '98. You may attach an additional page if desired:____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________PARTICIPANT'S AGREEMENT:
I further agree to submit evidence of physical fitness on a current Personal Health and Medical Record Form, Class 2 No. 34414 signed by a licensed medical practitioner. I will obey the Scout Oath and Law, cooperate with my leaders, take all preliminary training as may be required, and wear the official uniform at all times. I understand that RENDEZVOUS '98 will be covered by the news media and film-making or broadcasting companies, and I consent to the use of my voice and/or photograph in news coverage or similar projects approved by Santa Clara County Council, BSA.
If selected, I WILL(____) WILL NOT(____) host a foreign Scout for a maximum of 7 days Home Hospitality and help him understand more about our way of life. In either event, I agree to be a Good Will Ambassador for Santa Clara County Council and the Boy Scouts of America.
SIGNATURE:_________________________________ DATE:______/______/______
APPROVAL AND CONSENT OF PARENTS OR GUARDIAN:
(I)(We) have read and understand the Participant Eligibility and Requirements, the Parents Agreement and the Participant's Agreement for RENDEZVOUS '98.
(I)(We) agree with the content and ARE(____) ARE NOT(____) willing to provide Home Hospitality for the period of August 01 through August 08, 1998. (I)(We) understand that it will be our responsibility to provide transportation to his departure point.
SIGNATURE:_________________________________ DATE:______/______/______
SIGNATURE:_________________________________ DATE:______/______/______
UNIT LEADER'S CERTIFICATION:
I have read and understand the Participant Requirements for RENDEZVOUS '98.
I affirm that the Applicant is an active participant in the program of Unit #__________, and meets the required standards of Citizenship, Leadership, Scout Skills and Physical Fitness. In my opinion, the applicant will be a worthy representative of Santa Clara County Council and the Boy Scouts of America.
SIGNATURE:_________________________________ DATE:______/______/______
APPROVAL OF COUNCIL SELECTION COMMITTEE:
We find the applicant's Scouting record to be correct and, based on the Unit Leader's recommendation of the applicant's personal qualifications, we approve participation in RENDEZVOUS '98.
SIGNATURE:_________________________________ DATE:______/______/______
Revised December 30, 1997 || Posted by the Rendezvous'98 Web Crew