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TWS Trek Registration Packet

The document provides information and forms for a youth pioneer trek, including a registration form, health history form, photo release, and supply list. Participants will pull handcarts up to 35 miles over 5 days and experience limited rations similar to pioneers. The trek requires physical preparation including multiple practice hikes and being able to walk 4 miles in under an hour. Permission forms signed by parents are required for under-18 participants.
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0% found this document useful (0 votes)
997 views9 pages

TWS Trek Registration Packet

The document provides information and forms for a youth pioneer trek, including a registration form, health history form, photo release, and supply list. Participants will pull handcarts up to 35 miles over 5 days and experience limited rations similar to pioneers. The trek requires physical preparation including multiple practice hikes and being able to walk 4 miles in under an hour. Permission forms signed by parents are required for under-18 participants.
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Participant Full Name:______________________________________ Ward:__________________________________________________________ Address:_______________________________________________________ Home Phone:________________Cell Phone:___________________ Sex:____________Age:________Birthday:________________________ School:__________________________Grade:_______________________ Parents Names:______________________________________________

Youth Pioneer Trek


Tucson West Stake
Date of Trek: May 29-June 2, 2012

Youth Fee: $35.00

Registration Form
.................................................................................................................................................................................... This form (both sides) must be completed, signed, and returned to your ward YM or YW President by March 11, 2012. Each participant (adults and youth) must complete a form. No one will be allowed to participate without it. Participant______________________________________________Sex______Age_______Birthday_____________________________ Address__________________________________________________________________Home Phone_____________________________ School_____________________________________________Grade________________Cell Phone________________________________ Insurance Company______________________Policy #_______________________ Parents Name (if a youth)__________________________________ Parents Cell Phone_________________________________ CONTRACT
1. I understand that I will push and pull a heavily loaded handcart up to 16 miles in one day and up to 35 miles during the whole week, and that I will be on food rations similar to what the pioneers experienced (limited at times) and may experience hunger and/or thirst. 2. I am a participant in the Trek of my own volition, and I will accept full responsibility for my actions under all conditions. I also agree to aid other members of the group in behaving responsibly. 3. I understand and appreciate that there are inherent risks involved in this activity which are beyond the control of Pioneer Trek or its staff and I agree to personally assume such risks. Also, Pioneer Trek and/or its staff cannot be held responsible for any injuries sustained which are not directly caused by their failure to take due care.
4.

I agree to abide by LDS standards. This means that high standards of honor, integrity, and abstinence from alcohol, tobacco, and harmful drugs are required of every participant during the trek.

5. I will try to condition myself physically for this experience to the point that I am able to complete the minimum recommendation of walking/running 4 miles on level ground in 60 minutes or less without undue stress and pay particular attention to the Foot Preparation Form provided in this packet. 6. I understand that I am responsible for bringing all items on the Individual Supply List provided in this packet. 7. I (and/or my guardian) agree to accept full responsibility for any medical or related bills incurred that are not covered by Stake DMBA insurance or my own policy. 8. In exchange for permission to participate, I hereby agree to release Tucson West Stake Pioneer Trek and its staff & leaders, from any and all claims for liability arising from participation in this program and to hold Pioneer Trek, its staff, harmless from all expenses, costs, and claims in connection with any injury. 9. I agree to fully participate in the Trek.

Date_____________________________________________ Signed__________________________________________________________

Participant Health History

Height:________ Weight:________ Family Doctor:_____________________________

Phone:___________________

If you currently suffer from, or have experienced any of the following conditions within the past year, please mark the appropriate space below Arthritis Major operation or serious illness Asthma Heart trouble Seizures Diabetes Emotional problems requiring medication Hypoglycemia Fainting spells Bleeding disorders Ulcers medication Severe allergic reactions Rheumatic fever Other medical conditions which might be Major bone or joint injuries aggravated by hiking. High blood pressure Explain:_____________________________ Describe any allergies or medication reactions: __________________________________________________________ __________________________________________________________________________________________________ Medications currently being used: _________________________________________________________________ No

Have you been hospitalized or had more than a minor illness or injury during the past year? Yes If yes, please explain:

______________________________________________________________________________

__________________________________________________________________________________________________ Is there anything not covered above that would keep you from participating fully in the Trek? If so, please explain:___________________________________________________________________________________________ __________________________________________________________________________________________________ Physical examinations are not required for each participant. However, it is the responsibility of the participant and their guardian to seek preventative medical care if they feel there is a need. If there are any doubts about whether the participant will be able to participate fully in the activities of Trek, we encourage you to seek attention from a medical professional. I agree to the above terms and declare the above statements are complete and correct.
_________________________________________________________ (Date) (Signature of Participant)

As a parent, I am aware that my child will be participating in the Stake Youth Pioneer Trek. I have read the Contract and the completed health history, and I am aware of the circumstances my child will undergo, and I hereby give my full permission for him/her to participate. I understand it is my responsibility to seek preventative medical care, prior to the Trek, for my child if I feel there is a need. Also, in the event any medical attention is needed, I hereby authorize any leaders to seek medical treatment and medical personal in charge of my child to administer such medical or surgical treatment or carry out such procedure as may be deemed necessary or advisable in the diagnosis or treatment of my child. This permission includes travel to and from the Youth Pioneer Trek as well as participation during the Trek.
I agree to the terms of the Contract and Release and declare the above statements are complete and correct. ____________________ (Date) _______________________________ (Signature of Parent/Guardian)

(Parent or guardian must sign here if participant is under 18 years of age. Participants 18 or older must sign here--for themselves

Youth Pioneer Trek


Photo Release Form
I understand that I may be photographed and/or videoed during the Youth Pioneer Trek. I give my permission for the Tucson West Stake to use any pictures or video taken of me in a video they will be putting together in remembrance of our experience during the trek. Youth Name _________________________________________________ Youth Signature_______________________________________________ Parent Signature______________________________________________ Date_______________________

Tucson West Stake

PLEASE DETACH THIS PAGE AND KEEP FOR FUTURE REFERENCE


Pre-Trek Hikes Locations & Meeting times may vary. Details will be given to your ward YM & YW leaders Hike Dates January 28th February 25th March 24th April 28th

Pioneer Trek Foot Preparation


Wearing the wrong shoes on the trek will rub you wrong and that means foot pain and blisters. Remember, your toes need room to expand, because your feet will swell a full shoe size as you walk on the trek. So be sure to bring only comfy trekking shoes. Running shoes are the best bet for trekkers because they are specifically designed for cushioning, motion control, and support. Keep in mind that hiking boots do not provide motion control features that many people need, and may be inflexible and heavy. And they are certain to rub you wrong! Since you know that you will be trekking soon, try to do a couple of walks with your trekking shoes and a light backpack. If, or when you feel hot spots forming, stop! Go home, rub your feet with rubbing alcohol and let them dry out. This should allow you to form calluses that can protect you on the trek. To physically prepare yourself for the trek, here are some general guidelines:

Walk 4-5 times per week For 2-3 times per week, walk 2-3 miles, and 2 times a week, walk 4-5 miles About 4 times before the actual Trek, walk longer periods of time up hill. If you are able to complete 4 miles in 1 hour we feel confident that the trek will be challenging but not too much for you to handle. This is a recommendation, but not a mandatory requirement. We will not be trekking this fast with the handcarts, but it is a good reference while you are personally preparing.

Please visit our Trek Blog http://www.weststaketrek.blogspot.com/ for all things Trek. We will be updating this blog regularly with helpful information.

Pioneer Trek Individual Supply List


5 gallon bucket and lid (Provided by Stake) 1 warm sleeping bag (it gets plenty nippy in the mountains)put inside plastic bag 1 old blanket (wool if possible) 1 old coat (warm) 1 rain poncho 1 pair of shoes to hike in (don't buy new ones -- they will give you blisters. Sturdy running or tennis shoes will work best. Hiking boots tend to be heavy, inflexible and are likely to rub you wrong which means foot pain and blisters therefore we do not recommend that you wear hiking boots) 3 pair of sturdy socks 2 sets of underclothing 2 bandannas (necessary items) 1 metal pie plate (sturdy) 1 metal spoon attached 1 tin cup 1 small hand towel and a comb or brush 1 toothbrush & baking soda 5 Band-Aids Prescribed medications only (will be held by Trek doctor) An old set of scriptures and your favorite church magazine 2 heavy duty garbage bags Water bottle Chapstick (lip balm), insect repellent, small package of HandiWipes and sunscreen Gloves WOMEN should bring: 2 mid-calf length, long-sleeved dresses or 2 mid-calf skirts and 2 long sleeve blouses 1 or 2 bonnets 1 pair of knee-length bloomers (can be made out of old pajama bottoms or hospital pants (patterns are available upon request) 1 apron 1 flannel nightgown Feminine hygiene supplies

MEN should bring: 2 pairs of wool, canvas, or cotton pants (not Levis) 2 long-sleeved shirts (flannel are best, but any will do) 1 wide-brimmed western style hat (no baseball or army hats allowed) 1 pair suspenders

Optional Items: Camera (There will be a Stake photographer taking photographs throughout the Trek) Personal journal and pen or pencil Folding pocket knife (4 inch blades or smaller with lock) Harmonica No electronic devices

ALL ITEMS MUST FIT IN THE TREK BUCKET


Do not bring: Electronic devices of any kind, included but not limited to: Cell phones, radios, ipods, ipads, TVs, Gameboys, CD players, tape players, and electronic games. Sodas and candy. Fixed-blade knives or sheath knifes are not allowed except for cooking, and will be used under the supervision of the Mas and Pas. Lighters are not permitted at any time. Aerosol spray products are not permitted No fireworks are allowed at any time

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