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Gemstone District
Spring Camporee 2015
May1-3
Van Hoy Campgrounds
Be Prepared…
for the Zombie Apocalypse
2015 Gemstone Spring Camporee
Be Prepared…
April 9, 2015
Attention all Webelos Leaders and Webelos Scouts:
The Webelos Spring Camporee will be May 2-3. The Camporee will be at VanHoy Campground
north of Statesville. From Exit # 65 on I-77, head towards Harmony but almost immediately turn
right. Map is in the The Webelos Leader’s Guide or at www.gemstonedistrict.com .
Schedule for the weekend can be found in the Webelos Camporee Leader’s Guide The main
check-in time starts at 9:00 A.M. on Saturday for Webelos and you can easily be on your way
home by 11:00 A.M. Sunday. Two night camping is allowed. The Order of the Arrow tap out
will be Friday night. PLEASE work with your Webelos and parents every way possible to come
and camp for the camporee. If the boys have schedule conflicts with sports, etc. , parent(s) can
come set up camp and then leave to go to a game or arrive later in the day to set up. The cost for
the camping is $8 per person for Webelos Leaders and Webelos. The $8 covers the cost of
patches, ribbons, supplies, insurance, facility rent (a charge per person) and porta-potties. Nonleader parents are $2. It is recommended and highly encouraged that each Webelos have one of
his parents, grandparents, etc. accompanying him for the entire weekend. When this is not
possible, an authorized adult can assume this responsibility.
The Webelos Patrols will have scored events on Saturday afternoon. See enclosed event list.
NOTE: Some events may be determined soon that Webelos will not participate in so some event
equipment might not be needed. Continue to check the Gemstone Website for updates.
SPECIAL NOTE: Even if not all money is collected by the 10:30 A.M. Saturday deadline then
still bring to the “circus tent” just as soon as you can before then the total number of Webelos in
your Patrol and the name of the Patrol so that a rotation schedule can be developed by the 1:00
P.M. starting time for the events. If you have just 4 or 5 in your Patrol/Pack then team up with
another 4 or 5 Webelos in a Patrol to make up a Patrol of 8 to 10 to go around together as a
group in the competition.
Campsites will be inspected Saturday afternoon being graded on the point system found in the
Webelos Leader’s Guide on the Gemstone Website. Blue, red and yellow ribbons will be
presented according to the points awarded. A special recognition will be given to the Patrol that
has the best “camp gadget”.
All Webelos and adults must bring a filled out Class 1 Health Form (included in this Webelos
Leader’s Guide) for each participant. These should be kept in your campsite.
Questions? Call Bill Hicks at 704-650-1026. If you have to leave me a message, please indicate
how late I can return a call to you at night. Or, email to wchicks@hotmail.com .
Your friend in Scouting,
Bill Hicks
P.S. Webelos Patrols will camp in the designated Webelos Camping Area or they can camp
adjacent to their “sister Troop”.
********** “Semi-final” Schedule
****************
Friday:
5:00
Check-in and set up for those desiring to spend two nights
8:00
Flag Retirement (come in Class “A” uniform)
8:30
Order of the Arrow Ceremony begins in the arena
10:00
TAPS – lights out. QUIET!
Saturday:
7:00-12:45
Reveille for those that checked in Friday, then cook breakfast, free time
and lunch
9:00-12:00
Check-in and set-up for one night campers. Only trailers to remain in
campsite
10:30
DEADLINE for registration and turn in of money at “circus tent” .
NOTE: Scored events in the afternoon need to have ideally 8 Webelos in
a Patrol. If a very small attendance from your Pack, try to pair up with
another small Pack to make around 8. Let Bill Hicks know when turning
in registration. If large attendance from your Pack, then okay to have two
or three Patrols.
12:00-12:45
Bag lunch from home suggested
12:45
Webelos, leaders and parents report to “circus tent” for instructions on
afternoon Patrol events. Wear Class “A” uniform (?).
1:00-5:00
Patrol events (see enclosed list)
5:00-7:00
Prepare supper, eat what you cooked and wash the dirty dishes.
5:00
Carry chilli to barn for competition
7:00-8:00
Scavenger Hunt (optional, but ribbions will be awarded). Send one
Webelos Scout and one Webelos Leader to the “circus tent”.
8:00
Flag retirement ceremony (Meet at flag pole in Class “A” uniform.
8:30
Zombies vs. Humans game Rules & Instructions
9:30 or about then Return to campsite,
9:45
Cracker-barrel (i.e. snacks and peach cobbler) by patrols.
10:20
Attempt winding down time
10:25
Winding down time!
10:30
TAPS – lights out. QUIET!
Sunday:
7:00
Reveille (bring your own clock if needed)
7:00-9:00
Breakfast and cleanup.
9:00
Report to flag pole for flag ceremony . Class “A” uniforms please.
9:30
Church Service in arena. Collection will be taken for World Friendship
Fund.
10:00
Presentation of ribbons.
10:30-11:00
Break camp and final campsite inspection. Patches given after campsite
passes inspection AND Evaluation Form turned in.
11:00
Or before – depart. Drive safely to the hot showers.
WEBELOS SPRING 2015
CAMPOREE SCHEDULE
May 2-3, 2015
Vanhoy Family Campgrounds
THEME : Be Prepared for the Zombie Apocalypse
SPECIAL NOTES:
1.
VEHICLES will be allowed in campsite for unloading only (5 minutes maximum).
Only one vehicle per Patrol at a time. Then move to the designated parking area.
Please keep roadway clear of vehicles so that other vehicles can get to their sites.
2.
Campsites will be inspected on Saturday afternoon. Ribbons will be presented.
Also, special recognition will be given to the Patrol for the best Webelos campsite
gadget.
3.
Cooking: Gas or propane stoves used only by adults. Wood fires are allowed on
the TOP of the ground only, pending any burning band. Remove all ashes and
wood before leaving.
4.
In case of no family member able to accompany the Webelos, an authorized adult
may assume this role. The authorized adult cannot sleep in the tent with this
Webelos. Parents may however tent with their own son.
5.
1st Aid for minor injuries, cuts, scraps, burns, stings, etc. will need to be provided
by your Webelos Leaders.
6.
All buildings, equipment and structures are off limits. Violators will be sent home
immediately.
7.
Porta-potty will be available near the sites. No latrines to be dug.
8.
NOTE: PLEASE keep the area clean that you camp in or pass thru. Remember,
good Scouts leave an area even cleaner than they find it. Carry home all trash.
9.
No radios, hand-held entertainment devices or any type objects of mayhem
allowed. Let’s listen to the birds, the other creatures in nature and the Webelos
Leader snoring in the tent next to you. No pets allowed in camp.
NO ACOHOLIC BEVERAGES MAY BE BROUGHT INTO CAMP.
10.
REMEMBER, no riding in any open vehicle such as bed of truck, tailgate of
family station wagon, trailer, etc. Riding of bicycles is not allowed.
11.
Set up fire pit the proper distant from trees. DO NOT dig fire pits. No bonfires.
Build safely on top of the ground. Remove all ashes, rock, etc. before leaving.
12.
All the Saturday afternoon events/stations may not all be open to the Webelos so
some event equipment listed on the enclosed list may not be needed. Watch for a
later update in the Webelos Leader's Camporee Guide on the Gemstone Website
as to what to bring. A different type scoring for the Webelos Patrols at events will
be as follows: Exercise/Test 4 points, Patrol listens to instructions 2 points,
Webelos complete without adult assistance 2 points and Patrol works as a group 2
points.
13.
Do not cut live trees. Okay to use wood already on the ground. You might want
to bring your own dry firewood.
14.
Fire and drinking water is available at several locations.
15.
Please come prepared for a collection to be taken at the Sunday morning worship
service. Collection will go to the World Friendship Fund.
16.
Webelos are responsible for feeding themselves. Please bring any leftover
desserts to the “circus tent” after supper on Saturday night.
17.
Sorry about all the Do’s and Don’t’s above but we want to have a safe camporee
and be allowed to come back again. If you have access to the internet then check
it later for possible updates on the camporee. www.gemstonedistict.com
If questions or comments, see Bill Hicks at the “circus tent”, or call 704-650-1026 before
Friday of the week of the camporee. Or email at wchicks@hotmail.com .
Driving directions to VanHoy Farms Campground
VanHoy Farms Family Campground is located in Harmony, North Carolina.
12 miles north of Statesville on I-77 at Exit 65 (Hwy NC 901).
Approximately 300 yards off of I-77 on Jericho Road.
For more information about VanHoy Farms Campground visit their website at:
www.vanhoyfarms.com
Gemstone district campsite inspection
Campsite appearance
evidence of campsite planning - campsite layout is symmetrical and allows for
walkways between tents/dining fly
dining fly pitched - campsite has dining fly/canopy securely anchored and large
enough to cover entire kitchen area
tents properly pitched - all tents are properly assembled and staked to ground
tent doors zipped and flaps rolled - all tent door/windows are zipped closed or
flaps rolled and tied if open
proper display of American and Pack/Troop flags - American flag is properly
displayed on the left looking into campsite with Pack/Troop flag on right
no vehicles in campsite - no vehicles are allowed in campsite unless authorized
by camporee chairperson(s)
campsite clean of litter and trash - no litter/trash on ground in the campsite area
firewood sorted and covered – neatly stacked, sorted by size, and covered
camp gadget – device or structure built with available natural materials and lashings but do not cut
down any live trees/plants. Scouts should practice Leave No Trace policies and ethics
Campsite health & safety
First Aid kit visible and stocked - First Aid kit must be clearly marked, visible, and
fully stocked in a central location of the campsite
campfire location with water bucket - campfire must be in an open area, away from
tents/dining fly, with no overhead tree limbs, and have filled water bucket within 10 feet
all tents have fire buckets filled - each tent should have a fire bucket containing water
or sand placed at the front
all tent lines are flagged for safety - all tent/fly guy lines should be flagged to provide
high visibility to prevent accidental tripping
all tools and equipment are safely stored - all tools should be stored away from
walkways with protective coverings placed over sharp cutting surfaces
liquid/bottled fuel properly stored - liquid fuel stored in marked/approved containers and all
fuels stored away from spark/heat sources
ax yard properly marked and safe - entire area clearly marked and all tools properly stored if not
in use.
latrine – if allowed, located away from campsite, streams, and trails
Campsite kitchen
menu and duty roster posted - visible and posted for each patrol
kitchen clean and orderly - all utensils/pot/pans clean and organized and all surfaces used for food
preparation clean/sanitary
food properly and safely stored - all perishable food items stored in chilled containers to maintain
freshness and no open food containers/bags that may attract wildlife into kitchen area
all garbage placed in suitable bag/container - garbage bags should be hung off of the ground
and containers should be covered to prevent access by wildlife
Gemstone district campsite inspection sheet
Max points
Campsite appearance
evidence of campsite planning
dining fly pitched
tents properly pitched
tents doors zipped and flaps rolled
proper display of American and Unit flags
no vehicles in campsite (unless authorized)
campsite clean of litter and trash
firewood sorted and covered
camp gadget
Campsite health & safety
First Aid kit visible and stocked
campfire location with water bucket
all tents have fire buckets filled
all tent lines are flagged for safety
all tools and equipment are safely stored
liquid/bottled fuel properly stored
ax yard properly marked and safe
latrine location
Campsite kitchen
menu and duty roster posted
kitchen clean and orderly
food properly and safely stored
all garbage placed in suitable bag/container
Score
5
5
5
5
5
5
5
5
5
5
5
5
5
5
5
5
N/A
5
5
5
5
100
Max total
Total
Be Prepared for the Zombie Apocalypse
•
Zombie theme with Zombie Hunter Staph
•
Alexandria (HQ) – Zombie Free Zone
•
Zombie Gateways-Scored as part of Inspection
•
Stations (****The Webelos will have a separate scoring system from the Troops****)
•
o
Archery – Lanes and instructors. Scored by patrol
o
Ax Throwing - Lanes and instructors. Scored by patrol
o
Rescue lines – Use a rope & bowline to rescue your buddies from Zombies
o
Zombie First Aid – Care for Zombie bites, scrapes etc.
o
Rope Bridge/ Supply Relay – Avoid Zombies crossing stream/ravine with patrol & gear
(****There is a chance Webelos may not participate in this****)
o
Scavenger Hunt – Find listed materials within Camporee grounds. NO STEALING from other units.
However, trading is encouraged.
o
Morse Code – Using light to transmit and receive signals: NO SOUND; it attracts walkers
o
Brain Food – Chili Cook-Off Contest
o
Ax Me – Zombie Survival Quiz
o
Stretcher Carry Relay – If possible bring a blanket and 2 staves for "making" a stretcher
o
Batter Up – Zombie “head” Pinata (Bring a ball bat)
o
Clean Contaminated Water - Pure water is hard to find. Using Scout skills purify water for drinking
(****Just bring fire starting tools****)
o
Brain Eating Contest (jello brains)
o
Zombie invasion game - Saturday evening – Zombies vs. People
(****Webelos will not do this Saturday night… We may develop a Webelos version of this****)
Patrol Equipment
o
Vehicle (wagon) or bags to transport patrol gear (or just lots of Webelos hands)
o
Supply bag (for transport across bridge… if we see that Webelos can do the bridge event)
o
Blanket – Warmth & Stretcher material
o
Minimum (2) Staves for stretcher
o
Bat
o
First Aid Kit
o
Clean Water – for drinking
o
Water purification tools (tablets and filter not needed, just fire building tools)
o
Water containers (Nalgene) for each scout
•
Selling T-Shirts - “Everyone Makes Fun of the Boy Scout Until the Zombie Apocalypse”
(****T-shirt sizes are based on adult sizes****)
•
Night activities
•
o
Capture the Flag Saturday evening– Zombies vs. People
(****Webelos will not do this Saturday night. We may develop a Webelos version of this****)
o
Brain Eating Contest (jello brains)
OA Callout Friday Night Ceremony (****Note change from usual Saturday night ceremony****)
Questions…? Call or email Bill Hicks at 704-650-1026 or wchicks@hotmail.com
World
Friendship
Fund
Through the World Friendship Fund, voluntary contributions of Scouts and leaders are
transformed into cooperative projects that help Scouting associations in other countries to
strengthen and extend their Scouting programs. The World Friendship Fund gives the youth
members of the Boy Scouts of America an opportunity to help fellow Scouts who are in need of
their support. It teaches Scouts that Scouting is global. Since the inception of the World
Friendship Fund, American Scouts and leaders have voluntarily donated more than $11 million
to these self-help activities.
The World Friendship Fund was developed during the closing days of World War II. At that
time, there was a great need to rebuild Scouting in those nations that had been wracked by war
and were just emerging from the shadows of totalitarianism.
Over the years, this fund has provided Scouts from around the world with Scouting literature,
uniforms, summer camp equipment, computers, and other Scouting-related supplies.
A collection for the World Friendship Fund
will be held during the Sunday morning
assembly and religious service.
Please remind Scouts to bring a small
donation that will be used to support their
fellow Scouts in need around the world.
Gemstone District 2015 Spring Camporee
Zombie Apocalypse T-shirt order form
T-shirt design is lime-green t-shirt with black print.
Submit orders to Peter Browne at:
121 Periwinkle Lane
Mooresville, NC 28117
Attn: Camporee T-shirts
or
peterbrowne_pe@yahoo.com
Payment can be submitted with order (if mailed) or at Camporee when submitting unit fee.
Please make checks payable to ‘Piedmont Council, BSA’ and note ‘Camporee T-shirts’ on memo line
Orders received by Friday, April 17, should have T-shirts available at Camporee.
Orders will continue to be received through Camporee weekend.
Orders received after April 17 will be contacted to schedule delivery date after Camporee.
Pack/Troop/Crew: ______
Unit leader (or contact): ____________________________
Phone: _____________ Email: _____________________
Size
Small
Medium
Large
X-Large
XX-Large
Quantity
Price
8.00
8.00
8.00
8.00
10.00
Total order price:
**** Note: above sizes are adult sizes ****
Total
STAPH
Everyone makes fun of the
Boy Scout until the
Zombie Apocalypse! WEBELOS
Spring 2015 Gemstone District
Camporee Registration
Pack: ________
Den/Patrol: ______________
Leaders
Leader in charge: __________________________
Adults (non-leaders)
1
2
3
4
5
6
7
Adults (non-leaders)
1
2
3
2
5
6
7
8
9
10
11
12
Scouts
1
2
3
4
5
6
7
8
9
10
11
12
Total leaders @ $8.00
Total scouts @ $8.00
________
________
$ __________
$ __________
Total adults (non-leader wanting patch) @ $4.00 ________
Total adults (non-leader no patch) @ $2.00
________
$ __________
$ __________
Total extra patches @ $2.00
________
$ _________
Total patches ordered
________
Total amount
$ __________
Make checks payable to: Piedmont Council BSA
A
Part A: Informed Consent, Release Agreement, and Authorization
High-adventure base participants:
Full name: _________________________________________ Expedition/crew No.:________________________________
DOB:
_________________________________________
Informed Consent, Release Agreement, and Authorization
I understand that participation in Scouting activities involves the risk of personal
injury, including death, due to the physical, mental, and emotional challenges in the
activities offered. Information about those activities may be obtained from the venue,
activity coordinators, or your local council. I also understand that participation in
these activities is entirely voluntary and requires participants to follow instructions
and abide by all applicable rules and the standards of conduct.
In case of an emergency involving me or my child, I understand that efforts will
be made to contact the individual listed as the emergency contact person by
the medical provider and/or adult leader. In the event that this person cannot be
reached, permission is hereby given to the medical provider selected by the adult
leader in charge to secure proper treatment, including hospitalization, anesthesia,
surgery, or injections of medication for me or my child. Medical providers are
authorized to disclose protected health information to the adult in charge, camp
medical staff, camp management, and/or any physician or health-care provider
involved in providing medical care to the participant. Protected Health Information/
Confidential Health Information (PHI/CHI) under the Standards for Privacy of
Individually Identifiable Health Information, 45 C.F.R. §§160.103, 164.501, etc.
seq., as amended from time to time, includes examination findings, test results, and
treatment provided for purposes of medical evaluation of the participant, follow-up
and communication with the participant’s parents or guardian, and/or determination
of the participant’s ability to continue in the program activities.
(If applicable) I have carefully considered the risk involved and hereby give my
informed consent for my child to participate in all activities offered in the program.
I further authorize the sharing of the information on this form with any BSA volunteers
or professionals who need to know of medical conditions that may require special
consideration in conducting Scouting activities.
or staff position:____________________________________
With appreciation of the dangers and risks associated with programs and
activities, on my own behalf and/or on behalf of my child, I hereby fully and
completely release and waive any and all claims for personal injury, death, or
loss that may arise against the Boy Scouts of America, the local council, the
activity coordinators, and all employees, volunteers, related parties, or other
organizations associated with any program or activity.
I also hereby assign and grant to the local council and the Boy Scouts of America,
as well as their authorized representatives, the right and permission to use and
publish the photographs/film/videotapes/electronic representations and/or sound
recordings made of me or my child at all Scouting activities, and I hereby release
the Boy Scouts of America, the local council, the activity coordinators, and all
employees, volunteers, related parties, or other organizations associated with
the activity from any and all liability from such use and publication. I further
authorize the reproduction, sale, copyright, exhibit, broadcast, electronic storage,
and/or distribution of said photographs/film/videotapes/electronic representations
and/or sound recordings without limitation at the discretion of the BSA, and I
specifically waive any right to any compensation I may have for any of the foregoing.
!
NOTE: Due to the nature of programs and
activities, the Boy Scouts of America and local
councils cannot continually monitor compliance
of program participants or any limitations
imposed upon them by parents or medical
providers. However, so that leaders can be as
familiar as possible with any limitations, list any
restrictions imposed on a child participant in
connection with programs or activities below.
List participant restrictions, if any:
!
None
________________________________________________________
I understand that, if any information I/we have provided is found to be inaccurate, it may limit and/or eliminate the opportunity for participation in any event or activity. If I
am participating at Philmont, Philmont Training Center, Northern Tier, Florida Sea Base, or the Summit Bechtel Reserve, I have also read and understand the supplemental
risk advisories, including height and weight requirements and restrictions, and understand that the participant will not be allowed to participate in applicable high-adventure
programs if those requirements are not met. The participant has permission to engage in all high-adventure activities described, except as specifically noted by me or the
health-care provider. If the participant is under the age of 18, a parent or guardian’s signature is required.
Participant’s signature:_________________________________________________________________________________________ Date:_______________________________
Parent/guardian signature for youth:______________________________________________________________________________ Date:_______________________________
(If participant is under the age of 18)
Second parent/guardian signature for youth:_______________________________________________________________________ Date:_______________________________
(If required; for example, California)
Complete this section for youth participants only:
Adults Authorized to Take to and From Events:
You must designate at least one adult. Please include a telephone number.
Name: _______________________________________________________
Name: _______________________________________________________
Telephone: ___________________________________________________
Telephone: ___________________________________________________
Adults NOT Authorized to Take Youth To and From Events:
Name: _______________________________________________________
Name: _______________________________________________________
Telephone: ___________________________________________________
Telephone: ___________________________________________________
680-001
2014 Printing
B
Part B: General Information/Health History
High-adventure base participants:
Full name: _________________________________________ Expedition/crew No.:________________________________
DOB:
_________________________________________
or staff position:____________________________________
Age:____________________________ Gender:_________________________ Height (inches):___________________________ Weight (lbs.):_____________________________
Address:_________________________________________________________________________________________________________________________________________
City:___________________________________________ State:___________________________ ZIP code:_______________ Telephone:_______________________________
Unit leader:_________________________________________________________________________________ Mobile phone:__________________________________________
Council Name/No.:___________________________________________________________________________________________________ Unit No.:_____________________
Health/Accident Insurance Company:__________________________________________________ Policy No.:____________________________________________________
!
Please attach a photocopy of both sides of the insurance card. If you do not have medical insurance,
enter “none” above.
!
In case of emergency, notify the person below:
Name:____________________________________________________________________________ Relationship:____________________________________________________
Address: _____________________________________________________________ Home phone:________________________ Other phone:__________________________
Alternate contact name:_____________________________________________________________ Alternate’s phone:_______________________________________________
Health
History
Do you currently have or have you ever been treated for any of the following?
Yes
No
Condition
Diabetes
Explain
Last HbA1c percentage and date:
Hypertension (high blood pressure)
Adult or congenital heart disease/heart attack/chest pain
(angina)/heart murmur/coronary artery disease. Any heart
surgery or procedure. Explain all “yes” answers.
Family history of heart disease or any sudden heartrelated death of a family member before age 50.
Stroke/TIA
Asthma
Last attack date:
Lung/respiratory disease
COPD
Ear/eyes/nose/sinus problems
Muscular/skeletal condition/muscle or bone issues
Head injury/concussion
Altitude sickness
Psychiatric/psychological or emotional difficulties
Behavioral/neurological disorders
Blood disorders/sickle cell disease
Fainting spells and dizziness
Kidney disease
Seizures
Last seizure date:
Abdominal/stomach/digestive problems
Thyroid disease
Excessive fatigue
Obstructive sleep apnea/sleep disorders
CPAP: Yes £
List all surgeries and hospitalizations
Last surgery date:
No £
List any other medical conditions not covered above
680-001
2014 Printing
B
Part B: General Information/Health History
High-adventure base participants:
Full name: _________________________________________ Expedition/crew No.:________________________________
DOB:
_________________________________________
or staff position:____________________________________
Allergies/Medications
Are you allergic to or do you have any adverse reaction to any of the following?
Yes
No
Allergies or Reactions
Explain
Yes
No
Allergies or Reactions
Medication
Plants
Food
Insect bites/stings
Explain
List all medications currently used, including any over-the-counter medications.
CHECK HERE IF NO MEDICATIONS ARE ROUTINELY TAKEN. IF ADDITIONAL SPACE IS NEEDED, PLEASE
INDICATE ON A SEPARATE SHEET AND ATTACH.
Medication
YES
NO
Dose
Frequency
Reason
Non-prescription medication administration is authorized with these exceptions:_______________________________________________
Administration of the above medications is approved for youth by:
_______________________________________________________________________ /________________________________________________________________________
Parent/guardian signature
MD/DO, NP, or PA signature (if your state requires signature)
Bring enough medications in sufficient quantities and in the original containers. Make sure that they
are NOT expired, including inhalers and EpiPens. You SHOULD NOT STOP taking any maintenance
medication unless instructed to do so by your doctor.
!
!
Immunization
The following immunizations are recommended by the BSA. Tetanus immunization is required and must have been received within the last 10 years. If you had the disease,
check the disease column and list the date. If immunized, check yes and provide the year received.
Yes
No
Had Disease
Immunization
Tetanus
Pertussis
Diphtheria
Measles/mumps/rubella
Polio
Chicken Pox
Hepatitis A
Date(s)
Please list any additional information
about your medical history:
_____________________________________________
_____________________________________________
_____________________________________________
_____________________________________________
DO NOT WRITE IN THIS BOX
Review for camp or special activity.
Reviewed by:_____________________________________________
Hepatitis B
Date:____________________________________________________
Meningitis
Further approval required:
Influenza
Reason:_________________________________________________
Other (i.e., HIB)
Approved by:_____________________________________________
Exemption to immunizations (form required)
Date:____________________________________________________
Yes
No
680-001
2014 Printing
Spring 2015 WEBELOS Camporee Evaluation
Please complete and submit to Mr. Bill Hicks before exiting
Pack # (optional):_____ Patrol (optional):_________ WEBELOS leader (optional): ___________________
Comments about your campsite. Was it adequate?
Comments about the campground/facility in general.
Comments about the activities/events. (to long, to short, etc.)
What comments did you hear about the activities/events from your WEBELOS?
What comments did you hear about the activities/events from WEBELOS Leaders and parents?
Comments about the staff. (helpful or not, prepared, courteous)
Would you care to mention a staff member who was special or stood out?
Comments about the Saturday evening assembly/Order of the Arrow call out ceremony.
Comments about the Sunday morning religious service.
Other comments.