ALUMNI BACKPACKING TRIP Request

June 30 - July 3

This form for must be submitted at least two (2) days prior to the event.

For the safety of our boys, and to follow industry standards, all 18 and over guests must have a background check completed prior to acceptance of their overnight stay at R.M. Pyles Boys Camp.

June 30th: Arrival and sleep at Main Camp

July 1-3: Backpacking Trip to Lion Meadows

July 3: Option to sleep at Main Camp or head home

More information (packing list, etc) will be provided as the event approaches.

Please note: Due to remaining hazards from the 2020 Castle Fire, we respectfully ask that attendees be physically able to hike the terrain from Jerkey to Lion at a 2-3MPH pace. There is very little shade and will be much ash from Jerkey until well past Grey Meadows. If you feel you are unable to make this challenging hike, we ask that you refrain from signing up and instead request to visit camp another time by clicking here.

Full Name

First Name

Last Name

Camp Name

Date of Birth

Street Address, City, State, Zip

Phone

(###)

###

####

Email Address

Service Information

1) Do you require a specific diet? (vegetarian, vegan, gluten free, etc) 2) Are there any food allergies we should be aware of? 3) Are there any health concerns you feel R.M. Pyles Boys Camp should be aware of? (Attach additional sheet if necessary)

Emergency Contacts - Please list at least 2 contacts

Name: Relationship: Home Phone: Cell Phone:

Emergency Treatment Authorization

I/we hereby grant R.M. Pyles Boys Camp and its agents full authority to hospitalize, secure proper treatment for, and order injection, anesthesia, or surgery regarding any member of my family’s health or mine in the case of an emergency where I/we are not able to make the decision during our stay at R.M. Pyles Boys Camp. I/we fully release R.M. Pyles Boys Camp and its agents from any liability in connection with those decisions. I/we grant permission for emergency treatment by a rescue squad, private physician and/or hospital or emergency health care facility staff, under the same circumstances as above, if needed. Any such action will be taken in the best interest of the family member involved and will be reported to me/us as soon as possible. I understand that first aid and medical care is the primary responsibility of the Participant.

Liability Waiver

In consideration of gaining membership or being allowed to participate in the activities and programs of R.M. Pyles Boys Camp and to use its facilities, equipment, and machinery in addition to the payment of any fee or charge, I do hereby waive, release and forever discharge R.M. Pyles Boys Camp and its officers, agents, employees, representatives, executors, and all others from any and all responsibilities or liability for injuries or damages resulting from my participation in any activities or my use of equipment or machinery in the above mentioned facilities or arising out of my participation in any activities at said facility. I do also hereby release all of those mentioned and any others acting upon their behalf from any responsibility or liability for any injury or damage to myself, including those caused by the negligent act or omission of any of those mentioned or others acting on their behalf or in any way arising out of or connected with my participation in any activities of R.M. Pyles Boys Camp or the use of any equipment at R.M. Pyles Boys Camp.

Image Release

I/We grant R.M. Pyles Boys Camp, their agents and representatives the irrevocable, perpetual worldwide right to use mine/my family’s/my guests' names, voices and likenesses in any combination for purposes of promoting R.M. Pyles Boys Camp in all media, including but not by way of limitation, illustrations, advertising, publications, trade, and video programs. All film, photographs, negatives, tapes or recordings shall constitute the sole property of R.M. Pyles Boys Camp with full right of disposition in any legitimate manner whatsoever.

Visitor’s Agreements

• I agree to NOT bring any weapons, drugs, or alcohol to camp. • I agree to preserve the sanctity of Pyles Boys Camp and not be a distraction or a disruption to the Pyles Boys Camp Program while visiting. • I agree to be added to the Pyles Boys Camp mailing/email list, and will notify office staff in writing if I choose to be removed from mailing/email list. • I agree to respect the privacy of all campers and staff by NOT entering their living areas. • I agree to adhere to all camp rules during my visit. • I agree to NOT to bring any pets to camp. • I agree to take full responsibility for all members of my party for the duration of our stay at camp. • I agree to replace and/or reimburse any damaged Pyles Camp property that might occur by me or members of my party during my staff at Pyles Boys Camp.

Background Check Agreement

National Background Investigations, Inc. Customized Background Screening Solutions…. Simplified Acknowledgement and Authorization I acknowledge receipt of the disclosure regarding background investigations and summary of your rights under the fair credit reporting act and certify that I have read and understand both of those documents. I hereby authorize the obtaining of “consumer reports” and/or “investigative consumer reports” by R.M. Pyles Boys Camp at any time after receipt of this authorization and throughout my time up at camp. To this end, I hereby authorize, without reservation, any law enforcement agency, administrator, state or feral agency, institution, school or university (public or private), information services bureau, employer, or insurance to furnish any and all background information requested by National Background Investigation, Inc. PO Box 966 Stevensville, MD 21666 1800-798-0079 another outside organization acting on behalf of R.M. Pyles Boys Camp at any time after receipt of this authorization and throughout my time up at camp. I agree that Fax, electronic, or photographic copy of this Authorization shall be as valid as the original. California applicants: by signing below, you also acknowledge receipt of the NOTICE REGARDING BACKGROUND INVESTIGATION, INC PURSUANT TO CALIFORNIA LAW Please initial here if you would like to receive a copy of an investigation whenever you have the right to receive such copy under California Law. I declare that all information presented herein is correct and complete, and conditions outlined by R.M. Pyles Boys Camp are accepted by me. My signature stands to that effect.