Participants in this program will receive a day camp experience

which includes demonstrations and active participation in

period arts, crafts and games, living history military & village life,

Native American warfare and culture presentations,

drill with militia, tomahawk throw, and much more.

Lunch and a t-shirt included with pre-registration.

CAMP 1812

www.fjfortfest.com Fort Jennings Park

Fort Fest - Fort Jennings, Ohio

Kindergarten to Sixth Grade

$15 Pre-Registration Includes Lunch & T-Shirt

Camp will conclude with participants marching to the Fort Jennings Monument and participating in the Tribute to the Unknown Soldier ceremony (which begins at 1:00 sharp). Participants should bring sunscreen, hat, insect repellant, and clothing appropriate for the weather as all activities will take place outdoors, rain or shine. Most participants bring a cinch-sac type bag to keep all of their things.

*** Must be received by August 1, 2019 *** Questions? Email Amy Ricker at amy.ricker@gmail.com or call 419-604-9127

* * 6th 7th 8th 9th Graders We are looking for 6th 7th 8th and 9th Graders willing to serve as Group Leaders during the Camp – Community Service Hours available

Incoming 6th graders have the option to be a CAMPER or a COUNSELOR Counselors will receive free registration, t-shirt and lunch Use registration form to sign up and write “CAMP COUNSELOR” at the top

Cub Scouts - Boy Scouts - Girl Scouts Opportunity to Complete Badge Work at the Camp

Scouts should bring their uniform shirt / sash / for our ceremony

Send Completed Registration Forms To:

CAMP 1812 FORM 20581 Road U-20 Fort Jennings, Oh 45844

Checks Payable To:

FJ Park Boosters

Date/Time: Saturday, August 17, 20189/ 9:00 am – 1:30 pm Check-In is 8:15 to 8:45am

Who: Boys and Girls entering Kindergarten to 6th Grade in September 2019

Where: Fort Jennings Park – 1812 Historic Area along Auglaize River

Fee Includes: Lunch for all participants & T-shirt with pre-registration

Registration: Pre-Registration: Due by August 1, 2019 : $15 per child (includes t-shirt)

Walk-In Registration: Day of Event : $15 per child (NO t-shirt provided)

Participant:

Name: __________________________________ E-mail: ___________________________

Address: ________________________________ T-shirt size:

________________________________ Age: ______ Grade 2019/2020: _______

Scout Leader: ____________________________ Scout Level: _____________________________

MEDICAL INFORMATION Medical Insurance Company _______________________________________________________

Phone _______________________ Group # _____________________ ID# _________________

Medical History if pertinent:

______________________________________________________________________________

______________________________________________________________________________

Allergies, present medications, special considerations:

______________________________________________________________________________

______________________________________________________________________________

EMERGENCY CONTACT INFORMATION

Parent/Guardian Name: ______________________________ Phone: ______________________

Second Parent/Guardian

or Contact Name: ___________________________________ Phone: ______________________

I give my permission for ______________________________ to attend and be a part of the Camp 1812 Program as listed above. In return for the opportunity for my child to participate in this program, it is agreed that all risks attendant to watching and/or participating in camp activities, including, but not limited to bodily injury, are assumed by the participant and his/her parents and/or legal guardian and that this assumption is acknowledged, approved, and agreed to by said participant and his/her parents and/or legal guardian as indicated by the signature below. I hereby certify that the above named participant is physically able to participate in Camp 1812 and that I know of no physical impairments which would in any manner limit his/her participation in such a program. I hereby grant permission for physicians, dentists, other licensed health care providers, emergency medical technicians and paramedics and their designees to deliver emergency procedures as necessary or to refer to other duly licensed medical personnel when necessary. In consideration for honoring the participant’s request to participate in the above activity, I, for myself, my executors, administrators, successors and assigns, do hereby release and forever discharge the Fort Jennings Park Board and Boosters, The Village of Fort Jennings, and their board members, officers, volunteers, employees, and agents from any claims that I might have myself or could bring on the participant’s behalf with regard to damages, demands or any actions whatsoever, including those based on negligence or failure to supervise, in any manner arising out of the participant’s participation in this activity. I also hereby agree to save, hold harmless, and indemnify the aforementioned parties against any and all claims, including claims of negligence and/or failure to supervise, which the participant may bring against them as a result of his or her participation in the above activity. I recognize that this Release means that I am giving up, among other things, rights to sue the aforementioned parties for injuries, damages or losses that my child may incur.

___________________________________________ ________________________________ Parent or Legal Guardian Signature Date ___________________________________________ ________________________________ Print Parent or Legal Guardian Name Relationship to Participant

YS YM YL AS AM AL AXL Adult

Parent/Guardian Permission

Please CIRCLE

Size

Youth