Teens in Action registration 20-21

1. Teens in Action Information

100% of survey complete.

The Camp FIre Teens in Action program is youth-led and youth-driven, guided by trained adults. Through our service-learning framework, teens learn to identify community needs, decide what issues they want to advocate for, then take action to make a difference in their communities. Teens in Action Service Learning and Leadership program is designed to assist students develop leadership and complete a portion of the community service requirement. All student who wish to participate in Orientation, service projects, school opening service activities, service road trips, and social events need to complete this form. All Students should complete this questionnaire so that we can be in contact with your regarding the Service Learning Program. Questions can be directed us at teensinaction@campfirepatuxent.org.

Parents are invited to participate in service and other programs as mentors and chaperones.

We welcome all teens no matter what school or program they are enrolled in. For more information contact teensinaction@campfirepatuxent.org.

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* 1. Teens in Action Status

I was a member of Teens in Action/Camp Fire Last Year

I am interested in Joining for this year

I want to know more information about TEENS IN Action

I would like to help to recruit new members

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* 2. Please provide the following Registration Information for participation in Teens in Action Middle and High School Service leaning Program. It is our practice to communicate with both the students and the parents for risk management reasons. Youth receiving emails at their own address must also have listed a parents email address for this reason. Parents please ensure that your teen has completed this form. We ask for parent occupation info for the purposes of career mentors for our career enrichment program.

Last Name

First Name

Date of Birth

Age

Graduation Year

School

Tee Shirt Size

Home street address

City

State

Zip

HOme phone

Student Cell phone

Student Email Address

Do you speak Spanish Fluently

Do you speak French Fluently

Parent 1 Parent/Guardian's First Name

Parent 1 Parent/Guardian's Last Name

Parent 1 Parent/Guardian's Email address

Parent 1 Parent/Guardian's Preferred contact number

Parent 1 Occupation

Parent 2 Parent/Guardian's First Name

Parent 2 Parent/Guardian's Last Name

Parent 2 Parent/Guardian's Email address

Parent 2 Parent/Guardian's preferred Contact number

Parent 2 Occupation

Emergency Contact if Parents are not available Name

Emergency Contact Relationship

Emergency Contact Phone number

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* 3. Do you have any medical conditions or allergies that we should know about to keep you safe during Camp Fire Activities? Please provide an explanation in the box below.

	Yes	NO
Allergies to Medications	Allergies to Medications Yes	Allergies to Medications NO
allergies to Food	allergies to Food Yes	allergies to Food NO
Medical Conditions	Medical Conditions Yes	Medical Conditions NO
Are your immunizations up to date?	Are your immunizations up to date? Yes	Are your immunizations up to date? NO
Was your last tetanus shot in the last 12 months. Please list date in box below?	Was your last tetanus shot in the last 12 months. Please list date in box below? Yes	Was your last tetanus shot in the last 12 months. Please list date in box below? NO
Are you taking any medications	Are you taking any medications Yes	Are you taking any medications NO

Explain any Yes Answers in this space

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* 4. What type of activities would you like to be involved in with Teens in Action, This year COVID19 Safety plans will be in place for all programs. IF and when we decide that it is safe to have some IN person activities, all students will be required to follow the guidance set for in the Camp Fire Risk Management Plan for that activity.

Service Learning Road Trips

Senior Service Projects/Capstone Projects

Voting Social Media Drive

Social Events and Activities

Earning Presidential Service Awards

Earning Congressional Service Awards

Participating in activities that build academic skills

Participating in Teen CERT-Emergency Readiness Program

Participating in Teen Financial Management Program

Participating in Teen Driving Safety Program Virtually with other schools

Participate in Camping and Outdoor activities.

Learning how to be an Activist on social issues

Participating in Camp Fire USA Leadership Activities and Conferences

Participating in Teen Conferences that are held in various locations around the country.

Serving as a Camp Fire Representative to regional or local boards

Helping with fundraising for scholarships and projects

What other things would you like to do?

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* 5. We are in the process of setting up meeting times. Please indicate what time would work best for you.

	Monday during activity period	Monday after school or evening	Tuesday During activity period	Tuesday afterschool or evening	Wed during activity period	Wed after school	Thursday during activity period	Thursday After School	Weekends
Yes	Yes Monday during activity period	Yes Monday after school or evening	Yes Tuesday During activity period	Yes Tuesday afterschool or evening	Yes Wed during activity period	Yes Wed after school	Yes Thursday during activity period	Yes Thursday After School	Yes Weekends
No	No Monday during activity period	No Monday after school or evening	No Tuesday During activity period	No Tuesday afterschool or evening	No Wed during activity period	No Wed after school	No Thursday during activity period	No Thursday After School	No Weekends

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* 6. WE will be designing a 2020/21 tee shirt. Please indicate your size. There will be a cost for this that will be determined based on the number of folks who want to purchase one.

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* 7. By completing this section, you agree to guidelines of Camp Fire USA and Teens in Action. Teens in Action youth are required to complete a code of conduct as part of their participation in our programs. This form is available on the forms section of www.campfirepatuxent.org. Youth are also required to have parental permission to participate. A fee of $20 for 2020 year is charged for membership and insurance which is payable upon receipt of the invoice.
I
I understand that we will be designing a 2020 tee shirt.

Additionally, there may be additional fees for meals, special events, trips, and some service opportunities.

I understand that beginning in Fall 2020, there will be strict safety precautions in place due to the COVID 19 Pandemic. I will follow the policies and risk management plan for each activity.

I understand these requirements and want to be part of Camp Fire USA Teens in Action. I understand that I will receive a signature page and the code of conduct after I complete this form.

I have advised my parents of my intentions to be part of the Teens in Action Program and they agree to allow me to participate.

Yes

Type the name of the individual who completed this application.

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* 1. Teens in Action Status

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* 3. Do you have any medical conditions or allergies that we should know about to keep you safe during Camp Fire Activities? Please provide an explanation in the box below.

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* 5. We are in the process of setting up meeting times. Please indicate what time would work best for you.

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* 6. WE will be designing a 2020/21 tee shirt. Please indicate your size. There will be a cost for this that will be determined based on the number of folks who want to purchase one.

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* 8. My parents are interested in assisting as a mentor or chaperone of some activities. Please provide the best way to reach them.