CAMPS FOR CHAMPIONS

The James Jones Legacy Foundation Summer Youth Enrichment Camp

July 17 -19, 2012

Florida International University Biscayne Bay Campus

3000 N.E. 151 Street North Miami, FL 33181

CAMPS FOR CHAMPIONS (MIAMI) The Department of Children and Families "Camps for Champions (CFC)", in partnership with James Jones Legacy Foundation and Our Kids of Miami Dade/Monroe, Inc., provides an opportunity for children and young adults from South Florida's foster care system to participate in a summer camp experience that might otherwise not have been possible. The wellness and leadership activities are created and led by nationally recognized role models, community partners and DCF staff who will help these young adults build self-esteem and confidence to succeed in life.

JAMES JONES LEGACY FOUNDATION SUMMER YOUTH ENRICHMENT CAMP

JULY 17 - 19, 2012 Established in the summer of 2009, James Jones Legacy Foundation is in its second year of inspiring youth to become positive influences in the community. James Andrew Jones (aka “Jhoops” or “J.R.”), an NBA player with the Miami Heat and a native Miamian, shot a PSA for Tobacco Free Florida in 2008 to encourage people not to use tobacco products and incorporates that message when visiting schools to speak with kids.

Summer Youth Enrichment Camp activities will include teams building games (Ropes Challenge), basketball, football, kickball, swimming, kayaking, dance/baton twirling, swamp safari, empowerment sessions, inspiring lectures and of course, FUN!

Breakfast, lunch and snacks will be provided. At the end of camp, a bag pack filled with school supplies will be given to each participant. A special guest (Hint: a professional athlete) is scheduled to make a special appearance. Pick-up locations for transportation in the North, South, and Central will also be provided for parents who are not able to drive the kids to the camp. Detail information for pick-up locations will be given in the acceptance packet.

Selection Process and Criteria Youth ages 11 – 14 (middle school age group) receiving services from Our Kids in Miami-Dade and Monroe are eligible to apply for consideration. Our Kids will conduct the application process, and recommend campers to the Selection Committee, which will have the final approval and will select 60 youth from the applicants. Applications should be submitted no later than June 1, 2012 to: Our Kids of Miami-Dade/Monroe, Inc. Attn: Dito Sudito P.O. Box 010951 Miami, FL 33101 Or, by e-mail: suditod@ourkids.us, fax: (305) 384-4932. Space is limited. Only 60 youth will be selected to attend. Please submit the application form along with the required documents as soon as possible. A letter to inform whether or not the child has been selected to attend the camp will be sent by June 15, 2012. An acceptance packet, which will include information for the transportation, what to bring and not to bring, dress code, etc., will be sent to those who have been selected to attend the camp. For more information, please contact Mr. Dito Sudito at (305) 301-3824 or e-mail: suditod@ourkids.us

SELECTION CRITERIA: 1. Youth ages 11 – 14 (middle school age group) 2. Possess Leadership Qualities, providing a positive example for others, being a good role

model 3. Physically able to participate in physical activity 4. Ability to follow staff and camp rules 5. Teamwork, Ability to function in a group setting, be able to interact responsibly with fellow

campers and staff 6. Must be socially competent, not exhibiting unwanted behaviors that will warrant removal

from a group activity or setting 7. Not be a risk for wandering or running away from the camp facility 8. No serious hindrances such as fire setting, DJJ involvement within the past year, mental

health issues that are not currently being treated, or other behaviors that would pose a risk to other campers

APPLICATION REQUIREMENTS: • Completed Camp application • Copy of report card • A recommendation letter from a teacher, school counselor, mentor, pastor or case manager. • Copy of the youth’s last physical, signed by a medical doctor. Physicals must be completed

within one year of the start of the Camp. • Provide a photo of the youth

CAMP LOCATION: Florida International University Biscayne Bay Campus 3000 N.E. 151 Street, North Miami, FL 33181

SCHEDULES:

TEAM HEAT TEAM DOLPHINS TEAM MARLINS TEAM

HURRICANES TEAM STRIKERS

TEAM

PANTHERS

7:30%AM

8:00%AM%)%8:15%AM

8:30%)%8:45%AM

9:00%AM%–%9:45%AMFitness Fun Recreation –

Kayaking Fitness Fun Recreation –

KickballFitness Fun Recreation –

BasketballFitness Fun Recreation –

KayakingFitness Fun Recreation –

KickballFitness Fun Recreation –

Basketball

9:45%AM%–%10:30%AMFitness Fun Recreation –

BasketballFitness Fun Recreation –

KayakingFitness Fun Recreation –

KickballFitness Fun Recreation –

BasketballFitness Fun Recreation –

KayakingFitness Fun Recreation –

Kickball

10:30%AM%)11:15%%AMFitness Fun Recreation –

KickballFitness Fun Recreation –

BasketballFitness Fun Recreation –

KayakingFitness Fun Recreation –

KickballFitness Fun Recreation –

BasketballFitness Fun Recreation –

Kayaking

11:15%AM%)%12:00%PMFitness Fun Recreation –

FootballFitness Fun Recreation –

FootballFitness Fun Recreation –

FootballFitness Fun Recreation –

Dance/ Baton TwirlingFitness Fun Recreation –

Dance/ Baton TwirlingFitness Fun Recreation –

Dance / Baton Twirling

12:00%PM%)%12:15%PM

12:15%PM%)%12:45%%PM

12:45%PM%)1:30%PM

1:30%PM%)%1:45%PM

1:45%PM%)%3:45%PM

3:45%PM%–%5:00%PM

5:00%PM%–%5:30%PM

TEAM HEAT TEAM PANTHERS TEAM

HURRICANES

TEAM

DOLPHINS TEAM MARLINS

TEAM

STRIKERS7:30%AM

8:00%AM%)%8:30%AM

8:45%AM%)%9:30%AM

9:30%AM%–%12:15%PM Billy Swamp Safari Billy Swamp Safari Billy Swamp Safari Billy Swamp Safari Billy Swamp Safari Billy Swamp Safari12:15%PM%)1:15%PM1:15%PM%)%4:00%PM Billy Swamp Safari Billy Swamp Safari Billy Swamp Safari Billy Swamp Safari Billy Swamp Safari Billy Swamp Safari

4:00%PM%–%5:30%PM

TEAM HEAT TEAM PANTHERSTEAM

HURRICANES

TEAM

DOLPHINS TEAM MARLINS

TEAM

STRIKERS 7:30%AM

8:00%AM%)%8:15%AM

8:30%AM%)%8:45%AM

9:00%AM%–%12:15%PMTeam Ropes Adventure

Challenge – Part 1Team Ropes Adventure

Challenge – Part 1Team Ropes Adventure

Challenge – Part 1Team Ropes Adventure

Challenge – Part 1Team Ropes Adventure

Challenge – Part 1Team Ropes Adventure

Challenge – Part 112:15%PM%)1:15%PM

1:15%PM%)%4:00%PMTeam Ropes Adventure

Challenge – Part 2Team Ropes Adventure

Challenge – Part 2Team Ropes Adventure

Challenge – Part 2Team Ropes Adventure

Challenge – Part 2Team Ropes Adventure

Challenge – Part 2Team Ropes Adventure

Challenge – Part 2

4:00%PM%–%5:30%PM

THURSDAY,*July*19,*2012

Mentors, Volunteers, Staff arrival, Check-in and assignments

Camper Arrival, Check-in & Breakfast

Morning%Recap

Lunch/ Discussion

Closing Remarks, Awards Ceremony, Discussion and Goodbye - MEDIA OP

WEDNESDAY,*July*18,*2012

Mentors, Volunteers, Staff Carpool to Billie Swamp Safari

Campers Transported to Billie Swamp Safari from Pick-up Locations

Camper%Arrival,%Check)in%&%Breakfast

Lunch/ Discussion

Closing Remarks and Campers Transported to Bus Stops

Swimming

Closing Remarks and Goodbye

Mentors, Volunteers, Staff arrival, Check-in and assignments

Camper Arrival, Check-in & Breakfast

Opening%ceremony,Drum%Line,%expectaMons%of%campers,%consequences,%overview%of%camp.%%Speakers%–%James%Jones,%Secretary%Wilkins%and%Modesto%Abety.%)%MEDIA*OP

Transitional Break

TUESDAY,*July*17,*2012

Campus Tour

Lunch

Transitional Break

Break Out Empowerment Sessions - BoysTopics: Leadership, Fitness & Nutrition, Decision Making and Education

Break Out Empowerment Sessions - GirlsTopics: Leadership, Fitness & Nutrition, Decision Making and Education

APPLICATION FORM

Please Fill Out Completely and print legibly

Date of Application: Legal Name of Young Adult:

First Middle Last Nickname:

Date of Birth: / / Age: Race Sex

Current Grade Level: Shirt Size (Please circle): S M L XL XXL

Present Living Arrangement: Foster Care: Relative Non-Relative Adoptive Care

Name of Person Having Legal Custody: First Middle Last

Relationship/Title:

Home # ( ) Work # ( ) Cell # ( )

E-mail Address:

Mailing Address:

City State Zip

Case Manager (If Available)

Name of CBC Case Manager:

Name of Case Management Organization:

Case Manager’s Phone Numbers: Office ( ) Cell ( )

Case Manager’s Email address:

Required Documents Checklist: Release forms Copy of report card. A recommendation letter from a teacher, school counselor, pastor or case manager. Copy of the youth’s last physical, signed by a medical doctor. Physicals must be completed

within one year of the start of the Camp. Provide a photo of the youth.

List any medications the young adult is taking, dosage and frequency: Any special diet: vegetarian, etc? List any allergies the young adult may have:

List achievements/awards the young adult has accomplished so far: List extra-curricular activities, volunteer and community involvement that the young adult has participated in:

Any problem areas the Camp staff should be aware of such as drugs, alcohol, tobacco, stealing, lying, running away, setting fires, etc.? ______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

Has the young adult been involved with the Department of Juvenile Justice? If yes, please describe the reason for involvement: ______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

How does the young adult get along with adults/authority figures, peers? Describe the social skills that the young adult possesses: ______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

Additional comments regarding the young adult:

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

MEDICATION / ALLERGIES / DIET

ACHIEVEMENTS / AWARDS / COMMUNITY INVOLVEMENT

BEHAVIOR / SOCIAL SKILLS

RELEASE FORM

As the parent/legal guardian of ________________________________, I hereby agree: 1. To hold harmless the James Jones Legacy Foundation, the Department of Children and Families, Our Kids of Miami-Dade and Monroe under F.S. 409.1671, Florida International University or staff associated with this event responsible for any illness or injury. 2. To give permission for my child to actively participate in approved Camp activities, including but not limited to the exercise and fitness program, group leadership activities, sports/league competition, and motivational speaker presentations. 3. To give the Camp complete authority regarding non-physical discipline matters, and authority to make decisions regarding medical problems and plans for treatment. 4. To give the Camp permission to transport my child and hold harmless release the Camp and private parties providing Camp facilities and transportation from all liability.

Please check the appropriate box and initial before the check box _____ Yes, I will be dropping off my child at the pick-up location (locations will

be announced in the acceptance packet). _____ No, I will be driving my child to the camp. 5. To give permission for the young adult to be photographed and participate in public speaking activities. Please check the appropriate box and initial before the check box

_____ Yes, child can be photographed *Child must be TPR’D or have parent’s permission.

_____ No, you cannot photograph this child.

Date:

Name of parent/legal guardian:

Signature of parent or legal guardian only

Please submit the application and the required documents the latest by June 1, 2012 to: Our Kids of Miami Dade and Monroe, Inc. Attn: Dito Sudito P.O. Box 010951 Miami, FL 33101 Or, fax: (305) 384-4932; e-mail:suditod@ourkids.us

FLORIDA INTERNATIONAL UNIVERSITY TEAM ROPES ADVENTURE CHALLENGE (TRAC)

RELEASE AND ASSUMPTION OF RISK AGREEMENT I, the undersigned, , of (your address), do agree and promise the following for and in consideration of my participation in the Team Ropes Adventure Challenge (TRAC) offered by Florida International University (FIU or the University) to be held on ___________ and all activities related thereto (the Program). The Program includes navigating a network of ropes, beams, cables, swings, and/or pulleys some of which may be 25 to 40 feet above the ground, and kayaking. The Program is set in out-of-doors surroundings and can also be on the water.

I. My participation in the Program is voluntary. I have chosen to participate in the Program because of the learning experiences I will gain. I acknowledge that, in the course of my participation in the Program, I may be exposed to risks, some of which are known and some of which are unknown, which may result in property damage or loss, as well as personal or bodily injury which could be painful, permanently disfiguring, debilitating and even fatal. I voluntarily assume full responsibility for all such risks including, but not limited to, sickness, bad weather, broken bones, partial and/or total paralysis, other ailments that could cause serious disability, drowning, and/or death. I further expressly assume full responsibility for any risk of bodily injury, death, or property damage due to the negligence of the State of Florida, Florida Board of Governors, the FIU Board of Trustees, and/or FIU and their respective employees and agents, or otherwise.

II. I represent that I have no medical condition that would prevent me from participating in the activities associated with the Program, which include navigating a network of ropes, beams, cables, swings, and/or pulleys some of which may be 25 to 40 feet above the ground, and kayaking. I understand that it is my choice to participate in the Program and that I choose at which level of physical difficulty that I will participate in.

III. I acknowledge that the State of Florida, the Florida Board of Governors, the FIU Board of Trustees, and/or FIU and their respective officers, employees, and agents are not responsible for losses or expenses suffered by me due to delays, changes in itinerary, changes in the content of Program, or other matters which are beyond their control.

IV. I, for myself, my heirs, personal representatives and assigns voluntarily agree to release, waive, discharge and relinquish and to indemnify and hold harmless FIU, from and against all claims, suits, or causes of action for bodily injury, property damage, wrongful death, loss of services or otherwise which may arise from my participation in the trip and its related activities or from personal unrelated activities whether the same should arise by reason of negligence of anyone organizing or participating in the trip or otherwise. I specifically understand that I am releasing, discharging, and waiving any claims or actions that I may have presently or in the future for the negligent acts or other conduct by the State of Florida, Florida Board of Governors, the Florida International University Board of Trustees, and/or FIU and their respective employees and agents, or otherwise. I agree that, under no circumstances, will I or anyone claiming through me, prosecute or present any claims for personal or bodily injury property damage or loss, or wrongful death against the State of Florida, Florida Board of Governors, the Florida International University Board of Trustees, and/or FIU and their respective employees and agents, or otherwise.

V. I further expressly agree that this Release and Assumption of Risk Agreement is intended to be as broad and as inclusive as the laws of the State of Florida will allow, and that if any portion thereof is held to be invalid, it is agreed that the balance shall, notwithstanding the invalid portion, will continue in full legal force and effect.

I HAVE READ THE ABOVE RELEASE AND ASSUMPTION OF RISK AGREEMENT AND, BY SIGNING IT, AGREE THAT IT IS MY INTENTION TO EXEMPT AND RELIEVE FIU FROM LIABILITY FOR PERSONAL LIABILITY, PROPERTY DAMAGE, OR WRONGFUL DEATH CAUSED BY NEGLIGENCE OR ANY OTHER CAUSE OF ACTION.

I state that I am the legal guardian or parent of (name of child) _____________________________ (Participant). I am signing to approve the Participant’s participation in the Program. By signing, I agree that the Participant and I are bound by the terms of this Release and Assumption of Risk Agreement.

Signed and dated this ______ day ____________ of 20____.

PARTICIPANT*: Signature

Print Name

* If the participant is under 18 years of age, the parent or guardian must sign on behalf of the participant.

PARENT / GUARDIAN:

Signature

Print Name