Harborside Character Quest TrainingHarborside Character Quest TrainingAugust 3, 4 or 4,5August 3, 4 or 4,5

Hello Harborside Student Leaders,

On August 3rd – 5th, we are set to attend the Character Quest training near Galena, Illinois. Current freshman, this is your chance to join! Attached to this flyer you will find some necessary information for the trip.

Current and next year’s seniors will be going out on Friday the 3rd and most of them will return on the 4th. (A few will stay to lead with the younger students.) Future sophomores and juniors will come out on Saturday the 4th and return on Sunday the 5th.

At the training, our younger group of students will go through what the Character Quest staff calls their Orienteering program. Our older group will go through the Character Quest Commando Program. In the Orienteering program, students will be given challenges to accomplish in small groups. The challenges will be difficult and will require effective teamwork and communication as students maneuver through the woods at night. There are trained Carthage students that will be along on the trip that will work with our students. Character Quest will also have their staff on site. The Commando Program includes paintball activities. Older students involved in this portion of the training will be shooting and shot at with paintball. Proper protective eyewear will be used.

After experiencing the different challenges, our students will work with the college students and adults to discuss and reflect on the obstacles that they faced. It is our hope to help our students to recognize and identify the leadership that was shown and the additional leadership that is necessary to overcome adversity. Ultimately, we hope for our students to bring these leadership skills back to Harborside.

Testimonials from people that have participated have been incredibly positive. Dr. Robert Bonn, Athletic Director at Carthage College stated, “You will not believe the positive impact that this experience will have on your students and your school as a whole!”

Participating students and parents will be taking a bus to Galena We will stay overnight in tents (or in the housing that they provide) and leave for home at 11:00 am the following day. It is approximately a 3.5 hour drive. (STUDENTS WILL BE ALLOWED TO BRING THEIR OWN TENTS.) However it is not required. Character Quest now has permanent buildings where students can sleep. One for the guys and one for the girls. It is up to you.

Throughout the year we will continue to have leadership discussions relating to Character Quest at monthly breakfast meetings.

Our biggest goal is to build the school that we want for our students through positive student leadership. Character Quest, and the Harborside staff remain 100% committed to helping you to make our students grow into the best leaders that they can be!

Necessary Information for Character Necessary Information for Character Quest TripQuest Trip

Student Packing List:Pack and dress accordingly for outdoor camping trip.

Sleeping bag or blanketsBug SpraySun Screen

2nd pair shoes & socks REQUIRED (Preferably older shoes)2nd set of clothes (Nothing fancy – long pants are required)

(Avoiding cotton is always a good idea.)(Shorts really do not work for this activity. Too much time in the woods. You will also want to bring at least 1 long sleeve shirt.)

Sleeping shorts & shirtsTowel

Light rain jacket – If it rains, we will get wet!Hat (To block sun)

Water Bottle is REQUIREDCell phone ok, but we will ask you to turn it off and keep it in your

bag . It is not necessary.Don’t forget lunch money for both travel days.  (We will stop the

bus to eat.)

Other Information:Other Information:Future Seniors:

We will meet at Harborside at 9:00 am on August 3 rd and arrive in Galena around 1:00.

We will depart Galena at 11:00 am be back at school at approx. 3:00 pm on August 4 th.

(Remember, experienced seniors can choose to stay for both days to serve as group leaders.)

Future Sophomores and Juniors:

We will meet at Harborside at 9:00 am on August 4 th and arrive in Galena around 1:00.

We will depart Galena at 11:00 am be back at school at approx. 3:00 pm on August 5 th.

Harborside will pay:

There is a $30 registration fee for each student. (Please contact Mr. Haithcock or our office staff if funding is a problem at this time. We do not want anyone to miss this opportunity because of money. –

Thanks!)

(Students will be eating MRE – Military Rations only for the evening meals this year. We will have a variety of fruit and granola bars for breakfast the following morning.)

Please, do not bring snacks or candy. The MRE’s are part of the experience. We are roughing it!

We are also asking that each student and adult bring money for lunch while we travel. (We will stop on the way out, and on the way home to eat at some kind of fast food place.)

Mr. Haithcock will keep his cell phone on during the trip Please call (262) 945-1688 if there are any reasons to contact us.

If anyone needs help with a ride to or from school, just let us know.

We will also be looking for parent chaperones for the trip…. Interested? Please let us know. (See next sheet.)

Parent VolunteersParent VolunteersWe have staff that have committed to attend, but we are also interested in having parent volunteers to come along to help chaperone. The more you know about this, the better. There are also 50 10th and 11th grade students invited to attend this year!

If you are interested in coming along, please complete the form below and send it back to school with the student permission slip. (Note – a parental permission slip or a medical form is not required if you , the parent/guardian, is coming on the trip.)

Parent volunteer (name): __________________________

_____ I will stay on site (in a tent)._____ I would rather stay inside if possible at the camp.

_____ I will ride with the student bus to the trip._____ I will drive separately from the group.

_____ I will attend the Friday – Saturday Session._____ I will attend the Saturday – Sunday Session.

Permission SlipPermission SlipAll Forms are due back to school!!!All Forms are due back to school!!!

I (Parent Name)______________________ give my permission for my student (Student Name)__________________ to attend the overnight Harborside Trip to the Elizabeth, Galena, Stockton area in Northern Illinois on August 3 & 4, or August 4 & 5 with Mr. Haithcock. I understand that the students will travel to the experience on a bus, sleep in tents (or indoors), and participate in several outdoor physical challenges. I also understand that seniors will participate in paintball activities.

My future senior ________________________ would like to volunteer to stay both nights and help with the younger students on day 2. (Please understand that priority will be given to students that have attended Character Quest both years prior to this one.)- Students volunteering to stay both nights must have their permission slip submitted by July 22nd. If you attended both years, you will be accepted. If you were there only one year, we will have an answer for you on Friday the 29th.)

I also understand that this club is a year long activity. There are monthly meetings in the morning before school. Students that do not follow through with the meeting portion of the commitment will be charged the $30.00 fee that the school pays to Character Quest for the summer training. (We know that people will have to miss from time to time, but we do not want you to simply sign up and plan to only attend the summer training.)

(Parent Signature)_____________________

(Date) _____/______/__2012_

If you are bringing medication, please ensure that you also include the attached medical information form. Any medication should be brought in a plastic zip lock bag with the students name on it and turned in to Mr.

Haithcock. (As always, medication cannot be held by the students.) All students must also submit the liability waiver and the media release forms attached to this packet or e-mail.

Remember, If you are 18, you can sign for yourself. Please also include a check or cash for the $30.00 fee that will help cover the cost of meals and the bus.

Student Lodging Student Lodging Information:Information:

____ I am planning to stay in the building provided by Character Quest. (One trailer for boys and one for girls.)

____ I am planning to bring my own tent.

◦ ___I am going to share my tent with _______________________________________.

◦ ___I am fine sharing my tent with other Harborside students that Mr. H assigns to my tent.

____ I do not have a tent, but I am willing to stay wherever Mr. H puts me. (Character Quest building or with other students.)

When complete, please fax , drop off, or mail the last three pages to school. (Fax number is (262) 359-8450). The school address is 714 49th St. Kenosha, WI. 53140. All forms are due back to school by the July 30th. (Remember, we move schools by the end of June. I do not recommend sending a fax after the end of June.)

CQ - RELEASE, INDEMNIFICATION AND HOLD HARMLESS AGREEMENT (Page 1)

In consideration of participating in MBA Services - Character Quest 1542 West Saltsage Drive, Phoenix, AZ 85045 For receiving leadership training, team building, experiential training, and for other good and valuable consideration, I hereby agree to release and discharge from liability arising from negligence MBA Services - Character Quest and its owners, directors, officers employees, agents, managers, volunteers, participants, and all other persons or entities acting for them (hereinafter collectively referred to as “Releasees”), on behalf of myself and my children, parents, heirs, assigns, personal representative and estate, and also agree as follows:

I. I acknowledge that Team, Leadership, and Character effectiveness training programs involve known and unanticipated risks which could result in physical or emotional injury, paralysis or permanent disability, death, property damage, risks include, but are not limited to, [activities may include: running, jumping, balancing and other physically demanding training and competition that might result in injury; medical conditions resulting from physical activity; and damaged clothing or other property. I understand such risks simply cannot be eliminated, despite the use of safety equipment, without jeopardizing the essential qualities of the training activity.

2. I expressly accept and assume all of the risks inherent in this activity or that might have been caused by the negligence of the Releasees. My participation in this activity is purely voluntary and I elect to participate despite the risks. In addition, if at any time I believe that event conditions are unsafe or that I am unable to participate due to physical or medical conditions, then I will immediately discontinue participation.

3. I hereby voluntarily release, forever discharge, and agree to indemnify and hold harmless Releasees from any and all claims, demands, or causes of action which are in any way connected with my participation in this activity, or my use of their equipment or facilities, arising from negligence. This release does not apply to claims arising from intentional conduct. Should Releasees or anyone acting on their behalf be required to incur attorney’s fees and costs to enforce this agreement, I agree to indemnify and hold them harmless for all such fees and costs.

4. 1 represent that I have adequate insurance to cover any injury or damage I may suffer or cause while participating in this activity, or else I agree to bear the costs of such injury or damage myself. I further represent that I have no medical or physical condition which could interfere with my safety in this activity, or else I am willing to assume — and bear the costs of— all risks that may be created, directly or indirectly, by any such condition.

5. In the event that I file a lawsuit, I agree that the sole venue and jurisdiction for any lawsuit will be the Circuit Court of the fifteenth Judicial Circuit, Jo Daviess County, Illinois.

6. I agree that if any portion of this agreement is found to be void or unenforceable, the remaining portions shall remain in full force and effect.

By signing this document, I agree that if I am hurt or my property is damaged during my participation in this activity, then I may be found by a court of law to have waived my right to maintain a lawsuit against the parties being released on the basis of any claim for negligence.

I have had sufficient time to read this entire document and, should I choose to do so, consult with legal counsel prior to signing. Also, I understand that this activity might not be made available to me or that the cost to engage in this activity would be significantly greater if I were to choose not to sign this release, and agree that the opportunity to participate at the stated cost in return for the execution of this release is a reasonable bargain. I have read and understood this document and I agree to be bound by its terms.

 

Signature _______________________________________ Date______________

Print Name _______________________________________

Address ________________________________ Zip ______________

City _________________________________ State ______________

Telephone (____)__________

CQ - RELEASE, INDEMNIFICATION AND HOLD HARMLESS AGREEMENT (Page 2)

PARENT OR GUARDIAN ADDITIONAL AGREEMENT

(Must be completed for participants under the age of 18)

MBA Services - Character Quest 1542 West Saltsage Drive, Phoenix, AZ 85045 815 238 3788

In consideration of _____________________________________ (PRINT minor’s names) being permitted to participate in this activity, I further agree to indemnify and hold harmless Releasees from any claims alleging negligence which are brought by or on behalf of minor or are in any way connected with such participation by minor.

Parent or Guardian___________________________ Print Name_________________________

Date__________ (If notarization is necessary, please sign & stamp this side of form.)

CQ MEDIA RELEASE FORMPhoto – Typed – Written – Audio

I hereby grant MBA Services LLC – Character Quest permission to use my student’s likeness in a photograph or other digital reproduction in any and all of its publications, including website entries, without payment or any other consideration. I further give permission to MBA Services LLC – Character Quest to share my photo, typed, written or audio records for use in any and all of its publications, including website entries, without payment or other consideration.

 

I understand and agree that these materials will become the property of MBA Services LLC – Character Quest and will not be returned. I hereby irrevocably authorize MBA Services LLC – Character Quest to edit, alter, copy, exhibit, publish or distribute my photo, typed, written or audio records for purposes of publicizing its programs or for any other lawful purpose.

 

In addition, I waive the right to inspect or approve the finished product, including written or

electronic copy, wherein my likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of the photograph. I hereby hold harmless and release and forever discharge MBA Services LLC – Character Quest from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization.

 

I have read this release before signing below and I fully understand the contents, meaning, and impact of this release.

 

 

_____________________________________________

(Parent Signature)

 

 

 

_____________________________________________

(Printed Name)

 

 

__________________________

(Date)

KUSD - FIELD TRIP PERMISSION FORMWAIVER AND RELEASE OF LIABILITY;

INDEMNIFICATION AND HOLD HARMLESS AGREEMENT

KENOSHA UNIFIED SCHOOL DISTRICT

(Student) (Age)

(Parent(s)/Guardian(s)) (Grade Level)

(Address) (Date(s) of Field Trip)

(City) (State) (Zip Code)

(Home Telephone No.) (Work Telephone No.)

YOUR CHILD HAS THE OPPORTUNITY TO PARTICIPATE IN THE FOLLOWING FIELD TRIP AWAY FROM SCHOOL:

ON AUGUST 3RD – 5TH, WE ARE SET TO ATTEND THE CHARACTER QUEST TRAINING NEAR GALENA ILLINOIS. CURRENT FRESHMAN, THIS IS YOUR CHANCE TO JOIN! ATTACHED TO THIS FLYER YOU WILL FIND SOME NECESSARY INFORMATION FOR THE TRIP.

CURRENT AND NEXT YEAR’S SENIORS WILL BE GOING OUT ON FRIDAY THE 3RD AND MOST OF THEM WILL RETURN ON THE 4TH. (A FEW WILL STAY TO LEAD WITH THE YOUNGER STUDENTS.) FUTURE SOPHOMORES AND JUNIORS WILL COME OUT ON SATURDAY THE 4 TH AND RETURN ON SUNDAY THE 5TH.

AT THE TRAINING, OUR YOUNGER GROUP OF STUDENTS WILL GO THROUGH WHAT THE CHARACTER QUEST STAFF CALLS THEIR ORIENTEERING PROGRAM. OUR OLDER GROUP WILL GO THROUGH THE CHARACTER QUEST COMMANDO PROGRAM. IN THE ORIENTEERING PROGRAM, STUDENTS WILL BE GIVEN CHALLENGES TO ACCOMPLISH IN SMALL GROUPS. THE CHALLENGES WILL BE DIFFICULT AND WILL REQUIRE EFFECTIVE TEAMWORK AND COMMUNICATION AS STUDENTS MANEUVER THROUGH THE WOODS AT NIGHT. THERE ARE TRAINED CARTHAGE STUDENTS THAT WILL BE ALONG ON THE TRIP THAT WILL WORK WITH OUR STUDENTS. CHARACTER QUEST WILL ALSO HAVE THEIR STAFF ON SITE. THE COMMANDO PROGRAM INCLUDES PAINTBALL ACTIVITIES. OLDER STUDENTS INVOLVED IN THIS PORTION OF THE TRAINING WILL BE SHOOTING AND SHOT AT WITH PAINTBALL. PROPER PROTECTIVE EYEWEAR WILL BE USED.

PAGE: 1

AFTER EXPERIENCING THE DIFFERENT CHALLENGES, OUR STUDENTS WILL WORK WITH THE COLLEGE STUDENTS AND ADULTS TO DISCUSS AND REFLECT ON THE OBSTACLES THAT THEY FACED. IT IS OUR HOPE TO HELP OUR STUDENTS TO RECOGNIZE AND IDENTIFY THE LEADERSHIP THAT WAS SHOWN AND THE ADDITIONAL LEADERSHIP THAT IS NECESSARY TO OVERCOME ADVERSITY. ULTIMATELY, WE HOPE FOR OUR STUDENTS TO BRING THESE LEADERSHIP SKILLS BACK TO HARBORSIDE.

 

PARTICIPATING STUDENTS AND PARENTS WILL BE TAKING A BUS TO GALENA WE WILL STAY OVERNIGHT IN TENTS (OR IN THE HOUSING THAT THEY PROVIDE) AND LEAVE FOR HOME AT 11:00 AM THE FOLLOWING DAY. IT IS APPROXIMATELY A 3.5 HOUR DRIVE. (STUDENTS WILL BE ALLOWED TO BRING THEIR OWN TENTS.) HOWEVER IT IS NOT REQUIRED. CHARACTER QUEST NOW HAS PERMANENT BUILDINGS WHERE STUDENTS CAN SLEEP. ONE FOR THE GUYS AND ONE FOR THE GIRLS. IT IS UP TO YOU.

THROUGHOUT THE YEAR WE WILL CONTINUE TO HAVE LEADERSHIP DISCUSSIONS RELATING TO CHARACTER QUEST AT MONTHLY BREAKFAST MEETINGS.

 

 

II. ACKNOWLEDGMENT OF RISK: In exchange for the Student’s participation in the field trip activity, the Student and Parent(s)/Legal Guardian(s) acknowledge and fully understand that there are inherent risks, including the acts or omissions of the Student or other Students, associated with the field trip activity and that all inherent risks cannot be described as part of this document.

 

III. STUDENT WAIVER OF RIGHTS AND RELEASE OF LIABILITY: Student and Parent(s)/Legal Guardian(s), hereby release, waive and discharge the School District, its employees and agents and volunteers from liability claims and demands of negligence on the part of the School District, its employees and agents and volunteers arising in connection with participation in the field trip activities, including but not limited to those risks described in paragraph #1 above, providing, however, that this waiver and release does not include injury, damage, or loss as a result of the intentional or reckless acts of the School District, its agents or employees or volunteers.

 

IV. INDEMNIFICATION AND HOLD HARMLESS: Student and Parent(s)/Legal Guardian(s), further agree to indemnify and hold harmless the School District, its employees and agents and volunteers, against all losses, damages, monetary awards and expenses, including all costs and attorneys’ fees, incurred in connection with any and all claims of negligence on the part of the School District, its employees and agents and volunteers, brought by the Student, Parent(s)/Legal Guardian(s), his or her heirs, successors, assigns, and legal representatives, for any injury, death, illness, disease, or damage to property, arising from or connected with participation in the field trip activity of the School District. The indemnification and hold harmless agreement does not include losses, damages, monetary awards and expenses as a result of the intentional or reckless acts of the School District, its employees and agents and volunteers.

 

V. MISCELLANEOUS. The parties agree that the provisions of this “Waiver and Release of Liability; Indemnification and Hold Harmless Agreement” (“Agreement”) shall be deemed severable, and that the invalidity or unenforceability of any one or more of the provisions or clauses shall not affect the validity or enforceability of the other provisions or clauses except as specifically set forth herein. The terms of this Agreement constitute the entire agreement and understanding between the parties. This Agreement is made pursuant to and shall be construed under the laws of the state of Wisconsin.

page: 2

  VI. OPPORTUNITY TO NEGOTIATE. You are encouraged to carefully review the contents of this “Waiver and Release

of Liability; Indemnification and Hold Harmless Agreement” (“Agreement”) and take time to review it. DO NOT SIGN this Agreement unless you understand and agree to the terms and conditions of this Agreement. If you wish to NEGOTIATE any of the terms of this Agreement for modifications, deletions, or additions, please contact William Haithcock at (262) 359-8400 prior to signing and executing this Agreement. If you do not contact the School District prior to signing and executing this Agreement, the School District understands that you are accepting the terms and conditions as set forth above, and that you do not wish to pursue any further negotiations regarding the terms and conditions of this Agreement.

  I CERTIFY THAT I HAVE READ THIS WAIVER AND RELEASE OF LIABILITY; INDEMNIFICATION AND HOLD HARMLESS

AGREEMENT AND THAT I UNDERSTAND THAT I AM GIVING UP SUBSTANTIAL RIGHTS AND ASSUMING SUBSTANTIAL RESPONSIBILITIES BY SIGNING IT, AND THAT I SIGN IT VOLUNTARILY.

  I give my child permission to attend this Harborside Academy organized trip.       Date: (Student)   Date: (Parent/Legal Guardian)*   Date: (Parent/Legal Guardian)*   *Must sign if the Student is under age 18 years of age. Both parents/guardians, if applicable, must sign the Agreement.

page: 3