Program Forms Program Forms Evening Programs Evening Programs Name * First Name Last Name Week Number * Week 1 - Medieval Week 2 - Athlete Week 3 - Adventure Week 4 - Music & Arts Week 5 - Spy Week 6 - Space What Day is this Evening Program taking place? * Monday Tuesday Wednesday Thursday Friday Please check which cabins are participating in this Evening Program. * Mountain Top Rocky Glen Ravine Forest Grove Lakeview Where is this Evening Program taking place? * What supplies are needed? * How will you introduce and explain the activity to the campers? * Please explain the activity in detail. * Please provide enough information so that someone else could lead the activity in case you are unavailable. Please detail out clean up procedures and your closing prayer. * Thank you! Program Area Lesson Plans Program Area Lesson Plans Name * First Name Last Name Program Area Archery Arts & Crafts Athletics Challenge Course Nature Zip Line Week Number * Week 1 - Medieval Week 2 - Athlete Week 3 - Adventure Week 4 - Music & Arts Week 5 - Spy Week 6 - Space Which Camp Characteristic is this lesson teaching? * Compassion Confidence Persistence Respect Teamwork Please outline your opening devotional * Please explain how you introduce the activity * Please explain the activity including setup and rules. * Please provide enough information so that someone else could lead the activity in case you are unavailable. Please outline closing and clean up procedures as well as your closing prayer. * Please check which cabins this lesson plan is for. * MT A/B MT C/D RG A/B RG C/D RV A/B RV C/D FG A/B FG C/D LV A/B Thank you! Program Supply Request Form Program Supply Request Form Line This form is for Program Coordinators ONLY. Please do NOT request Evening Program supplies here. Evening Program supplies should be requested using the Evening Program Planner form. Name * First Name Last Name What area you requesting equipment for? * Archery Arts & Crafts Athletics Challenge Course Nature Zip Line Forest Grove Lakeview Mountain Top Rocky Glen Ravine General Counseling Grace Team Jesus Theater General Staff Other Please list the items you requesting for purchase * Thank you! Challenge Course Forms Daily Challenge Course Inspection Form Daily Challenge Course Inspection Form Date * MM DD YYYY Name * First Name Last Name Please check each item daily before first use. Structures and equipment are free from damage or vandalism. * Pass Fail All Bolts are secured. * Pass Fail All joint and connections are correct. * Pass Fail All cables appear free of kink and barbs. * Pass Fail Harnesses and tethers are free of frays and rips. * Pass Fail Helmets are free of cracks and have all padding in place. * Pass Fail Caribiners are free from rust and latches move freely. * Pass Fail Grounds are free from trash and debris. * Pass Fail All equipment is stored properly. * Pass Fail Lesson plan is complete and has been prepared for implentation. * Pass Fail Thank you! Weekly Challenge Course Inspection Form Weekly Challenge Course Inspection Form 2 Date * MM DD YYYY Name * First Name Last Name Please check each item daily before first use. Trolleys Please check if any of the following require repair or replacement. Clean and Functional Straps Harness Please check if any of the following require repair or replacement. Seams Straps Front Loop Buckles Helmets Please check if any of the following require repair or replacement. Exterior Chin Strap Interior Padding Back Head Band Zip Line Course Please check if any of the following require repair or replacement. Launch Tower Landing Tower Storage Shed Challenge Course Please check if any of the following require repair or replacement. Balance Board Team Course Cargo Net Nitro Crossing Thank you! Weekly Challenge Course Skills Verification Weekly Challenge Course Skills Verification Date * MM DD YYYY Name of Supervisor * First Name Last Name Zip Line Name of Zip Line Coordinator * First Name Last Name Properly put on, adjust and clip into a commercial harness * Pass Fail Properly fit a climbing helmet * Pass Fail Properly attach and orient a carabiner * Pass Fail Proper zip pulley set-up * Pass Fail Assessing that the zip corridor is clear * Pass Fail Proper take-off procedures for zip participant * Pass Fail Properly set up and position a ladder * Pass Fail Proper instruction and management of take-down procedures at end of zip Pass Fail Properly lower off participants on high elements Pass Fail Proper management of the retrieval rope Pass Fail Challenge Course Name of Challenge Course Coordinator First Name Last Name Teach and model basic spotting techniques on a variety of elements Pass Fail Assess when and where spotting is necessary during an activity Pass Fail Provide an appropriate and thorough briefing of an element including goals, participant roles, and spotting considerations. Pass Fail Sequence activities appropriately and have the ability to assess a group’s readiness for a particular element Pass Fail Connect the activity to the program goals through processing. Pass Fail Thank you! Waterfront Forms Waterfront Skills Verification Waterfront Skills Verification Date * MM DD YYYY Waterfront Director Name * First Name Last Name Name of lifeguard * First Name Last Name Lifeguard Role * Certified Lifeguard Uncertified Lookout Basic swimming skills/physical endurance. 300-yard swim total without stopping comprised of both Front Crawl and Breast Stroke * Pass Fail Non-spinal rescue skills (all skills performed while using appropriate equipment, i.e. Rescue Tube) Appropriate entry into water: stride, compact jumps. * Pass Fail Extension assist from deck/dock. * Pass Fail Swimming extension rescue. * Pass Fail Active drowning victim front rescue. * Pass Fail Passive drowning victim rear rescue. * Pass Fail Submerged victim rescue. * Pass Fail Removing unconscious victim from water; 2 rescuers, 1 victim. * Pass Fail Spinal injury management techniques. Head-splint technique - shallow water. * Pass Fail Head-splint technique - submerged victim. * Pass Fail Backboard use and victim removal - shallow water, 2 rescuers. * Pass Fail On land: immobilization and backboard use for standing victim with suspected head, neck or spinal injury. * Pass Fail On land: immobilization and backboard use for standing victim with suspected head, neck or spinal injury. * Pass Fail Site specific safety systems. Zone coverage specific to site, rehearsed. * Pass Fail Scanning specific to site, rehearsed. * Pass Fail System to account for participants AND count participants (i.e. tag board and/or buddy board), rehearsed. * Pass Fail Mock rescues (site specific). Missing swimmer - shallow water (chest-deep or less). Pass Fail Missing swimmer - deep water. * Pass Fail Other: * Pass Fail Thank you! Watercraft Skills Verification Watercraft Skills Verification 4 Date * MM DD YYYY Waterfront Director Name * First Name Last Name Name of lifeguard * First Name Last Name Lifeguard Role * Certified Lifeguard Uncertified Lookout Aquatic Facility and Equipment Knowledge of the aquatic environment where the activity takes place. * Pass Fail Knowledge of the aquatic environment where the activity takes place. * Pass Fail Knowledge and familiarity of small craft equipment including PFDs, oars, and rescue equipment. * Pass Fail Knowledge and implementation of emergency procedures for severe weather. * Pass Fail Basic Water Rescue Help-and-Huddle Positions * Pass Fail Reaching assist with equipment * Pass Fail Reaching assist without equipment * Pass Fail Throwing Assist (ring buoy, rope) * Pass Fail Kayaking Wet Exit * Pass Fail Kayak over kayak rescue * Pass Fail Towing Assist * Pass Fail Thank you! Weekly Watercraft Inspection Form Weekly Watercraft Inspection Form Date * MM DD YYYY Name * First Name Last Name Watercraft Being Inspected Single 1 Single 2 Single 3 Single 4 Single 5 Double 1 Double 2 Double 3 Double 4 Double 5 Canoe Rescue Pontoon Please check any items that require repair or replacement Exterior Condition Hull Damage Interior Condition Seats Other: Thank you! Archery Forms Weekly Archery Inspection Weekly Archery Inspection Date * MM DD YYYY Name * First Name Last Name Please check each item daily before first use. Targets Targets are clean and suitable for use with arrows * Pass Fail Bows Please check if any of the following require repair or replacement. Limbs/Grips Strings Nock Arrow Rest Cam/Wheels Cable Guard Arrows Please check if any of the following require repair or replacement. Nocks Fletchings Shafts Points Other Equipment Please check if any of the following require repair or replacement. Arm Guards Straps Netting Bow Stands Quivers Other Thank you! Weekly Archery Skills Verification Weekly Archery Skills Verification Date * MM DD YYYY Name * First Name Last Name Name of Supervisor * First Name Last Name Demonstrate adequate level of skill proficiency * Pass Fail Determine proper bow size/strength * Pass Fail Check bow strings for safety * Pass Fail Check arrows for safety * Pass Fail Store archery equipment appropriately * Pass Fail Perform minor equipment repair * Pass Fail Set up and maintain archery course * Pass Fail Describe and follow appropriate range commands * Pass Fail Describe proper safety procedures * Pass Fail Describe proper emergency response to varying situations Pass Fail Give clear orientation to participants Pass Fail Describe adaptive measures for varying skill levels Pass Fail Describe adaptive measures for varying skill levels Pass Fail Appropriately demonstrate correct stance Pass Fail Appropriately demonstrate and correct arrow position Pass Fail Appropriately demonstrate correct pull Pass Fail Demonstrate and describe correct use of arm guard * Pass Fail Demonstrate and describe correct use of finger tabs * Pass Fail Demonstrate ability to correct technique problems * Pass Fail Thank you!
