august 2013 frg newsletter
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The Joker Journal HHC 1/34 Brigade Special Troops Battalion
August/September
2013
Issue 4
Page 1
Bloomington National Guard Armory
Commander: CPT Charles Beck
First Sergeant: 1SG Rick Lindner
Unit Address: 3300 West 98th St.
Bloomington, MN 55431
Unit Telephone: (651) 268-8100
Hello, HHC Soldiers and Families.
Can you believe it’s August already? Our Soldiers will spend the first two weeks at Camp
Ripley for Annual Training. This year, families are invited to visit their Soldiers on Saturday,
August 10th. For more details on the 1/34 BSTB Family Day, see the Upcoming Events and
Important Dates section in the newsletter.
In addition to the family day at Camp Ripley, the unit will host a family picnic on Sunday,
September 22nd in Bloomington. We will be selling unit t-shirts so bring your cash! Money
raised will help offset the cost of the Holiday Party in December.
And make sure you check out the Deals, Discounts and Family Resources section as there
are some great discounts for military families over the next two months, including Military
Appreciation Day at the Minnesota State Fair!
Thanks, and have a great couple of months.
Your FRG Leadership Team,
Jolene, Molly, Karen and Andrea
FRG Leadership
Leader – Jolene Lindner
(800) 646-9614 x 5
Co-Leader – Molly Andersen
(903) 920-4366
Treasurer – Karen Langer
(651) 334-9929
Secretary – Andrea Curley
(612) 751-0933
In This Issue: Pages 2-3: Upcoming Events and Important Dates
Page 4: FRG T-Shirt Fundraiser
Page 4: HHC Family Picnic
Page 5: Our Military Kids (OMK) Grant Program Changes
Pages 5-6: Deals, Discounts and Family Resources
Pages 7-8: HHC BSTB Family of the Month – “The Friedrichs”
Page 8: In the News
Page 9: Note from the Commander
Page 10: How to Contact the FRG & Stay Connected
The Joker Journal HHC 1/34 Brigade Special Troops Battalion
August/September
2013
Issue 4
Page 2
Upcoming Events and Important Dates
HHC 1/34 BSTB “Annual Training”
Friday, August 2 – Saturday, August 17
Camp Ripley
MACV Stand Down Tuesday, August 6 and Wednesday, August 7
Boy Scout Base Camps, Bloomington
Event includes free services for veterans, including meals, clothing, legal assistance and much more. For
more details, see the attached flyer.
1/34 BSTB Family Day Saturday, August 10: 10:00 a.m. – 4:00 p.m.
Camp Ripley
This is an informal event during which Soldiers can show their family what they do during Annual
Training and to check out the Camp Ripley Museum. There will be lawn games available on the grounds
between the Education Center and Building 7-1 and lunch will be served from 11:00 a.m. to 1:00 p.m. in
the same area. Families are also invited to attend the NCO Induction Ceremony at 3:00 p.m. For more
details and directions, see the attached flyer.
Kraus-Anderson Boot Camp Saturday, August 17: 9:00 a.m. – 12:00 p.m.
Boy Scouts of America Base Camp, Fort Snelling
Come join Kraus-Anderson Boot Camp, a family friendly fitness challenge fundraiser. Activities
include indoor rock climbing, indoor/outdoor rope courses, archery and a flight simulator. Around 75
free tickets are available to military families on a first come - first serve basis. Free tickets may be
acquired at the Cottage Grove Armory, in the west end of the building (operations section) or by mailing
a SASE to DCS PAO, Attn: SSG Holley, 8180 Belden Blvd, Cottage Grove, MN 55016. Envelope must be
postmarked no later than August 10.
Minnesota Peer-to-Peer Overnight
Friday, August 23 and Saturday, August 24
Minnesota Zoo, Apple Valley
While spending the night at the zoo, military-connected youth ages 10 to 13 will learn how resilient
animals can be while watching them from the tide pool at the zoo. Children will have the opportunity to
go on behind-the-scenes tours, a resilience scavenger hunt using iPads and other fun activities. This
The Joker Journal HHC 1/34 Brigade Special Troops Battalion
August/September
2013
Issue 4
Page 3
overnight stay is being offered to provide military-connected youth with the opportunity for peer-to-
peer support networking. Those planning to attend the free event should bring a sleeping bag and
pillow. To register, click here or see the attached flyer for more information.
Tennis Clinic Fundraiser
Saturday, August 24: 10:00 a.m. – 4:00 p.m.
National Sports Center, Blaine
The fundraiser is offered at no cost in the form of a tennis clinic for individuals of all ages and skill levels.
The even includes free food, chair massages and a raffle and silent auction. Proceeds will benefit the
Minnesota Military Family Foundation. For more details, click here.
Minnesota Peer-to-Peer Overnight
Friday, September 7 and Saturday, September 8
Sea Life Aquarium at Mall of America, Bloomington
While spending the night at the aquarium, military-connected youth ages 10 to 13 will learn how
resilient animals can be while watching them from the tunnel at the aquarium. Children will have the
opportunity to go on behind the scenes tours, a resilience scavenger hunt using iPads and other fun
activities. This overnight stay is being offered to provide military-connected youth with the opportunity
for peer-to-peer support networking. Those planning to attend the free event should bring a sleeping
bag and pillow. To register, click here or see the attached flyer for more information.
Operation Welcome Home
September 13-15
Ironwood Springs Christian Ranch, Stewartville
Operation Welcome Home is a faith-based weekend to provide encouragement, hope and inspiration to
veterans and their spouses. For more information, click here.
Camp Ripley Open House
Sunday, September 15: 10:00 a.m. – 3:00 p.m.
Camp Ripley
Open house features a classic car show, inflatable obstacle course, rock climbing wall and much more.
Additionally, the Heroes of the Homefront Ceremony will take place at 1:00 p.m. Click here for more
information.
HHC 1/34 BSTB Drill Saturday, September 21 and Sunday, September 22
Bloomington Armory
The Joker Journal HHC 1/34 Brigade Special Troops Battalion
August/September
2013
Issue 4
Page 4
FRG T-Shirt Fundraiser
The FRG is selling unit t-shirts to Soldiers and their family members. T-shirts are PT approved! We will be
taking orders at the Family Day at Camp Ripley on Saturday, August 10th, as well as the unit family picnic
on Sunday, September 22nd.
HHC Family Picnic
When: Sunday, September 22: 1:00 – 5:00 p.m. (Immediately following
drill)
Where: Moir Park, 104th Avenue S. and Morgan Avenue South, Bloomington
Activities: Playground, softball, volleyball, and other family-friendly activities planned by the FRG
(details to come)
We will email specific directions closer to the picnic!
Adult:
Small, Medium, Large & XL - $15.00
2XL and 3XL - $16.50
Youth:
Small, Medium & Large - $15.00
The Joker Journal HHC 1/34 Brigade Special Troops Battalion
August/September
2013
Issue 4
Page 5
Our Military Kids (OMK) Grant Program Changes
Our Military Kids (OMK), a non-profit organization that supports
military children during times of deployment, has had to change
the eligibility requirements for its grant program. As of July 1,
2013, children ages 3 and 4 are no longer eligible to apply for
grants from the organization.
Our Military Kids has been operating as a public/private
partnership with the Army National Guard. When the Army
National Guard renewed its contract back in 2012, it did not
include funding for children ages 3 and 4. Our Military Kids continued to provide grant awards to three
and four year-olds with money raised from the private sector, however, as deployments continue and
the demand for the grant program remains high, the organization has found private sector contributions
have not grown at a pace to keep up.
To learn more about this change, read OMK’s press release here. Please direct questions or concerns to:
Carolyn Ashworth
1/34 ABCT Family Readiness Support Assistant (FRSA)
Phone: 651-282-4137
Email: [email protected]
Attached you will find the new grant application for Army National Guard and Air National Guard
families.
Deals, Discounts & Family Resources
Operation Homefront: Back-to-School-Brigade – Sunday,
August 4: 1:00 – 4:00 p.m.
Operation Homefront will be distributing approximately 200 backpacks filled
with essential school supplies. If children already have a backpack, families can
bring it and fill it up with supplies needed. Supplies are limited and are on a
first come, first serve registration process. The event is taking place at La
Quinta Inn & Suites on American Blvd. West in Bloomington. To register for
the event, click here.
The Joker Journal HHC 1/34 Brigade Special Troops Battalion
August/September
2013
Issue 4
Page 6
Sittercity.com – Free Membership for Military
Families
Sittercity can help you find babysitters, nannies, last minute care,
before/after school care, pet sitters and more. The Department of Defense funds memberships for
military families including active duty, Reserve and Guard. Click here to activate your fully paid
membership or see the attached flyer for more details.
Blue Star Museums – Now through Labor Day
Thanks to a collaboration among the National Endowment for the
Arts (NEA,) Blue Star Families, the Department of Defense, and a
record‐breaking 2,000 museums across America, Blue Star Museums offers free admission to our
nation’s active duty military personnel and their families. A complete list of participating museums is
available here.
Special Offer from the Minnesota Lynx – Sunday, August 4 at
6:00 p.m.
Join the Minnesota Lynx in honoring our military heroes and save up to 25
percent on tickets to the Sunday, August 4th game against the Seattle Storm. Click
here and then enter offer code MILITARY.
Angeliques Bridal’s 6th Annual Bridal Gown Giveaway – Sunday,
August 4: 12:00 – 4:00 p.m.
In the military and planning your wedding? Angelique's Bridal Salon in Blaine is
looking for military men, women or fiancées of those in the military to submit their
love story for an opportunity to win a free bridal gown, free rental tuxedos, free
flowers and many other great prizes. For more information, click here.
Minnesota State Fair “Military Appreciation Day” –
Tuesday, August 27
Active military, their spouses and kids receive a discounted admission
ticket price of $7.00 when they purchase tickets at the gate and present
valid documentation of military service.
The Joker Journal HHC 1/34 Brigade Special Troops Battalion
August/September
2013
Issue 4
Page 7
HHC BSTB Family of the Month
This month, we are featuring SFC Steven M. Friedrichs and his family. A big thank you to the Friedrichs
for sharing their story with the FRG! Are you willing to be featured in an upcoming newsletter? Email
Molly Andersen, FRG Co-Leader, at [email protected].
1. Soldier’s name and rank:
SFC Steven M. Friedrichs
2. Spouse/significant other’s name:
Amy Friedrichs
3. Children’s names and ages:
Hallie – 8 years
Nicholas – 5 years
Madelyn – 2 years
Jackson – 3 months
4. Soldier’s branch/MOS and duty position:
91X / Readiness NCO
5. Soldier’s civilian/full-time job:
Being a Dad!!
6. Military experience and history: I joined the military on 16 April 1992. I joined for the college
money and to serve my country. I hold the following MOS’s: 11B, 19K and 91X. I have been with
the following units: C Co 1-194 INF, C Co 1-94 AR, B Co 2-194 AR, C Co 1-194 CAB, C Co 2-136
CAB, B Co 134 BSB, HHC 134 BSB, A Co 134 BSB, and HHC BSTB. I deployed to Bosnia from 2003-
2004 and to Iraq from 2005-2007. I started my AGR tour in 2008 and came to the BSTB in
January of this year.
7. About the Friedrichs: I met my wife in college at Minnesota State University, Mankato through
Amy’s brother. Amy is a full-time Family and Consumer Science (Home Ec) teacher at the High
School in Monticello. Our oldest daughter Hallie has been involved in dance since she was 3-
years-old. Nicholas completed his first year of wrestling this past winter, and hopes to do
another sport again this year. As a family we enjoy going to our cabin on Leech Lake in Walker,
The Joker Journal HHC 1/34 Brigade Special Troops Battalion
August/September
2013
Issue 4
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MN. We also enjoy riding our bikes, flying kites, trapping gophers, visiting the Minnesota Zoo
and going for walks around our neighborhood.
8. Family support: I think it is harder to be a family member of a Soldier than it is to be a Soldier.
My family has been there for me every time I need a pick-me up, even after when I have missed
so many family events due to military training or deployments. I have missed birthdays,
anniversaries, dance recitals, wrestling tournaments, weddings and many other once in a life
time events. Taking the time to write this has been kind of a reality check for me. I take so many
awesome things for granted, like all the awesome art projects they do for me and my co-
workers, or the excitement they display when I come home from drill or we pass an Army truck
on the road. Those are just a few ways my family supports me.
In the News
National Guard Soldiers deploy from Litchfield, Minn. West Central Tribune – Read the entire story here.
Friends, family members and supporters of the Minnesota National Guard’s 849th Mobility
Augmentation Company lined the streets on July 16th to send 95 Soldiers off to Texas, according to the
West Central Tribune. The Soldiers, based in Litchfield, Minn., are training at Ft. Bliss, TX before
deploying to Afghanistan in support of Operation Enduring Freedom. The send-off parade included
Litchfield fire, police and rescue vehicles escorting the two buses carrying the Soldiers out of town.
After 60 Years, Korean War Not Forgotten by Vets
Military.com – Read the entire story here.
On July 27, 1953 an armistice was signed to end the fighting in Korea, but a peace treaty was never
reached. Technically, the war is still on. The inconclusive ending may have something to do with why the
conflict has become known as “The Forgotten War,” but for those who fought in it, it’s certainly not
forgotten. Almost 1.8 million U.S. troops served in the Korean War and about 37,000 were killed. To put
that in perspective, for the time span of each conflict, it was deadlier than Vietnam.
The Joker Journal HHC 1/34 Brigade Special Troops Battalion
August/September
2013
Issue 4
Page 9
Note from the Commander
Greetings HHC BSTB Family,
I hope this note finds everyone well and enjoying your summer.
Mine has been very busy but pleasant otherwise. For the Soldiers of
HHC BSTB these past few months have been spent preparing for
Annual Training which is right around the corner. Our Annual
Training is the most important training period of the year. During
this time we accomplish several tasks including individual skill
sustainment, weapon qualification, physical fitness improvement,
personnel readiness processing, and team building to name a few.
Needless to say the daily training schedule for these 15 days is
packed from sun up to sun down!
Also during Annual Training this year and again in September there
will be opportunities for families to join us for a day. On August 10th,
families of all BSTB units are invited to attend the 1/34 Brigade Special Troops Battalion Family Day
event. The event is scheduled from 10:00 a.m. to 4:00 p.m. and will take place on the grounds between
the Education Center and Building 7-1. This is an opportunity for Soldiers to show their families what
they do during Annual Training and visit some of the facilities on post. Families are also invited to attend
the Non-Commissioned Officer induction ceremony scheduled for 3:00 p.m. in the Camp Ripley Training
and Community Center (TACC) auditorium.
Back in Bloomington for September drill, HHC will hold its own family day event with support from our
Family Readiness Group and the Bloomington Beyond the Yellow Ribbon (BYTR) group. Our event will
take place on Sunday, September 22nd at 1:00 p.m. The location is Moir Park in Bloomington. Again,
families are encouraged to join us here in the cities for an enjoyable afternoon together. The Soldiers
will be released from drill early enough to meet with family members before arriving at the park at 1:00
p.m. I hope to see everyone there!
- CPT Beck
The Joker Journal HHC 1/34 Brigade Special Troops Battalion
August/September
2013
Issue 4
Page 10
How to Contact the HHC FRG
Stay Connected
A Network of Support
The best way to reach us is through [email protected], but you can always call Jolene or Molly at the
numbers above.
Also, the Family Assistance Center (FAC) exists to help Families in a number of ways. You can reach the Brooklyn
Park FAC Coordinator at (651) 282-4055 or the 934th Air Lift Wing (Minneapolis) FAC Coordinator at (612) 713-1518.
For a list of FACs near you, click here.
We want to be here for as many Family members/loved ones of Soldiers as we can, but we can’t do that without
your help. If you know someone who might be interested in the FRG, please forward them our contact information.
Your Family Readiness Group
We want the FRG to be your FRG, meaning we want your input. If there is something you would like us to do or
need, let us know.
Providing us with your address, phone number, and Soldier(s)’ name for our records is confidential and voluntary,
but greatly assists us in communicating with you. Thanks for your support!
The HHC 1/34 BSTB FRG: [email protected]
Jolene Lindner – Leader [email protected] (800)-646-9614 x 5
Molly Andersen – Co-Leader [email protected] (903) 920-4366
http://www.facebook.com/134BSTB?fref=ts
www.btyr.org
https://www.facebook.com/BeyondTheYellowRibbon
https://twitter.com/BTYRmn
http://www.facebook.com/MinnesotaNationalGuard
https://twitter.com/MNNationalGuard
http://www.facebook.com/minnesotaredbulls http://www.youtube.com/MinnesotaRedBulls http://www.twitter.com/MnRedBulls http://www.flickr.com/photos/minnesotaredbulls
You’re Invited to...
1/34 BSTB Family Day
When: August 10, 2013, 10:00am-4:00pm
Where: Camp Ripley
Who: Family members of 1/34 BSTB
(HHC, Alpha, Bravo, Charlie) and HHC
1/34 ABCT Soldiers
About: This is an informal event during which Soldiers can show their
family what they do during Annual Training and to check out the Camp
Ripley Museum. There will be lawn games available on the grounds
between the Education Center and Building 7-1 and lunch will be served
from 11:00am-1:00pm in the same area. Families are also invited to attend
the NCO Induction Ceremony which will be held at 3:00pm in the Camp
Ripley TACC.
Enter in the Main Gate and (18+) be ready to provide a form of photo ID
Remember there is no cell phone use permitted while driving on post so families should
coordinate a meet up location with their Soldier ahead of time
Event parking is by the Education Center
Camp Ripley Museum Info: www.mnmilitarymuseum.org
We hope to see you on August 10th!
Education Center &
event parking
Lunch &
Lawn
Games
Building 7-1
Camp Ripley TACC
& NCO Induction
Ceremony at 3:00pm
Camp Ripley
Museum
Infa
ntr
y R
oad
Camp Ripley Main
Gate Entrance
CAMP RIPLEY – driving directions from Little Falls (US-10W) to the Camp Ripley Main Gate:
Head north on US-10 W
Slight right onto MN-371 N
Take the MN-115/County Highway 47 exit toward Randall
Go West on MN-115
Turn right onto Infantry Road (road to Main Gate)
Continue straight on Infantry Road (Museum, Education Center and Building 7-1 will all be on the right hand side)
SSTTAANNDDDDOOWWNN AAUUGGUUSSTT 66TTHH –– 77TTHH,, 22001133
ALL BAGS WILL BE SUBJECT TO SEARCH UPON ENTRANCE – NO ALCOHOL OR DRUGS ALLOWED
FOR MORE INFORMATION CALL MACV (651) 224-0290 OR (612) 726-1327
FOR FASTER REGISTRATION PLEASE PROVIDE PROOF OF SERVICE (DD214)
Free shuttle from the Fort Snelling Light Rail Station Free Parking Available at Base Camp and at LRT Station
GATES OPEN 8:00 A.M. – 5:00 P.M.
REGISTRATION 8:00 A.M. – 5:00 P.M. TUESDAY
(8:00 A.M. – 4:00 P.M. WEDNESDAY N UNREGISTERED VETERANS ADMITTED AFTER 5 P.M.)
WELCOMING CEREMONY 11:00 A.M. AUGUST 6TH
BBOOYY SSCCOOUUTT BBAASSEE CCAAMMPP 220011 BBLLOOOOMMIINNGGTTOONN RROOAADD,, FFOORRTT SSNNEELLLLIINNGG CCOONNVVEENNIIEENNTTLLYY LLOOCCAATTEEDD OOFFFF OOFF HHIIGGHHWWAAYY 5555 AANNDD BBLLOOOOMMIINNGGTTOONN RROOAADD IINN FFOORRTT
SSNNEELLLLIINNGG,, MMNN.. 11//33 OOFF AA MMIILLEE FFRROOMM TTHHEE FFOORRTT SSNNEELLLLIINNGG LLIIGGHHTT RRAAIILL SSTTAATTIIOONN..
FREE SERVICES AVAILABLE
MEALS CLOTHING VA BENEFITS LEGAL ASSISTANCE COURT PUBLIC BENEFITS HAIRCUTS
FEDERAL & STATE TAX ASSISTANCE
VA MEDICAL CARE, DENTAL, OPTOMETRY STATE DMV HOUSING AA/NA
EMPLOYMENT ASSISTANCE
MENTAL HEALTH COUNSELING WELLNESS AND MORE!
WELCOME VETERANS!
Who: 10-13 year olds
What: While spending the night at the zoo, tweens will learn how
animals are resilient and spend the night near the tide pool.
When: Aug. 23rd-24th
Where: Minnesota Zoo
Why: Provide military connected youth with an opportunity for peer to peer support networking.
Who: 10-13
year olds
What: While
spending the
night at the
aquarium ,
tweens will learn
how Sea Life
creatures are
resilient and
spend the night
in the tunnel.
When: September 7th-8th
Where: Mall of America– Sea Life
Aquarium
Why: Provide military connected
youth with an opportunity for peer to
peer support
networking.
Moriah Legvold: Child and Youth Program Coordinator: [email protected] 6512688378
Bring a sleeping bag and a pillow.
Cost: Free
We need 4 parent chaperones for each event. Please contact, Moriah Legvold, if
interested.
Food is provided at the aquarium. Please eat before you come to the zoo.
Minnesota
Zoo
Peer to Peer
Overnight
Camps
Sea Life Aquarium Peer to Peer Overnight Camps
To register for these events go to
http://www.btyr.org/events-a-deals
or contact Moriah Legvold. Registration deadline
is: Aug. 2
Who: 10-13 year olds
What: While spending the night at the zoo, tweens will learn how
animals are resilient and spend the night near the tide pool.
When: Aug. 23rd-24th
Where: Minnesota Zoo
Why: Provide military connected youth with an opportunity for peer to peer support networking.
Who: 10-13
year olds
What: While
spending the
night at the
aquarium ,
tweens will learn
how Sea Life
creatures are
resilient and
spend the night
in the tunnel.
When: September 7th-8th
Where: Mall of America– Sea Life
Aquarium
Why: Provide military connected
youth with an opportunity for peer to
peer support
networking.
Moriah Legvold: Child and Youth Program Coordinator: [email protected] 6512688378
Bring a sleeping bag and a pillow.
Cost: Free
We need 4 parent chaperones for each event. Please contact, Moriah Legvold, if
interested.
Food is provided at the aquarium. Please eat before you come to the zoo.
Minnesota
Zoo
Peer to Peer
Overnight
Camps
Sea Life Aquarium Peer to Peer Overnight Camps
To register for these events go to
http://www.btyr.org/events-a-deals
or contact Moriah Legvold. Registration deadline
is: Aug. 2
Minnesota Zoo Peer to Peer Overnight 2013
Registration Form (Print clearly, fill out completely)
Contact Information
Youth’s Name Last First Middle Initial
Youth’s Address Street or Box City State Zip Code
Youth’s Phone Number ( ) Birth Date Age Sex: M F Month/day/year
Emergency Contact: Name Relationship to Youth: Parent Guardian Other:
Daytime Phone Number ( ) Evening Phone Number ( )
Cell Phone Number ( ) Address City State
Alternate Emergency Contact: Name Relationship to Youth: Parent Guardian Other:
Daytime Phone Number ( ) Evening Phone Number ( )
Cell Phone Number ( ) Address City State
Health Information
Youth has the following:
Health concerns (check all that apply): Asthma Convulsions Fainting Spells Physical Impairment
Bronchitis Diabetes Heart Trouble Hay Fever Other (list) _______
Allergies or reactions to drugs (check all that apply): Aspirin Penicillin Other (list) _______
Allergies or reactions to foods (check all that apply): Dairy Gluten Peanuts Shellfish
Other (list)
Allergies or reactions to things in nature (check all that apply): Insect bites or stings Ivy/oak/sumac toxins
Other (list)
Youth experiences the following (check all that apply): Separation Anxiety Sleep walking Bed wetting
Other (list) _______________________________________
Youth has a condition that requires medication: Yes No
If yes was answered, what is the condition? (list)
What is the name of the medication? (list)
Will the medication be in the possession of the youth? Yes No
Is the youth capable of self-administering the medication? Yes No
Date of Youth’s last Tetanus Immunization Month Date Year
Medical Insurance Company Policy No.
Physician or Clinic Address Phone ( ) Street or Box City
Military Branch please indicate which branch you are affiliated with Air Force Army Coast Guard Marines Navy Army National Guard Air National Guard
Reserves (please indicate which branch represented) ________________________________
Revised for Overnight camp 6/13
Authorization
If an injury or illness develops during an activity or event, medical care will be provided and I will be
notified as soon as possible. I understand that it is my responsibility to provide updates (including changes in
health conditions and medical coverage) prior to events in which the above-named youth participates. I
understand and accept the above statements and further authorize each of the following:
A. The health history and medical information I have provided is correct and the above-named youth
has my permission to engage in all program activities as noted. I understand that it is my
responsibility to provide updates (including changes in health conditions, medical coverage, or
activity restrictions) throughout the program year and prior to any events/activities in which the
above-named youth intends to participate.
B. If an injury or other medical condition occurs or arises, I grant permission for medical treatment to
be obtained for the youth and authorize the physician and/or the other medical staff to employ such
diagnostic procedures and medical treatment as deemed necessary.
C. I authorize the release of any medical records necessary for treatment, referral, billing, or insurance
purposes.
D. I understand that I am financially responsible for charges and hereby guarantee full payment to the
attending physicians and/or health care unit.
Parent/Legal Guardian’s Signature Date
Youth’s Signature Date
Furthermore, I agree that all activities and use of all facilities relating to participation in Minnesota National
Guard Youth Programs activities shall be undertaken at the sole risk of the youth/family and the Minnesota
National Guard Youth Programs shall not be liable for any claims, demands, injuries, damage, actions or
causes of action, whatsoever, to me, my family, or my property arising out of or connected with participation
in Minnesota National Guard Youth programs/events or the premises where the programs/events occur and I
do hereby expressly forever release, discharge, and hold harmless the Minnesota National Guard Youth
Programs and youths of the program from all such claims, demands, injuries, damage to person or property,
actions or causes of action, including but not limited to all acts of active or passive negligence on the part of
the Minnesota National Guard, Youth Programs, their servants, agents, or employees. I do not, however,
release these individuals and entities from liability for intentional, willful or wanton acts and this
release shall not be construed to include such acts.
I have read and understand and agree to the terms and conditions of this release. I understand that I have
given up rights by signing this release and sign it freely and without inducement.
Parent/Legal Guardian’s Signature Date
Youth’s Signature Date
Revised for Overnight camp 6/13
Minnesota Zoo Peer to Peer Overnight
(Print clearly, fill out completely)
Agreement for Use of Photographs, Artwork, and Name From time to time photographs, videos, and/or audio clips may be taken of youth and adults engaging in Minnesota National Guard Youth Programs and Beyond the Yellow Ribbon programs and activities. The Minnesota National Guard Youth Programs and the Beyond the Yellow Ribbon Program request the right to use all photos, videos, and/or audio clips taken of youth and adults, programs and activities. These may be used for promotional brochures, promotions or showcase of programs on our web sites, showcase of activities in local newspapers, and other not-for-profit purposes. By signing this form, I consent to allow the Minnesota National Guard Youth Programs and the Beyond the Yellow Ribbon Program to use photos, videos, and/or audio clips that they have of me/my child participating in the Minnesota Military Teen Panel. By signing this form, I confirm that I understand and agree to the above request and conditions. I agree to give up my rights with regards to Minnesota National Guard Youth Programs photos, videos, and/or audio clips of me. I sign this form freely and without inducement.
Parent/Legal Guardian’s Signature Date
Youth’s Signature Date
GRANT APPLICATION
Army National Guard, Army Reserve, Navy Reserve, Marine Reserve, Coast Guard Reserve
ALL GRANTS ARE SUBJECT TO AVAILABILITY OF FUNDS
**Our Military Kids requires ALL information and documentation to process application**
Please read and initial each of the following eligibility requirements:
______ Deployment period must be at least 180 days OCONUS (OVERSEAS), there are at least 60 days remaining on orders AND child will
start activity before service member returns home.
______ Child is at least five (5) years of age AND not yet graduated from high school.
______Grant will cover up to six months of future instruction, lessons or tutoring for ONE activity/program with a maximum
grant award of $500.00 per child. Grants are not available for activities that have already taken place. Our Military Kids will issue
only one check to one provider for the child’s activity. Choose wisely - once a check has been issued to the provider, the activity
may not be changed.
GRANT AWARDS CANNOT BE PROCESSED WITHOUT THESE ITEMS. I have attached a copy of:
______ 1) Title 10, mobilization/deployment orders (child is eligible as of “Report Date” on orders);
______ 2) Child’s military dependent ID card OR copy of birth certificate if the deployed service member is the biological parent of the
child, OR DD Form 1172, OR copy of DEERS/MilConnect Service Member profile page with child listed as dependent.
______ 3) Program brochure, registration form, or letter from the service provider with fee information, address, and telephone number.
Child’s Name: ______________________________________________________Grade: ____ M__ F____ Birthdate: ________________
Parent/Guardian: ________________________________________________________1st phone number: _________________________
Cell/Work phone: __________________________________ Email Address:________________________________________________
Country of Deployment: ____________________________ FRG Leader/Family Assist. Rep. phone (if known):_____________________
Family’s Postal Address :________________________________________ _____________________________ _______ __________
Number and Street City State Zip
PLEASE VERIFY WHERE THE CHECK SHOULD BE SENT. MANY TIMES IT IS A DIFFERENT ADDRESS FROM
WHERE THE CHILD PARTICIPATES IN THE ACTIVITY.
Grant Request Amount: _____________________ Activity (i.e., soccer, dance): ________________________________________ (Attach documentation to validate amount not to exceed $500; Our Military Kids does not cover private school tuition, including preschool, or day care expenses.)
Organization Name: _______________________________________________________________________________________________
Make check payable to (if different from organization): ___________________________________________________________________
Mailing Address: __________________________________________________________________________________________________
Street City State Zip
Organization Contact Information: _____________________________________________ _____________________________________
Name Telephone Number
CONSENT TO EXCHANGE INFORMATION
I understand that additional information may be required to adequately verify eligibility for a grant. By signing this form, I am allowing a
representative of Our Military Kids, Inc. to communicate with the contact of the organization and/or the contact provided on the military orders.
I certify all the information I have supplied is true and correct. I permit Our Military Kids, Inc. staff to verify the information on this application.
I declare that receipt of a grant will aid in easing a financial burden which would otherwise exist if expenses related to my child’s activity
were paid out of family funds.
_______________________________________________, am signing this form for _____________________________________________
Full printed name of parent/guardian Printed name of child
__________________________________________________
Parent/Guardian Signature
Mail to: Fax to: Questions:
Our Military Kids, Inc. 703-734-6503 Call: 703-734-6654
6861 Elm Street, Suite 2-A Toll Free: 1-866-691-6654 McLean, VA 22101 Email to: [email protected]
Sea Life Aquarium Peer to Peer Overnight
2013
Registration Form (Print clearly, fill out completely)
Contact Information
Youth’s Name Last First Middle Initial
Youth’s Address Street or Box City State Zip Code
Youth’s Phone Number ( ) Birth Date Age Sex: M F Month/day/year
Emergency Contact: Name Relationship to Youth: Parent Guardian Other:
Daytime Phone Number ( ) Evening Phone Number ( )
Cell Phone Number ( ) Address City State
Alternate Emergency Contact: Name Relationship to Youth: Parent Guardian Other:
Daytime Phone Number ( ) Evening Phone Number ( )
Cell Phone Number ( ) Address City State
Health Information
Youth has the following:
Health concerns (check all that apply): Asthma Convulsions Fainting Spells Physical Impairment
Bronchitis Diabetes Heart Trouble Hay Fever Other (list) _______
Allergies or reactions to drugs (check all that apply): Aspirin Penicillin Other (list) _______
Allergies or reactions to foods (check all that apply): Dairy Gluten Peanuts Shellfish
Other (list)
Allergies or reactions to things in nature (check all that apply): Insect bites or stings Ivy/oak/sumac toxins
Other (list)
Youth experiences the following (check all that apply): Separation Anxiety Sleep walking Bed wetting
Other (list) _______________________________________
Youth has a condition that requires medication: Yes No
If yes was answered, what is the condition? (list)
What is the name of the medication? (list)
Will the medication be in the possession of the youth? Yes No
Is the youth capable of self-administering the medication? Yes No
Date of Youth’s last Tetanus Immunization Month Date Year
Medical Insurance Company Policy No.
Physician or Clinic Address Phone ( ) Street or Box City
Military Branch please indicate which branch you are affiliated with Air Force Army Coast Guard Marines Navy Army National Guard Air National Guard
Reserves (please indicate which branch represented) ________________________________
Revised for Overnight Camps 6/4/13
Authorization
If an injury or illness develops during an activity or event, medical care will be provided and I will be
notified as soon as possible. I understand that it is my responsibility to provide updates (including changes in
health conditions and medical coverage) prior to events in which the above-named youth participates. I
understand and accept the above statements and further authorize each of the following:
A. The health history and medical information I have provided is correct and the above-named youth
has my permission to engage in all program activities as noted. I understand that it is my
responsibility to provide updates (including changes in health conditions, medical coverage, or
activity restrictions) throughout the program year and prior to any events/activities in which the
above-named youth intends to participate.
B. If an injury or other medical condition occurs or arises, I grant permission for medical treatment to
be obtained for the youth and authorize the physician and/or the other medical staff to employ such
diagnostic procedures and medical treatment as deemed necessary.
C. I authorize the release of any medical records necessary for treatment, referral, billing, or insurance
purposes.
D. I understand that I am financially responsible for charges and hereby guarantee full payment to the
attending physicians and/or health care unit.
Parent/Legal Guardian’s Signature Date
Youth’s Signature Date (If the youth is 18 or over, BOTH the parent/legal guardian and youth must sign.)
Furthermore, I agree that all activities and use of all facilities relating to participation in Minnesota National
Guard Youth Programs activities shall be undertaken at the sole risk of the youth/family and the Minnesota
National Guard Youth Programs shall not be liable for any claims, demands, injuries, damage, actions or
causes of action, whatsoever, to me, my family, or my property arising out of or connected with participation
in Minnesota National Guard Youth programs/events or the premises where the programs/events occur and I
do hereby expressly forever release, discharge, and hold harmless the Minnesota National Guard Youth
Programs and youths of the program from all such claims, demands, injuries, damage to person or property,
actions or causes of action, including but not limited to all acts of active or passive negligence on the part of
the Minnesota National Guard, Youth Programs, their servants, agents, or employees. I do not, however,
release these individuals and entities from liability for intentional, willful or wanton acts and this
release shall not be construed to include such acts.
I have read and understand and agree to the terms and conditions of this release. I understand that I have
given up rights by signing this release and sign it freely and without inducement.
Parent/Legal Guardian’s Signature Date
Youth’s Signature Date (If the youth is 18 or over, BOTH the parent/legal guardian and youth must sign.)
Revised for Overnight Camps 6/4/13
Sea Life Aquarium Peer to Peer Overnight (Print clearly, fill out completely)
Agreement for Use of Photographs, Artwork, and Name From time to time photographs, videos, and/or audio clips may be taken of youth and adults engaging in Minnesota National Guard Youth Programs and Beyond the Yellow Ribbon programs and activities. The Minnesota National Guard Youth Programs and the Beyond the Yellow Ribbon Program request the right to use all photos, videos, and/or audio clips taken of youth and adults, programs and activities. These may be used for promotional brochures, promotions or showcase of programs on our web sites, showcase of activities in local newspapers, and other not-for-profit purposes. By signing this form, I consent to allow the Minnesota National Guard Youth Programs and the Beyond the Yellow Ribbon Program to use photos, videos, and/or audio clips that they have of me/my child participating in the Minnesota Military Teen Panel. By signing this form, I confirm that I understand and agree to the above request and conditions. I agree to give up my rights with regards to Minnesota National Guard Youth Programs photos, videos, and/or audio clips of me. I sign this form freely and without inducement.
Parent/Legal Guardian’s Signature Date
Youth’s Signature Date