Overnight Camp Request Form
Your Name
*
First Name
Last Name
Your Email
*
example@example.com
Your Phone Number
*
Please enter a valid phone number.
Your Rank
*
Please Select
Cho Dan
E Dan
Sam Dan
Sah Dan
Oh Dan
Chil Dan
Pal Dan
Other (gup, no rank)
Your Role (Regional Director, Camp Director, etc)
*
Region
*
Please Select
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
Reason for overnight Camp (please explain why a single-day camp is not possible)
*
Name and location of Camp or Facility (please include street address, city, state, country and zip/postal code)
*
Has the contract been reviewed by Legal Affairs?
*
Yes
No
If so, are there any specific requirements we should be aware of (e.g., indemnification for sexual misconduct, extra insurance requirements, etc. – when in doubt, please contact LAC)
*
Yes
No
If the LAC has not reviewed the contract, why not?
*
Describe the location (rural vs. metropolitan, cabins vs hotel style, etc.)
*
Rural
Suburban
Urban/Metropolitan
Cabins
Hotel
YMCA or similar
Please provide a map, if available, of the facility
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Name of Contact at Location
*
First Name
Last Name
Email of Location Contact
*
example@example.com
Phone Number of Location Contact
*
Please enter a valid phone number.
Date Camp Starts
*
Date Camp Ends
*
Is this a combined youth and adult camp?
*
Yes
No
If so, are the accommodations separate (i.e., will adults, other than chaperones, be in the same building(s) overnight as the youth)?
*
Yes
No
Potential number of youth students attending
*
Potential number of adults attending
*
Will any adults who are NOT WTSDA members be in attendance?
*
Yes
No
Why will such non-members be in attendance?
*
Do all the chaperones and adult WTSDA members have recently (valid within the last 5 years) completed background checks
*
Yes
No
Who reviews the result of background checks?
*
Are there any chaperones who have anything other than “clean” background checks (for purposes of this question, any background check with anything other than minor safety violations is NOT considered “clean”)?
*
Yes
No
Will parents be (some or all of) the chaperons?
*
Yes
No
Are they the only chaperones or included (e.g., they are BB members and instructors)
*
Yes
No
Approximately how many students expected per cabin/hotel room (etc.)?
*
Approximately how many students expected per each chaperone?
*
What type of medical support will be available?
*
Please Select
Volunteers
Paid (EMTs, etc.)
None
Other
Please describe
*
How will dispensing of medication (please include storage facilities, who will dispense, will youth be permitted to keep medication other than inhalers, epipens and non-prescription items, with them?
*
What other activities besides TSD or martial arts practice will be available?
*
Provide tentative schedule for review
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Do you have a counselor’s guide?
*
Yes
No
If so, please provide a copy
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Do you have a parent’s guide?
*
Yes
No
If so, please provide a copy
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Submit
Should be Empty: