Dear Students and Parents,

We want to thank you for your interest in Appalachian Teen Trekkers. Appalachian Teen Trekkers (AT2) provides members with an excellent opportunity to meet new friends, become more involved at Abingdon High School and the surrounding community, as well as develop leadership skills that can be applied both in and outside of the classroom. We have some unique opportunities this year, some located around Abingdon High School after-school and other programs throughout the community and surrounding area in the beautiful mountains over the weekends. Our mission is to “growing leaders through service, adventure, and experience”. AT2 provides experiences to participants which will challenge you to expand your personal growth in a safe and supportive environment.

We accomplish our mission by providing experiences which include team building, problem solving, environmental education programs, service-learning activities, and outdoor adventure expeditions. Our carefully selected group of staff include college age mentors, teachers, and community leaders. Safety is a primary concern on each of our outings and staff have the necessary experience, training and credentials to ensure that each participant is challenging themselves in a safe and supportive learning environment.

We are open to all skill levels, abilities and the like. We have the necessary equipment and knowledge so you do not need to come into our program with past experience or knowledge, just a willingness to participate and grow!

Most of our outings will be heavily subsidized by Appalachian Teen Trekkers and its partners as we grow, which means that these experiences are provided with little to no cost to you! In return we are counting on members to play an active role in fundraising activities throughout the year and program promotion within the community to insure our program will grow in the community and the schools.

Please fill out the attached form so that we may better serve you throughout the school year. We can assure you that all information will remain confidential and only Appalachian Teen Trekkers staff will have access to it. For more information visit our website www.at2.mountainalliance.org or stop by our office at the school, room 404, and we will be more than happy to talk with you!

We are looking forward to many exciting adventures with you!Appalachian Teen Trekkers

Appalachian Teen Trekkers Program ApplicationThroughout the year updates and announcements will be distributed via email, phone, and the AT2 website www.at2.mountainalliance.org. Be sure to “like” our Facebook page as well for additional updates and information. It is important that you write clearly on all forms so we can correctly contact you and retain your personal information.

Respect GuidelinesAppalachian Teen Trekkers, Inc. strives to create and maintain a positive learning environment that is safe for every participant. We ask that participants do not take or use electronic devices while on AT2 trips as this is distracting and separates you from the group interaction. We have also identified the following items as “disrespectful” or “unsafe” in regards to the wellbeing of the Appalachian Teen Trekkers community: Alcohol, Drugs, Tobacco Products, Violence/ Weapons. We have a no-tolerance policy in regards to the above mentioned items. Anyone suspected to be in violation of these respect guidelines while attending an AT2 function will result in immediate removal from the program. In addition, both parents and school officials will be notified upon return from the activity, students will be subject to Washington County Schools Discipline policy by Washington county Schools personnel. Please do not put us in a position to have to enforce this policy! You have the ability to make responsible decisions, please do so!

Membership GuidelinesAppalachian Teen Trekkers operates both as a club within Abingdon High School and as a non-profit organization. Members are encouraged to participate in: 2 Adventure Outings, 2 Service Projects, and Membership meetings each semester. Come talk to us and communicate your scheduling conflicts. Remember, you will truly only get out as much as you put in!

Media ReleaseBy signing this form below, I grant permission for Appalachian Teen Trekkers, Inc. to use photographs, video, audio recordings, and/ or textual material created by me for use in promotional publications, including web sites or other electronic forms of media without notification. This material may only be used for Appalachian Teen Trekkers, Inc.

Student CommitmentI am committed to honoring the Respect and Membership guidelines of Appalachian Teen Trekkers, Inc. and the standards of Washington County Schools. I am also committed to being an active participant in the programs I attend, to make the best of this opportunity, and to promise my fellow participants and instructors respect at all times.I have read and understand the above mentioned guidelines, and promise to uphold them.

Signature of Participant: ____________________________________ Date: _____________

Signature of Parent/ Legal Guardian: __________________________ Date: _____________

Appalachian Teen Trekkers, Inc. Parental Consent Form

Participant’s Name ___________________________________

Parent’s Name(s) ___________________________________Phone(h)_____________(w)________________________________________________Phone(h)_____________(w)_____________

Emergency Contact:_____________________ Phone(h)_____________(w)_____________

Insurance Company Name __________________________________________

Liability ReleaseAs the Parent/Legal Guardian of the above-mentioned participant, I hereby give my consent forparticipation in the Appalachian Teen Trekker program(s). I understand that although all programs will be led by competent, trained, adult staff & volunteers, utilizing all the necessary safety precautions, there still remains an inherent risk of injury and/or loss of life resulting from participation in these programs.

Acknowledgement of RiskI assume all risks and hazards incidental to such participation, including transportation to andfrom the program, and hereby waive, release, and agree to hold harmless Appalachian Teen Trekker, its employees, its volunteers, and any sponsoring agency for any claims arising out of any loss or injury that the participant might sustain while engaged in this program.

Permission to transport and administer care in the event of an emergency in which my child must be taken to the hospital for treatment, I hereby give permission to transport my child and for hospital staff to begin treatment immediately.

By signing below I am stating that I have read understand the liability release, acknowledgement of risk, and permission to transport and administer care paragraphs above.

________________________________________ _______________Signature of Parent/Legal Guardian if under 18 Date:

____________________________________ _______________Signature of Participant Date

Participant Health Information

Participant’s Name _________________________________________

Birth date ____________________________________

Date of last Tetanus Booster Immunization ________________________________

Medication(s) taking _______________________________________________________________

Dosage(s) __________________________Time to be administered_________________________

Any adverse reactions to drugs/medications?(Penicillin? Aspirin?) ______________________________ ____________________________________________________________________________________

Is participant a sleepwalker?_________________________ Asthmatic?_________________________

Does participant have allergies? use an inhaler? (please Describe) _________________________________________________________________________________________________________________

Has participant ever had any previous allergic reaction to bee stings, foods, dust, etc? (Please describe)______________________________________________________________________________________________________________________________________________________________________

Does participant have a history of seizures?__________________________________________________

Has participant ever slept away from home?_________________________________________________

Please list any physical restrictions, previous medical conditions, operations, etc. that might affect participation. _____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Can participant swim? (CIRCLE ONE)     Good Swimmer        Can Swim         Non Swimmer

Does participant get carsick? ____________________ Height_______________ Weight ____________

Other factors we should be aware of to care for your child: ______________________________________________________________________________________________________________________________________________________________________________

_________________________________________ ____________Signature of Parent/Legal Guardian if under 18 Date