National 4-H Shooting Sports Western Heritage Workshop Safety First Shooting Association Winton, CA March 13-16, 2016 Information Items

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National 4-H Shooting Sports Western Heritage Workshop Safety First Shooting Association Winton, CA March 13-16, 2016 Information Items Thank you for taking part in the 2016 National 4-H Shooting

1 National 4-H Shooting Sports Western Heritage Workshop Safety First Shooting Association Winton, CA March 13-16, 2016 Information Items Thank you for taking part in the 2016 National 4-H Shooting Sports Western Heritage Workshop. Your state shooting sports program coordinator and I are pleased that you will attend this certification course. This training is strictly for adults (21 years of age or older) 4-H volunteers and staff. The delegates who complete this training will be certified to lead the 4-H Western Heritage project in their home state: Before you take part in this unique learning experience there are some things of which you should be aware. This program is geared toward developing your shooting skills, knowledge of youth development, and teaching methods. Our goal is to prepare you to return to your home state/county and serve as a resource person and instructor that will help the 4-H Shooting Sports Program grow. You will need to sign the University of California waiver of liability as well as the Safety First Shooting Association waiver to participate. Fees/Registration The cost for this course: $100 per person, paid and registered by March 4, 2016 To receive registration information and a registration packet, contact your State 4-H Coordinator. Your coordinator is listed at this link: Registration fee includes the following: Course shooting supplies (firearms, ammunition, targets) Meals. 3 lunches & 3 suppers Leader training manual (Supplemental leader curriculum is available for purchase from the instructor for $25) Arrival/Departure You should arrive by 3:00 p.m. on Sunday, March 13, Closing events will be Wednesday March 16, 2016 by 5:00 p.m. Safety First Shooting Association Safety First Shooting Association is a privately operated facility in Winton, CA (Merced County). To view their website visit: The classroom and parking are wheelchair accessible; the range areas consists of compacted soil. 1

2 Airport The nearest airport to the facility is the Fresno Yosemite International Airport: If you choose to fly in, you will need to arrange your own ground transportation. The airport is approximately 80 miles from the Safety First Shooting Association. The Merced Regional Airport Macready Field has limited connector service but is only 15 miles from the range facility. Lodging The facility is located approximately 15 miles out of Winton and Merced. You will need to arrange your own motel lodging. A list of nearby accommodations has been provided. On Site Camping Dry tent camping and self-contained RV camping on the range site for free is available. There is no internet service available. Verizon coverage is good at the facility. Meals Lunches of sandwiches will be served in the grove area near the range. Suppers will be served at covered patio area. Meals provided will be: Sunday, March 13: supper Monday, March 14: lunch, supper Tuesday, March 15: lunch, supper Wednesday, March 16: lunch Weather The average temperature for Winton, CA in March is 56 degrees with a high of 82 and a low of 30 degrees. Be sure to bring clothing that will keep you warm and dry. The ranges are open areas and there will be pop up shades available. Dress This workshop focuses on western heritage, it is encouraged that participants wear period clothing or western style apparel. Be sure to wear shoes that do not have open toes. You will need eye and ear protection. If you are particular about the type of safety glasses and hearing protection you like to use, you should bring your own. Firearms Guns for the course will be provided. You may bring your own firearms if you like but they must be period type and appropriate for the course. You must be responsible for their security. Questions If you have questions, please contact the following: Registration: Facilities and lodging: John Borba Dave Givens (661) (209) jaborba@ucanr.edu RiverOaksTraining@gmail.com 2

3 2016 National 4-H Shooting Sports Western Heritage Workshop March 13 16, 2016 Safety First Shooting Association - Winton, CA This training certifies participants as instructors for the 4-H Western Heritage project of the 4-H Shooting Sports Program: Cost: Registration is $ per person. Registration forms and fees are due to the event registrar by March 4, 2016 and class size is limited. The fee includes Sunday supper, Monday lunch and supper, Tuesday lunch and supper, and Wednesday lunch. It also covers the cost of class shooting supplies. Travel expenses, lodging, and breakfasts are not included in the registration fee and are the responsibility of the participant or the individual or the State 4-H Program. Cancellation/Refund Policy: If you need to cancel your registration for any reason the following policy applies. A $50 cancellation fee will apply or the registration may be transferred to another suitable candidate if notification is at least one week in advance of the training and the individual registers for the same discipline. The new person will need to fill out all forms. No refunds will be given after March 11, Applications: Applications are available from your State 4-H Shooting Sports Coordinator. To locate your state coordinator, visit: A completed application packet includes: 1. National 4-H Shooting Sports Application Form 2. University of California Waiver of Liability, Assumption of Risk, and Indemnity Agreement 3. University of California Adult Volunteer Treatment Authorization Form 3

4 Motels near the Safety First Shooting Association Range Facility Turlock 32 mile drive to range Candlewood Suites - Group Discount $109 one king bed, Group Discount $119 two queen beds 1000 Powers Ct, Turlock CA Phone: (209) , Monte Vista Exit adjacent to restaurants and shopping Merced driving miles to range Holiday Inn Express - $139 is the regular rate for king or double queen rooms 151 S Parsons Ave, Merced CA Phone: (209) Courtyard Merced - $109 Address: 750 Motel Drive, Merced, CA Phone: (209) Holiday Inn Express & Suites - $90 Address: 151 S Parsons Ave, Merced, CA Phone: (209) Hampton Inn & Suites Merced - $114 Address: 225 S Parsons Ave, Merced, CA Phone: (209) Best Western Plus Inn - $ Motel Drive, Merced, CA Phone: (209) Ramada Merced - $ E Childs Avenue, Merced, CA Phone: (209) Americas Best Value Inn - $ V Street, Merced, CA Phone: (209) Travelodge Merced Yosemite - $ Yosemite Pkwy, Merced, CA Phone: (209) Budget Inn - $ R Street, Merced, CA (209) Motel 6 - $ V Street, Merced, CA (209) Super E Childs Avenue, Merced, CA Phone: (209)

5 H Shooting Sports Workshop National 4-H Shooting Sports Application Form STATE: The 2016 National 4-H Shooting Sports Western Heritage Workshop will be held at Safety First Shooting Association in Winton, CA (Merced County). Return completed application with full payment to your State 4-H Shooting Sports Coordinator. State Coordinators are to return the completed applications to the event registrar: John Borba, 4-H Youth Development Advisor/Kern County 1031 S. Mt. Vernon Ave. Bakersfield, CA (661) Registration is considered complete when all forms and full payment is received. Payment is requested to be ONE CHECK PER COUNTY OR STATE, if possible, made payable to: California 4-H Shooting Sports. Registration is on a first-come, first-served basis. Your State 4-H Shooting Sports Coordinator is: Phone: PARTICIPANT INFORMATION Name: Mr. Ms. Mrs. Address: City: State: Zip: Home Phone Business Phone: County: Cell Phone: Special Dietary Needs (list any special dietary needs you have): Reasonable Accommodation This facility has disability-related access available. 5

6 Criteria In order for a participant to attend this workshop, he/she must be at least 21 years of age and meet the following: 1. Must currently be enrolled in 4-H as a shooting sports leader 2. Must currently hold certification as a 4-H shooting sports leader in at least one of the following disciplines: pistol, rifle, shotgun or hold and be able to show proof of certification as a Range Safety Officer in one of the following organizations: National Congress of Old West Shootists, Single Action Shooting Society, Cowboy Action Shooting Society 3. Be supportive of 4-H and positive youth development 4. Have been recommended by their State 4-H Shooting Sports Coordinator. STATE 4-H SPORTS COORDINATOR VERIFICATION I verify that this individual has met the guidelines of the National 4-H Shooting Sports Committee to attend the National Workshop. State 4-H Shooting Sports Coordinator Signature: Date: APPLICANT SELECTION and MEMORANDUM OF UNDERSTANDING 1. I understand that if I attend this workshop, I will assist with at least one State-level 4-H Shooting Sports Training Workshop for leaders in my State each year for the next three years. 2. I understand that if I attend I will be required to sign a release of liability waiver for the Safety First Shooting Association. 3. I give to The Regents of the University of California, National 4-H Council, National 4-H Headquarters (USDA), Cooperative Extension and units, its nominees, agents, and assigns, unlimited permission to copyright and use, publish, and republish for purposes of advertising, public relations, trade, or any other lawful use, information about me and reproduction of my likeness (photographic or otherwise) and my voice, whether or not related to any affiliation with 4-H, with or without my name. I hereby waive any right that I may have to inspect or approve the copy and/or finished product or products that may be used in connection therewith or the use to which it may be applied. By signature, I consent and agree to the foregoing terms and provisions. Signature of Applicant: Date: 6

7 EXPERIENCE WITH 4-H OR OTHER YOUTH ORGANIZATIONS Please describe your experience in working with youth through 4-H, Scouting, or similar organizations. PREVIOUS 4-H SHOOTING SPORTS TRAINING List previous 4-H shooting sports training received, and any certifications you have received. Discipline Training Received Date Certification Level SHOOTING BACKGROUND Do you have hunting experience? Yes No Types of Hunting Specialized Training Honors/Recognition COMPETITIVE EXPERIENCE Do you have competitive shooting experience? Yes No Disciplines: Past/Present Classifications Specialized Training Honors/Recognition 7

8 COMMUNITY ACTIVITIES Please list your participation in community activities and organizations, and offices or leadership positions held. Organization or Activity Offices/Leadership Positions Held Honors/Recognition HOBBIES/OTHER INTERESTS Describe any other interests, skills or hobbies you enjoy. Organization or Activity Offices/Leadership Positions Held Honors/Recognition Physician s name and phone number: Health Insurance Carrier and Group/Policy: PLEASE INDICATE IF YOU HOLD ANY CURRENT FIRST RESPONDER CERTIFICATION (e.g., EMT, Registered Nurse, Medical Doctor, Military Medic/Combat Lifesaver, etc.) Submit this completed form to your State 4-H Shooting Sports Coordinator Thank you for your interest in educating youth and supporting your state s 4-H Shooting Sports Program! For more information about 4-H Shooting Sports find the National 4-H Shooting Sports Program visit 8

While I am attending or traveling to or from this 4-H function, I HEREBY AUTHORIZE THE ADULT 4-H VOLUNTEER OR 4-H STAFF MEMBER, or in his/her absence or disability, any adult accompanying or

9 While I am attending or traveling to or from this 4-H function, I HEREBY AUTHORIZE THE ADULT 4-H VOLUNTEER OR 4-H STAFF MEMBER, or in his/her absence or disability, any adult accompanying or assisting him/her, TO CONSENT TO THE FOLLOWING MEDICAL TREATMENT FOR ME SHOULD I BE UNABLE TO MAKE A DECISION: Any x-ray examination, anesthetic, medical or surgical diagnosis or treatment, and hospital care which is deemed advisable by, and is to be rendered under the general or special supervision of any physician and/or surgeon licensed under the provisions of the Medical Practices Act, California Business and Professions Code Section 2000 et seq.; or any x-ray examination, anesthetic, dental or surgical diagnosis or treatment, and hospital care to be rendered by a dentist licensed under the provisions of the Dental Practices Act, California Business and Professions Code Section 1600 et seq. This authorization is given pursuant to the provisions of Section 25.8 of the Civil Code of California. This authorization shall remain effective until I complete my activities in this program unless sooner revoked in writing. I understand that I will be respon sible for the cost of any service or treatment provided not covered by the 4-H Accident/Sickness Insurance Program sponsored by UC Cooperative Extension. University policy and the State of California Information Practices Act of 1977 require the following information be provided when collecting personal information from you: The information entered on this form is collected under authority of the Smith-Lever Act. Submission of the medical data is voluntary. However, a signature is required on one or the other of the two signature lines above. Failure to provide the medical information and authorization may result in our inability to provide necessary medical treatment. You have the right to review University records containing personal information about you, with certain exceptions as set forth in policy and statute. Copies of University policies pertaining to the collection, use, or release of personal data are available for your examination from the local UCCE County Director, 4-H Youth Development Advisor, 4-H Program Representative or the Associate Director of 4-H Program & Policy at University of California, Division of Agriculture and Natural Resources, California State 4-H Office, 2801 Second Street, Davis, CA , (530) , ca4h@ucanr.edu. Only your own records are open to your review. 9

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Waiver: In consideration of being permitted to participate in any way in California 4-H Youth Development Activities and Projects, I, for myself, my heirs, personal representatives or assigns, do

11 Waiver: In consideration of being permitted to participate in any way in California 4-H Youth Development Activities and Projects, I, for myself, my heirs, personal representatives or assigns, do hereby release, waive, discharge, and covenant not to sue The Regents of the University of California, its officers, employees, and agents from liability from any and all claims including the negligence of The Regents of the University of California, its officers, employees and agents, resulting in personal injury, accidents or illnesses (including death), and property loss arising from, but not limited to, participation in California 4-H Youth Development Activities and Projects. Assumption of Risks: Participation in California 4-H Youth Development Activities and Projects carries with it certain inherent risks that cannot be eliminated regardless of the care taken to avoid injuries. The specific risks vary from one activity to another, but the risks range from 1) minor injuries such as scratches, bruises, and sprains; 2) major injuries such as eye injury or loss of sight, joint or back injuries, heart attacks, and concussions; and 3) catastrophic injuries including paralysis and death. I have read the previous paragraphs and I know, understand, and appreciate these and other risks that are inherent in California 4-H Youth Development Activities and Projects. I hereby assert that my participation is voluntary and that I knowingly assume all such risks. Indemnification and Hold Harmless: I also agree to INDEMNIFY AND HOLD The Regents of the University of California HARMLESS from any and all claims, actions, suits, procedures, costs, expenses, damages and liabilities, including attorney s fees brought as a result of my involvement in California 4-H Youth Development Activities and Projects, and to reimburse them for any such expenses incurred. Severability: The undersigned further expressly agrees that the foregoing Waiver and Assumption of Risk Agreement is intended to be as broad and inclusive as is permitted by the law of the State of California and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect. Acknowledgment of Understanding: I have read this Waiver of Liability, Assumption of Risk, and Indemnity Agreement, fully understand its terms, and understand that I am giving up substantial rights, including my right to sue. I acknowledge that I am signing the agreement freely and voluntarily, and intend by my signature to be a complete and unconditional release of all liability to the greatest extent allowed by law. 11

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