Welcome to the University of Wisconsin – Madison! We’re excited that you’re going Canoe Camping on the Wisconsin River with Wisconsin Basecamp as part of your orientation to the University. Basecamp provides an opportunity for you to meet your fellow classmates and find out from junior and senior student leaders what classes are like, campus resources that are available for you, and what challenges lay ahead while experiencing a great wilderness experience. Thank you for your deposit/payment for your Basecamp trip, the complete trip fee and all forms sent in one month prior to trip departure. You can call the Outdoor UW/WI Basecamp Office at 608-262-1630 with credit card information to pay the full deposit. Please fill out the following forms will include: 1. Wisconsin Basecamp Participant Information 2. Wisconsin Basecamp Behavior Agreement 3. Basecamp Risk, Indemnification, Consent for Emergency Treatment 4. Medical Form 5. Academic record/progress-which includes you in a study of this program’s effectiveness. 6. Assumption of risk and waiver for Outfitter If you have any questions or concerns prior to the trip, don’t hesitate to contact us. Enjoy your summer and see you soon! Julie Brown [email protected]Wisconsin Basecamp Manager Check us out: http://www.union.wisc.edu/basecamp.htm Facebook: https://www.facebook.com/WisconsinBasecamp/ Friend us on Facebook!!
Transcript
Welcome to the University of Wisconsin – Madison!
We’re excited that you’re going Canoe Camping on the Wisconsin River with Wisconsin Basecamp as part of your orientation to the University. Basecamp provides an opportunity for you to meet your fellow classmates and find out from junior and senior student leaders what classes are like, campus resources that are available for you, and what challenges lay ahead while experiencing a great wilderness experience.
Thank you for your deposit/payment for your Basecamp trip, the complete trip fee and all forms sent in one month prior to trip departure. You can call the Outdoor UW/WI Basecamp Office at 608-262-1630 with credit card information to pay the full deposit.
Please fill out the following forms will include:1. Wisconsin Basecamp Participant Information2. Wisconsin Basecamp Behavior Agreement3. Basecamp Risk, Indemnification, Consent for Emergency Treatment4. Medical Form5. Academic record/progress-which includes you in a study of this program’s effectiveness.6. Assumption of risk and waiver for Outfitter
If you have any questions or concerns prior to the trip, don’t hesitate to contact us. Enjoy your summer and see you soon!
Check us out: http://www.union.wisc.edu/basecamp.htmFacebook: https://www.facebook.com/WisconsinBasecamp/ Friend us on Facebook!!
Return forms by mail or scan/email Julie Brown Wisconsin Basecamp 800 Langdon St Madison, WI 53706
RefundsDeposit is non-refundable. And there are no refunds one month prior to the start date of your trip. We have a minimum of 5 participants per trip, if your trip does not fill then we will offer to move you to another trip. If you cannot attend then we will reimburse you for the trip.
Can I rent gear for the canoeing trip? We have limited supplies of rental items. Group gear such as clothing, tents, group cooking supplies are included in the cost. If you need something, please call in advance to reserve and pay for the items. To reserve call 608.262.1630 between noon and 7 pm. Let them know you are a Basecamp Participant.
Food Allergies and dietary restrictions?We will do our best to accommodate for special needs. Please be sure to call ahead if you have a specific needs and any specific life threatening allergy. While we will try our best, we cannot promise that there will be no exposure to certain allergies. The earlier we know about restraints the better we can try to accommodate. With certain restraints the student might need to bring supplemental foods.
Traveling far to come on the trip? Many students from out-of-state choose to schedule a Basecamp trip that starts the day after their SOAR orientation ends. If you choose to combine SOAR and Basecamp, we recommend that you do SOAR first so you can possibly stay in campus housing the night before your trip goes out. We cannot have participants end SOAR and start Basecamp on the same day. Some choose to do SOAR and Basecamp separately, which is totally acceptable.
Don’t know your roommate yet? A lot of students have signed up for the same trip with their new roommate. This allows for you to get to know each other in a fun, dynamic environment. You can then start the year together with mutual friends and experiences.
Please remind family and friends that you will be unavailable during your Basecamp experience.We will be focused on connecting to new friends and experiences while on Basecamp, which equates to being unplugged from email, phones, texting, etc. In case of a true emergency (family death or serious incident, event) Basecamp will do our best to reach the affected participants’ group, however this might take at least a day or more. Please only contact Basecamp emergency numbers if its is a true emergency (family/friend death, serious incident, event).
Typically upon departure and return we like to post group pictures on Facebook. Tell your family and friends to check it out Facebook/WisconsinBasecamp. If you are curious about our leaders go to union.wisc.edu/WisconsinBasecamp and check out our Leader Profiles.
Emergency contacts during the trip- PLEASE ONLY CALL for true EMERGENCY otherwise call- office or Julie Brown desk phone
1. Basecamp (Outdoor UW) Office – 608.262.16302. Julie Brown, Basecamp & Outdoor UW Manager- 608.262.8452 or 970.443.8944 cell3. Emily Schaefer, Basecamp Assistant Manager/Intern- 414.380.2795 cell4. Amos Mayberry- Basecamp Assistant Manager/Intern-715.514.7297 cell5. Jacob Hahn, Outdoor UW Director- 608.262.2214 or 608.358.7381 personal cell6. Joe Webb, Outdoor UW Manager- 920.377.00647. Susan Dibbell, Asst. Director – Social Education- 608.263.4009 office and 608.219.0295 cell8. Ric Gibbs, Director of Risk Management- 608.262.8925 office and 262.278.2313 cell
Gear Questions?Feel Free to contact us with any questions you have regarding gear. We encourage you to look at thrift stores, online, and/or borrow gear. Any questions regarding Medications and/or Toiletries feel free to ask Julie.
Times and Directions8:15 AM - Participant drop off4:00PM - Participant pickup
Participants will be gathering at Memorial Union at the beginning (and end) of the trip.Meet at the Park St. turnaround, where N. Park St. meets Lake Mendota. Look for our Basecamp sign!
Day 18:15 AM – Participants meet at Memorial Union. Welcome and overview of trip with Trip Leaders. (Please eat a good breakfast before arriving).
9:30 AM – Depart for Boscobell/ Shuttle to Sauk.
12:30 AM –Sack lunch will be provided. Wisconsin River Launch and paddle and camp on the River
Day 2 & 3On the Wisconsin River, paddling, floating, overnight camping on sandbars, and fun…with campfires and activities at night. Be prepared for a lot of sand camping.
Day 4Approx. 12 Noon – Off the river. Drive to Devil’s Lake State Park for overnight camping and enjoying this special and scenic park.
Tuesday Lunch = special celebratory cookout at Devil’s Lake.
4:00PM – Participants back in Madison, available for pickup/departure. Trip concludes.
Wisconsin Basecamp Canoe Trip Gear List
EQUIPMENT QuantityPRIORITY
COMMENTS Required Suggested Rental
Pack
/B
eddi
ng
Duffle/ float bag/Backpack 1 -3 X $13/trip all gear must be in bag(s)Pack Liner/Plastic Bags 6 X Lining all bag(s)-waterproofing
Sleeping Bag 1 X $13/trip 3-season; synthetic fillSleeping Pad 1 X $7/trip example: Therm-A-Rest
Travel Pillow/sheet or tarp 1 X No full size pillows/ sheet or tarp helps keep things out of sand
Hea
dwea
r/U
pper
Bod
y
Hat 1 X example: baseball capLight Weight Jacket 1 X or sweater; suggest fleeceLong-Sleeve T-Shirt 1 XShort-Sleeve T-shirts 2 X
Rain Jacket 1 XSunglasses 1 X UV protective
Foot
wea
r/L
ower
Bod
y
Sneakers 1 pair XSocks 2-3 pair X
Long pants 1 X no jeansShorts 2 X
Swimsuit 1-2 XUnderwear as needed XWool Socks 1 pair X
Flip Flops/ athletic sandals 1 pair X alt: water shoes or sandalsRain Pants 1 optional
Toothbrush/toothpaste 1/1 XTowel 1 X camp or backpacking towel
Camp Soap 1 X biodegradableHand Sanitizer 1 X minimum SPF 15
Feminine Supplies 1 XMedications -- if needed
Mis
cella
neou
s Ite
ms
Bowl, mug, 2 Waterbottles 1 X Unbreakable, 32oz waterbottlesFork, Spoon, or Spork 1 X Metal or lexanFlashlight/Headlamp 1 X bring spare batteries
Cash $20-$40 XHealth Insurance Card 1 X or photocopy; must be currentJournal or Notebook 1 X optional
Pen or Pencil 1 XBook 1 X spare time activity
Camera 1 X pack in waterproof bagCamp Chair 1 Optional -example: Crazy Creek
Glasses or Contacts 1 If needed1. Please DO NOT bring makeup or electronic devices on the trip (Trip Leaders will have cell phones in case of emergency).2. “Required” items are those which our experience has shown to be the most important to have.3. Depending on the weather conditions we encounter, you may not need all of the gear listed above. You will be camping in sand.4. Where possible, we urge you to use equipment you already own or can borrow from others.5. Weight is factor in packing. Heavy bags lead to heavy boats and harder paddling. NO rigid suitcases, please.6. Where specific brands are listed, these are NOT recommendations. They are listed only as examples.7. Zip lock bags work well to protect small items from the water.8. We will do a final gear check prior to leaving campus to ensure that we are prepared for our journey.9. Females please bring a small stuff sack, 4 small plastic zip locks, and extra menstruation supplies no matter what your cycle is. 10. Don’t stress! Take your time, and enjoy preparing for your trip.
Participant Information (form 1)
Which trip would you like to go on? (circle one)
Canoeing: July 20-24 July 27-31 Aug 4-8 Aug 17-21 Aug 18-22 Aug 24-28
Name _________________________ Birth date ____ / ____ / ____ M ___ F ___
Street Address _______________________________________________________
City/State/Zip Code ______________________ E mail ______________________
Home Phone ________________________ Cell Phone _____________________
Phone: Home _______________ Work ________________ Cell _____________
Physician’s Name _______________________________ Phone ______________
Note: Participants are responsible for any medical expenses incurred. Please bring a copy of your health insurance card with you on the trip.Please list any special dietary needs you have (e.g., allergies, vegetarian, etc.):
Please list any medical information about you that Basecamp leaders should know (i.e., conditions which might affect your participation, medications, allergies, etc.):
By signing below, I certify that the information I have provided above is accurate and complete. I agree to abide by the trip rules as outlined in this packet and as may be amended by Wisconsin Basecamp leadership. I grant Wisconsin Basecamp permission to use photos or video of me for publicity purposes and reprint quotes, essays or other written or spoken materials I produce. Signature ____________________________________ Date _________________
Signature of Parent or Guardian (required if participant is under 18)
Signature ____________________________________ Date _________________
To help us ensure a positive environment for all our Basecamp participants we ask that you read below and agree to the below expectations of Basecamp trips:
1. I understand and agree to be committed to providing a safe, friendly, and inclusive environment for all participants. I am expected to act in a respectful, and responsible manner at all times while participating in Basecamp activities. Any verbal or physical conduct that demeans or threatens others is absolutely unacceptable.
2. I understand and agree to not participate in any inappropriate or unwanted comments, misconduct, touching, or bullying. If I witness any inappropriate behaviors I will report it to Basecamp Trip Leader and/or Manager.
3. I understand and agree to an alcohol, tobacco, and drug-free trip. Alcohol/ illegal drugs are not allowed in University vehicles at any time.
4. I understand and agree to no guns, knives, or other weapons are allowed on trips (multi-tool/Swiss Army-type knives are acceptable, but not necessary).
5. No personal electronic devices allowed on the trip. This includes cell phones, tablets, video games, and any other non-medical electronics. (Trip Leaders will have cell phones in case of emergencies.)
Any individual violating the above standards will be required to meet Basecamp Leader and Managers to determine disciplinary outcomes from the incident/activity in question. Outcomes may include suspension or expulsion from Basecamp trips without refund. Basecamp Leaders and Managers retain the authority to immediately dismiss any participant in violation of this agreement or any University policies from a trip at the participant’s expense.
Strict Adherence is expected and required to ensure a safe, quality Basecamp experience for all participants. If you have any questions about these rules please contact us in advance. Thank you for your cooperation.
I understand and agree to the above standards
Full Name Signature Date
__________________________________________________Which trip are you participating on?
Please return to Outdoor UW/ BasecampWisconsin Basecamp/ Julie Brown 800 Langdon St Madison, WI 53706 Or Scan/email to:[email protected]
Basecamp Agreement for Assumption of Risk, Indemnification, Release,and Consent for Emergency Treatment (form 3)
My name: (print) __________________________________________________________ Age: _________________ IN CONSIDERATION OF MY VOLUNTARY PARTICIPATION IN THE UW-MADISON Wisconsin Basecamp, I UNDERSTAND THAT I AM BEING ASKED TO CAREFULLY READ EACH OF THE FOLLOWING PARAGRAPHS. I UNDERSTAND THAT IF I WISH TO DISCUSS ANY OF THE TERMS CONTAINED IN THIS AGREEMENT, I MAY CONTACT THE UW-MADISON OFFICE OF RISK MANAGEMENT AT EITHER 262-8925 OR 262-0379. Assumption of Risks: I understand that the specific activities of Wisconsin Basecamp, by their very nature, carry with them certain inherent risks that cannot be eliminated regardless of the care taken to avoid injuries. Activities will include canoeing and camping, and the risks range from: 1) minor injuries such as scratches, minor burns, and cuts, to 2) major injuries such as broken bones strains, and hypothermia, to 3) catastrophic injuries of drowning, head injuries, permanent disfigurement, disability, or even death. I understand that the University does not provide any type of medical coverage and that I must be personally responsible for any injuries I may incur . I understand and appreciate the risks that are inherent in the above-listed activity. I hereby assert that my participation is voluntary and that I knowingly assume all such risks.
Signature of Parent or Guardian (if Participant is under 18*)
Signature: _____________________________________ Date: _____________________ Hold Harmless, Indemnity and Release : In consideration of permission for me to voluntarily participate in Wisconsin Basecamp during Summer 2015, I, for myself, my heirs, personal representatives or assigns, agree to defend, hold harmless, indemnify and release, the Board of Regents of the University of Wisconsin System, its officers, employees, agents, and volunteers, from and against any and all claims, demands, actions, or causes of action of any sort on account of damage to personal property, or personal injury, or death which may result from my participation in the above-listed activity. This release includes claims based on the negligence of the Board of Regents of the University of Wisconsin System, and its officers, employees, agents, and volunteers, but expressly does not include claims based on their intentional misconduct or gross negligence. I understand that by agreeing to this clause I am releasing claims and giving up substantial rights, including my right to sue.
Signature of Parent or Guardian (if Participant is under 18*)
Signature: _____________________________________ Date: _____________________ Consent for Emergency Treatment: I authorize the University of Wisconsin-Madison and its designated representatives to consent, on my behalf, to any emergency medical/hospital care or treatment to be rendered upon the advice of any licensed physician. I agree to be responsible for all necessary charges incurred by any hospitalization or treatment rendered pursuant to this authorization.
*If your son, daughter or ward will be under 18 while participating in activities at the University of Wisconsin – Madison, it is our policy to request your agreement to the above terms, on behalf of your minor son, daughter or ward.
YOUR TRIP # ________________ TRIP DATES: _________________PARTICIPANT INFORMATION
Home Phone_(______)____________________________ Date of Birth_________________________
Preferred Name ______________________________________Neither the University of Wisconsin-Madison nor the Wisconsin Union provides medical insurance for participants. Participants are required to pay for any medical expenses and encouraged to provide their own insurance.
HEALTH CONCERNSDIET: G I eat a regular diet with no special needs. G I eat a vegetarian diet with no special needs. G I have special dietary requirements. (Please describe below.)
ALLERGIES: G I have no known allergies. G I have allergies to one or more of the following. G Food G Medicine G Environmental (insect stings, pollen, etc.) G Other (Please describe below and specify treatment.)
Other Accommodations:
Wisconsin Basecamp800 Langdon St
Madison, WI 53706
Wisconsin Basecamp Medical History Form (form 4)
Please complete these forms and return no later than 1 month before your trip to the address on the right. They may also be scanned to [email protected] completion of this form and the information you provide is voluntary. The information will be used by trip leaders for planning purposes and in the event of an emergency. This information will not be shared with others without your consent.
SWIMMING ABILITY: G None G Poor G Good G ExcellentMEDICAL AND HEALTH INFORMATION
MEDICATIONS: G I do not require any medications. G I require the following medications. (Please describe below.)
TYPE/NAME REASON DOSAGE SIDE EFFECTS SPECIAL STORAGE
PHYSICAL CONDITION: G I do not have any existing physical conditions issues. G I have the following conditions requiring special care or treatment, and which may limit my ability to take part in certain activities. (Please describe below.)
CONDITION DATE OF ONSET CURRENT TREATMENT SPECIAL REQUIREMENTS
CERTIFICATION AND WAIVERThe above information is a complete and accurate statement of the health factors that may affect my ability to participate in Wisconsin Basecamp activities. I realize failure to release information could result in serious harm to me or other participants. In the case of an emergency, I consent to allow the Wisconsin Union to release this information to the medical personnel or medical facility involved in my treatment. Signature_________________________________ Date______________________________________NOTE: If the trip participant is under the age of 18 at the time this form is completed, then their parent(s) or legal guardian(s) must cosign below.Signature___________________________ Relationship_________________ Date________________
I give the Office of the Registrar at the University of Wisconsin-Madison permission to release the following private/protected information to the recipient(s) listed below:
I. ___ My GPA ___ My Class Rank ___ A Copy of my Official Transcript _X_ Any/all academic information requested by the recipient ___ Other: ________________________________________
(Please specify) II.
Recipient authorized to receive the above designated information/ documentation:
Wisconsin Basecamp Program (including Julie Brown and Jacob Hahn) Name of individual or organization/company (please print legibly)N.B. If you authorize us to release the above information/ documentation to an/y agent acting on behalf of the above named individual/organization, please check and initial the following box:□ _________ (initialize)
III. This request to release the above information/documentation is pursuant to (indicate the purpose):___ A job application/interview___ Professional licensure___ Application to another college/university___ Insurance purposes_X_ Other: Assessment of Wisconsin Basecamp program effectiveness
(Please specify)
I understand that I will not be contacted when the above information/ documentation is released to the designated recipient. However, if there is a financial hold on my record I understand that the requestor will not receive the information and will be instructed to have me contact the Office of the Registrar. (See below.)
If there are any “holds” on my academic record which prohibit the release of my documentation/information, it is my responsibility to clear them and notify the Office of the Registrar of this fact. (Holds can be checked through “My UW”.)
If necessary, I can be contacted at the following e-mail address(es):____________________________________My signature below authorizes the Office of Registrar to act on my behalf as noted above. Furthermore, I release the Office of the Registrar and the University of Wisconsin of any/all liability in carrying out these directives.
Signature Date Printed Name UW Student ID# (if known)
SimpleTek Solutions, INC, DBA WI River Outings- Canoeing WaiverASSUMPTION OF RISK AND WAIVER AGREEMENT (form 6)
All adventure activities have inherent risks of physical injury or death associated with them. The guided canoe trips, canoe, kayak and tube rental offered by Wisconsin River Outings (WRO) are adventure activities and there is risk associated with being a participant.
Assumption of Risk: I, ___________________________________________________ understand that canoeing, kayaking and tubing exposes me to many hazards and participating in a WRO canoeing, kayaking, tubing and camping adventure entails unavoidable risk of death, personal injury and loss of or damage to property. I choose to participate in this trip in spite of these risks and hereby assume all risk of injury or loss of life to myself and loss of or damage to property arising out of my participation in such a trip.
Waiver: In consideration of WRO furnishing services and equipment to enable me to participate in a canoeing/kayaking/tubing trip, I specifically release and forever discharge WRO and its officers, agents and employees from any and all liability or claims for any injury, illness, death or loss of or damage to property which I may suffer while participating in this canoeing/kayaking trip.
In signing this document, I fully recognize that if injury, illness, death or damage occurs to me while I am engaged in this canoeing/kayaking/tubing trip, I will have no right to make a claim or file a lawsuit against WRO or its officers, agents or employees, even if they or any of them negligently cause me injury, illness, death or damage. I understand that though this may be a guided canoe trip, there will be times when the guide(s) or other participants may not be in a position to assist, or aid in my rescue in the case of a mishap or the occurrence of a problem. I understand that WRO recommends that all participants have the physical ability to assist in their own rescue. I understand that wearing a properly sized, adjusted and buckled personal flotation device (PFD) is critical to my safety. I hereby grant WRO the right to take and utilize photographs of me participating in trip related activities for the purpose of promotion and advertising.
This Waiver also releases and discharges any and all liability and responsibility of the landowner, Lake WI 2 LLC, who are lessors of the property in Sauk City and who are not involved, directly or indirectly with, or participate in, the rental or operation of the canoe, kayak or tube business or tours, for any injury, death or loss of, or damage to, property. The landowner is not involved in, responsible for the condition of, the services, equipment or transportation offered and provided by WRO.
If any portion or provisions of this Assumption of Risk and Waiver Agreement is or are deemed unenforceable by a Court of Law, the remaining portions and provisions shall remain in full force and effect.
I also understand that if WRO needs to retrieve my canoe/kayak/tube due to losing it on the river I am responsible for a recovery fee of $175.00 or the cost of the canoe/kayak/tube if it cannot be found/recovered.
I HAVE CAREFULLY READ THIS AGREEMENT AND UNDERSTAND ITS CONTENTS. I AM AWARE THIS IS A ASSUMPTION OF RISK AGREEMENT, WAIVER AND A RELEASE OF LIABILITY AND I SIGN IT VOLUNTARILY. Once your paddle hits the water there are no refunds or credits.
Signature ______________________________________________ Date ____________
Signing this waiver for my child or child I’m a guardian of.
