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DEPARTMENT OF THE ARMYJROTC DEPARTMENT

Waynesville Career Center400 GW Lane

Waynesville, Missouri 65583

WHS/WCC-JROTC 20 August 2016

MEMORANDUM FOR: Faculty, Advisers and JROTC Commanders

SUBJECT: Memorandum of Instruction (MOI) for the 2nd Annual Fort Leonard Wood Survival of the Fittest Raider Meet – 22 October 2016 (Initial Draft) 1. Waynesville Army JROTC and the 1st Engineer Brigade, Fort Leonard Wood, Missouri will host the 2nd Annual “Fort Leonard Wood Survival of the Fittest Raider Meet” on 22 October 2016, on Fort Leonard Wood, Missouri. This event will consist of 6 team events and the Ultimate Raider Buddy Team event.

a. Army Physical Fitness Test (Modified) (Annex A) b. 10K Road March (Annex B) c. One-Rope Bridge (Annex C) d. PECs (Physical Endurance Course) (Annex D)

* All teams will do a PECS course walk thru prior to beginning the course e. Monkey Fist Litter Carry) (Annex E) f. Gauntlet (Annex F) g. Ultimate Raider Buddy Run (Annex G)

(Not counted in the team score)

2. OBJECTIVES.

a. To host a safe, fair, and challenging competition that will test the physical and mental limits of all competitors.

b. To allow Raider Teams to compete against each other in a Raider Challenge competition.

c. To instill pride, teamwork, esprit de corps and self-confidence among JROTC cadets.

d. To test a Raider Team both physically and mentally. The Raider Challenge is designed to be a thorough evaluation of a Raider Team’s physical fitness level and technical competency in field tasks and teamwork. The competition is designed to be physically and mentally strenuous.

e. Have Fun.

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3. EXECUTION.

a. REGISTRATION: All schools wishing to participate are required to complete and submit the pre-registration form for each team. This form is attached as Annex I and is also available from 1SG(R) Meghan Fadl (mfadl@waynesville.k12.mo.us) - (573) 842-2500 ext 3919, COL(R) Charles Williams (cwilliams@waynesville.k12.mo.us) - ext 3921, or SGM(R) Bill Lindsey (blindsey@waynesville.k12.mo.us ) – ext 3920. Email is the preferred method of form submission. The suspense for pre-registration is NLT 1 October 2106. Final registration forms must be submitted NLT 15 October 2016.

b. We are limiting the total number of team submissions to 20. Additional teams may be added at the discretion of FLW and WCC Cadre if it is determined that the addition will not hinder the overall execution and quality of the event.

c. Arrival / In-processing will be at Fort Leonard Wood, beginning at 1530 hours on 21 October 2016. Teams will billeted in the 35th Engineer Battalion Initial Entry Training (IET) barracks and eating breakfast in their Dining Facility (DFAC). The Raider Meet TOC will be located in the barracks, and/or at the start and finish point for the 10k/Gauntlet. The location is still being finalized.

d. On Saturday morning, the competition day will begin at 0500 with registration for those teams that did not register on Friday. The commander’s meeting will take place at 0530. The APFT, 10k, and event order will be provided at the commander’s meeting – done via random drawing. All teams will do the APFT, then the 10k, and then all other events IAW with order provided.

e. The competition will begin at 0545 with the Army Physical Fitness Test (APFT). The APFT uniform is ACU bottoms, t-shirt and boots. See Annex A for Task, Conditions and Standards. APFT Standards WILL NOT be read before each event. It is the team coach/advisor’s responsibility to ensure that team members know the rules and requirements of the APFT. APFT grading will be to standard and provided by Active Duty Drill Sergeants and Instructors from Fort Leonard Wood.

f. The Modified APFT push-ups and sit-ups will be conducted on a field and the run will be conducted on a standard 400m track. Sit-ups will be done immediately after the push-ups. Once push-ups are completed, the team will move to the sit-up station and commence sit-up immediately. Teams will not proceed to the run until they are linked up with their evaluator after the sit-up event. Teams will ensure their 9th Raider or coach is with the evaluator for the 1-mile run, with boots, to assist in identifying the cadets as they finish.

g. Teams will execute breakfast immediately after the Army Physical Fitness Test. It is imperative that team commanders and team coaches stress that breakfast is not a social gathering. Get it, eat it, and move out!

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h. The 10K road-march is executed immediately following breakfast. The 10k will commence with each team starting at two minute intervals.

i. All other events will be conducted on the vicinity of Fort Leonard Wood. Maps will be issued to coaches and Team Commanders with locations of each event.

j. When teams cross the 10K finish line all teams will report to proceed to next event on their list for day IAW with the order provided. Teams can move to any event if there is an opening, and should try to avoid waiting for extended periods at event sites.

k. In the event of a tie for any event or an overall award, the tiebreaker event will be the 10K Road-March time. If an additional tie-breaker is necessary, the team APFT average will be used.

l. Please do not waste time between events or during the day. Please move from event to event as expeditiously as possible.

m. All events will be graded by active duty Drill Sergeants, NCOs, or Lieutenants. All teams will be provided a team escort, who will be a 2LT from the Engineer Basic Officer Leader Course (E-BOLC).

n. Teams are reminded that Cadets will be in and around Soldiers in IET, and prohibited from contact with these Soldiers. Coaches/Advisors are expected to keep teams together and under direct control throughout the events, but especially when in the Barracks and DFAC areas.

4. TIMELINE.

a. FRIDAY, 21 October 2016. Timeline for teams that arrive on 21 October 2016. These times are all tentative. Timeline is dependent upon the supporting unit. When you arrive, report to Building TBD On Iowa Ave. (See Map)

Arrival/In Process 1530 - UTC Dinner 1730 - UTC (on your own)Lights Out 2200

b. SATURDAY, 22 October 2016.Late Registration 0500Team Commander Meeting 0530APFT 0545Breakfast Immediately following APFT (DFAC)10K Road March Immediately following BreakfastAll other events As designated at the Commanders MeetingUltimate Raider Buddy Run 1500 (Target Time)Awards Ceremony 1600 (Target Time)

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5. ELIGIBILITY. To be eligible to enter the competition, cadets must be:

a. Full time high school students

b. Enrolled in JROTC, any service, at the time of the competition.

c. Permission and liability forms complete and signed.

6. SAFETY.

a. Safety is our paramount concern. Team commanders and advisers should ensure that safe practices and safe physical standards are incorporated throughout the competition. Simple preventive measures such as hydration and foot care should continually be emphasized. Coaches are responsible for the training and fitness level of their team. This will be a grueling event that requires a great degree of training.

b. Report any accidents, incidents or unsafe conditions to the Team Guide or an evaluator at any event station.

c. A Statement of Physical Condition (Annex L), and a Covenant Not to Sue (Annex K) are mandatory for every participating cadet. Coaches/Team advisers MUST turn in all release forms, properly completed, prior to the start of the competition. The Waynesville School District or Fort Leonard Wood will not be responsible for accidents or injuries.

d. Medical support will be available on-site, at each venue.

7. TEAM COMPOSITION AND ALTERNATES.

a. Each team must consist of 8 competing members. One alternate is allowed per team. Teams may consist of a mix of genders.

b. The one alternate can be utilized as a “pinch hitter” prior to the start of any event. An alternate may be utilized for any event as many times as the team desires so long as the 8 team members that start an event complete the event. No substitutions are allowed after an event begins. Alternate substitution must be declared verbally to the Team Guide or evaluator prior to the start of the event in which a substitution occurs.

c. In the case where a team does not complete an event with ALL 8 team members that started the event the team will forfeit that event. The event time and scores will not be computed for the overall team scores. It is the Team Commander’s responsibility to declare forfeiture for his or her team.

d. Any team found to have substituted an alternate AFTER an event begins or does not declare forfeiture when it applies will be disqualified entirely from the competition.

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8. UNIFORMS.

a. Instructor/Cadre uniform is ACU with patrol cap. For services other than the Army the prescribed duty utility uniform shall be worn.

b. Evaluator uniform is ACU with patrol cap or campaign hat. For services other than Army Services and Foreign officers wear appropriate duty utility uniform.

c. Cadet uniform:

(1) The uniform for the APFT is ACU trousers, t-shirt and boots.

(2) For all other events the uniform is complete ACU with patrol cap, canteen or a personal hydration system. Team T-shirts are authorized in lieu of the Tan ACU T-shirt, as long as the entire team is in the same shirt.

(3) Teams must carry one rucksack with all bridge building equipment through the entire course except if told otherwise by event graders. If the team prefers, each team member may carry their own seat building rope and snap links or equipment can be distributed amongst team members so long as all equipment is carried.

(4) Non-competing cadets are required to wear appropriate attire and can watch from a fair distance as long as non-competing cadets don’t get mixed up with the competing team. This applies to alternates as well. Alternates cannot negotiate a course event with the team, but they can watch.

9. AWARDS.

a. Overall Team Trophy: 1st, 2nd, 3rdPlace Trophies b. Army Physical Fitness Team Trophy: 1st, 2nd, 3rd Place Trophies c. 10K Road March Trophy: 1st, 2nd, 3rd Place Trophies d. One-Rope Bridge Trophy: 1st, 2nd, 3rd Place Trophies e. PECS Course: 1st, 2nd, 3rd Place Trophies f. Monkey Fist: 1st, 2nd, 3rd Place Trophies g. Raider Gauntlet: 1st, 2nd, 3rd Place Trophies h. Highest 3 male APFT Scores: 1st, 2nd, 3rd Place Medals i. Highest 3 female APFT Scores: 1st, 2nd, 3rd Place Medals j. Ultimate Raider buddy team event 1st Place Medals (for both)

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10. ENTRY FEES.

a. A fee of $125.00 per 9 cadet team is required. Payment may be made with pre-registration submission or during registration on arrival. Payment in person on arrival is the preferred method.

b. Checks must be made payable to Waynesville School District.

c. This basic entry fee includes the breakfast and lunch for the cadets, facility usage and awards.

11. BILLETING AND MEALS.

a. Cadet’s, chaperones and coaches billeting will be available on Friday night 21 October 2016, at the 35th Engineer Battalion Barracks, Building (TBD), Iowa Ave, Fort Leonard Wood. (See attached map)

b. Instructors and Chaperones will ensure that all cadets dress and act appropriately in the designated sleeping areas. Remember, we will be billeted in the same complex as IET Soldiers, wherein contact by JROTC is prohibited. At least one Instructor/Chaperone must stay with the Cadets in the barracks.

c. Cadets/Schools must provide their own sleeping bags and cots if you use them.

d. Male and Female showers are available in the barracks Friday night and Saturday morning, and at Cunningham Gym after the event.

e. Friday evening meals are on your own. There are numerous eating establishments right off post. The food court at the Post Exchange is open until 1900. The breakfast meal will be served in the 1st Engr. BDE Dining Facility (DFAC) Dining facility. There will be a nominal fee of ($2.60 Breakfast/$3.65 for dinner) per person for Instructors and chaperones; competeting cadets breakfast costs are covered by the entry fees..

f. Lunch for competing cadets and coaches on Saturday is MRE/Box Lunch and is provided by Fort Leonard Wood (included in the entry fee). They will be issued to the team prior to the competition. No lunch is provided for chaperones and spectators. Lunch will be consumed as allowed and at the discretion of team commanders during the competition. Lunch should not slow or hinder the progress of the meet.

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12. CADET LIABILITY.

a. SAIs/AIs must ensure that each cadet participating in the Fort Leonard Wood Raider Competition understands the requirements for medical coverage.

b. Raider competitions are a physically and mentally challenging event. Instructors should ensure that their cadets are physically capable of competing in this event.

c. Medical Support will be available on-site, at all venues.

13. Please direct any questions, issues or comments to 1SG(R) Meghan Fadl (mfadl@waynesville.k12.mo.us) 573-842-2500 Ext. 3919 / 573-528-2599, COL(R) Charles Williams (cwilliams@waynesville.k12.mo.us) Ext. 3921 / 573-433-9378, or SGM(R) Bill Lindsey (blindsey@waynesville.k12.mo.us) Ext. 3920 / 573-855-7343.

\\\\\\\\\ORIGINAL SIGNED\\\\\\\\\\CHARLES A. WILLIAMSColonel, United States Army (Retired)Senior Army Instructor

Enclosures

a. Army Physical Fitness Test (Annex A)b. 10K Road March (Annex B)c. One-Rope Bridge (Annex C)d. PECS Course (Annex D)e. Monkey Fist (Annex E)f. Gauntlet (Annex F)g. Ultimate Raider (Annex G)h. Pre-registration Form (Annex H)i. Registration Form (Annex I)j. Covenant Not to Sue (Annex J)k. Statement of Physical Condition (Annex K)l. Maps (TBD)

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ANNEX AMODIFIED ARMY PHYSICAL FITNESS TEST

TASK: Each team member will be evaluated physically by taking the Modified Army Physical Fitness Test (APFT). Teams will draw numbers for the order of the APFT.

CONDITIONS:

1. Scored Task:

a. 2 Minutes of Push-Ups

b. 2 Minutes of Sit-Ups

c. 1-Mile Run in combat boots

2. Uniform:

I. ACU bottoms, T-Shirt, combat boots.

STANDARDS:

1. The standards and instructions in FM 21-20 will be adhered to.

2. The event supervisor is the timer. For Push-Ups and Sit-Ups, the supervisor will call out the time remaining every 30 seconds and every second for the last 10 seconds of the four total minutes. Two minutes of push-ups will be executed first, then two minutes of sit-ups immediately following. Once Push-Ups are completed, the team will move to the Sit-Up station and commence Sit-Ups. There will be no break between events. NOTE: Remember push-up and sit-up will be done back to back for a total of 4 minutes. Totals will be recorded on the scorecard just as if the standard separation of the 2 events were used.

3. SAI’s/AI’s may assist scorers in identifying team members during the APFT 1 mile run. 1 Mile time will me multiplied by 2 for scoring.

4. Scoring will be used on the 17-21 year old age group. Extended Scale will be used for individual scores only. The standard scale will be used to determine team averages.

5. It is the team advisor’s responsibility to ensure that all team members are familiar with and understand the standards for this event. Abbreviated instructions will be given at the event. If a non-Army team needs a copy of the standards and instructions contained within FM 21-20 then email us for a copy.

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ANNEX B

10 KILOMETER ROAD MARCH

TASK: Each team must complete the 10K Road March with all team members. APFT Order will be the same for the 10k, at 2 minute intervals.

CONDITIONS:

1. Uniform:

a. ACU/BDU Uniform (Blouse, Bottoms, Boots)

b. Pistol Belt and Canteen completely full of water. Hydration systems are authorized for use as long as the entire team uses the same equipment. Either all are using canteens or hydration systems.

2. Equipment: One rucksack containing the team’s rope bridge equipment (Team provided)

STANDARDS:

1. The 10k route will be in Training Area (TA) 148 and will be an 11.4 KM cross country loop over very rough terrain.

2. Time will stop when the last team member crosses the finish line.

3. If any team member is unable to finish, the team will be disqualified from that event only.

4. Team will supply and carry one rucksack. The rucksack must include all the team’s rope bridging equipment. Team members have the option of carrying their individual Swiss/Aussie seats and distributing the contents of the rucksack amongst team members.

NOTE: SAIs/AIs/Chaperones and non-competing cadets are NOT allowed to go with their teams but may be on the course for safety. It is recommended that one member of the team carries a cellular phone in case of an emergency.

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ANNEX C

ONE-ROPE BRIDGE

b. ROPE BRIDGE1) General Scenario:a. Rope bridges will be constructed in accordance with the spirit and intent of a real rope bridgesituation. The basic premise must be that it be done as seriously and accurately as if a gorge or a river were actually being crossed. b. 8-members of the team must compete and complete the bridge construction and crossing.c. The uniform for this event: ACU pants and Jacket, t-shirt & boots. d. All teams will provide ALL of their own rope bridge equipment. Teams may use any kind of rope they choose – rope MUST BE 150 feet minimum! (NOTE: YOU MUST HAVE YOUR OWN150’ ROPES or make arrangements to borrow a rope from another team).2) Specific Details:a. No loops, bights and or pre-tied knots will be allowed on the rope. Swiss seats will be pre-tied in order to save time. Swiss seats will not be graded, only inspected for safety (prior to the start of the event time).b. Swiss seats and waist seats will be tied prior to reporting to the rope bridge site. Allparticipants will wear a rappel seat (Swiss seat). The first and last team members can wearsling ropes properly tied around the waist (minimum two wraps around the waist securedwith square knot and tied off with an overhand knot on each side of the square knot (Aussie seat).c. Upon arrival at the Start Point, the team will have their rope “back coiled” inside a ruck sack. Only the end of the rope may be outside the bag at the start line. There cannot be any knots of any kind pre-tied in the rope prior to the start of the event. This will cause the team to be disqualified if the team is found to have pre-tied knots. On the command “GO” the clock will start and the team will run to the near side anchor point, and immediately build a 1-rope bridge. Team will then cross the river as outlined. Time will continue to run until:

(1) the entire team and all equipment is out of the water, across the river and on the far bank (to include the rope!)(2) all knots are out of the rope(3) the team has announced, “TIME!”

d. The team with fastest time to include any penalty points added will be the winner.e. The only knots allowed on the near side anchor point will be the following: - Wireman’s Knot, Figure 8 Slip Knot OR Butterflyf. The only knots allowed on the far side anchor point will be the following: - Round Turn with TWO Half Hitches - Tension Anchor (A minimum of FOUR wraps on anchor)g. Quick release for the second half hitch is recommended on both sides.h. End of the line bowline or any figure 8 is used to attach the rope to the first person to cross the gorge and must be attached to the seat or waist rope with a snap link or bowline and/or figure 8 over the shoulder.i. A rope bridge that fails will not be counted or scored and will disqualify that team from thatsegment of the event. Judges will notify the team immediately to end their effort and avoid injury.

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j. There is no limit on the number of snap links used in the transport knot.k. Only 3 cadets can be clipped into the rope bridge at one time.l. All team members that cross the rope bridge must be hooked onto the rope and pullthemselves across the obstacle. m. All team members that cross the rope bridge must be hooked onto the rope withcarabineer and pull themselves across the obstacle using a rappel seat method. Progress ismade rotating under the rope and pulling with the hands and arms. There will not be a penaltyif feet fall below the rope while crossing).

Penalties:

1. A thirty (30) second penalty will be assessed for every piece of equipment that touches on or between the boundary lines.

2. A thirty (30) second penalty will be assessed for every knot improperly tied.

3. A thirty (30) second penalty will be assessed for any team members that touch on or between the boundary lines, for each instance.

4. A (60) second penalty will be assessed when 4 or more raiders are clipped into the rope bridge for each instance

* Spectators may not be allowed in the area of the Bridge Site, due to FLW safety rules and considerations.

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ANNEX D

PECs (Physical Endurance Course)

TASK: Teams must negotiate obstacles and stations that will test their endurance, knowledge, accuracy, and physical fitness. Teams will do a walk thru on the terrain walk prior to beginning the event.

CONDITIONS:

1. Uniform: ACU Uniform/team t-shirts.

2. Teams will be grouped with 2 to 3 other teams and will be walked through the course by cadre. The course and expectations for teams running through will be explained during the walk-through. Teams will then negotiate the course at staggered intervals. The fastest time will win.

PENALTIES:

- Failure to properly negotiate an obstacle (3 minute penalty) explained during walkthrough

- Basically, if a cadet cannot negotiate an obstacle they must make 3 attempts and then bypass the obstacle at which time they will be given a 3-minute penalty per instance.

- All 8 members do not complete the course (disqualification)

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ANNEX E

Monkey Fist (Liter Carry – Pull-Ups)

TASK: Cadets will run around a track (400m) with a litter (120lbs) and two rucks per 4 cadet team (35lbs) then execute 80 total pull-ups. This event will run like a relay.

- Four cadets take off from the starting point, with the liter and ruck sacks, and run around the track to the finish line. They will then pass the litter and rucks to the next four cadets who will repeat the process. Cadets must keep the ruck on their back while running with the litter. The entire team will then move to the pull up bars and perform 80 pull ups as a team. So long as between the 8 person team, 80 pull-ups are completed, it does not matter how many each individual cadet does.

- When the 8 person team has completed the course both the laps and pull ups the time will stop. The fastest time with penalties tabulated will win.

CONDITIONS:

1. Uniform:

a. ACU Uniform

b. Pistol Belt and Canteen or Personal Hydration System

c. Given 8 x 35 pound ruck sacks and 2 x 120 pound litters.

STANDARDS:

1. The team that accomplishes the given task in the shortest amount of time after penalties are assessed will be declared the winner of the event.

2. Forgetting the litter, forgetting a ruck, or running outside of the set course will result in a DQ for this event. Teams may lay the litter down and change rucks without penalty.

3. Failure to complete 80 pull-ups by the team will result in a 5 second penalty for each pull-up below the standard (80).

More instructions and details of this event will be given upon arrival at the station.

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ANNEX FTHE GAUNTLET

TASK: All eight team members will move over rough terrain, up and down hills carrying 4 x 35lb rucksacks and then return to the start line.

CONDITIONS: Competition Uniform, and 4 x rucksacks (35lbs each)

STANDARDS:

1. Teams will complete the course as quickly as possible.

2. From the starting point 4 cadets will carry 3 rucksacks weighing 35lbs each plus their bridge ruck.

3. Teams will be scored by using the overall completion time.

4. Any team failing to negotiate the Gauntlet with all equipment will be DQed from the event

5. The course will be approximately 1 mile out and 1 mile back, cross country over rough terrain. Additionally, course monitors will be positioned along the route to ensure all teams are heading in the correct direction and following the rules.

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ANNEX G

ULTIMATE RAIDER BUDDY RUN

General Scenario:

a. Each competing school may nominate TWO individuals (any combination preferably your team’s top two Raiders) to compete in the Ultimate Raider event. These cadets must be maintained on your competing cadet roster to be eligible for inclusion within the Ultimate Raider Buddy Run. This is not part of the team scoring.

b. This competition will be strictly a 2-person event among the most elite individual cadets attending the competition. The scores are not included into team awards. The fastest time will be awarded individual medals. Only first place will be recognized.

c. The course will be roughly 1.5 miles in length, 3/4 mile out and 3/4mile back, cross country, and over rough terrain.

Specific Details:

a. The Gauntlet Course will be used from the Ultimate Raider event

b. ALL COMPETITORS ARE REQUIRED TO WEAR BOOTS.

c. Spectators are allowed on virtually all aspects of the course; however the course will be designed to allow maximum spectator viewing of both the starting and finishing portions of the race. This will allow all attendees to cheer on their finest cadets as they start and end the race.

d. Buddy teams must stay together and finish together any team that does not stay together will be DQed.

Penalties:

- Failure to follow the course laid out will be cause for a subjective time penalty or disqualification depending on the infraction.

- Failure to stay together will result in DQ at the discretion of the evaluator

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Annex H– Pre-registration Form

DEPARTMENT OF THE ARMY

JROTC DEPARTMENTWaynesville Career Center

400 GW LaneWaynesville, Missouri 65583

8 July 2016

MEMORANDUM FOR: JROTC SAI’s, Instructors, and Raider Team Advisers

SUBJECT: Pre-Registration form, 2nd Annual Fort Leonard Wood Extreme Raider Challenge

SUSPENSE: Please return AS SOON AS POSSIBLE!Please complete this form and return by email to mfadl@waynesville.k12.mo.us. Email is the preferred method but in the event that you need to fax, please fax to: ATTN: JROTC (573) 842-2501.

NAME OF SCHOOLNumber of Teams you would like to competeRaider Adviser/Coach Name and Rank

Phone E-Mail

NAME OF SAI

Phone E-Mail

How many meals do you foresee as a requirement? Cadets, Cadre,

Chaperones

Cadets Cadre Chaperones

Will your team arrive on Friday,

21 Oct and stay overnight?Any other requirements or special requests?

Name and Rank of Person Completing this Form

ANNEX I – REGISTRATION FORM – One form must be completed for each team.

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Waynesville JROTC2nd Annual Fort Leonard Wood Extreme Raider Challenge

21 – 22 October 2016

SCHOOL: ______________________________________

TEAM NAME: __________________________________

ADDRESS: _____________________________________

_____________________________________

PHONE: _______________ FAX: _____________

E-MAIL: __________________________________

INSTRUCTOR: ___________________________________

CELL PHONE NUMBER _____________________________

TEAM MEMBERS

NAME (LAST, FIRST MI) AGE GENDER1.

2.

3.

4.

5.

6.

7.

8.

9.

Please submit NLT 1 October 2016. Make checks payable to Waynesville School District. Email to registration form to mfadl@waynesville.k12.mo.us , or fax (573) 842-2501, or mail to: WCC JROTC, 400 GW Lane, Waynesville, Missouri 65583. Fees can be paid at time of registration.Annex J – Covenant Not to Sue

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COVENANT NOT TO SUEOFF CAMPUS TRAINING AND PRACTICAL

FIELD/HIGH RISK TRAININGDATA REQUEST FOR ACT OF 1974

1.Authority: Title U.S. code 3201. 2. PRINCIPAL PURPOSE (S): To release the U.S. Government, the host institution and the state in which said institution is located from liability and injury, death, or damages for JROTC cadets participating in voluntary off-campus training programs, practical field and high risk training. 3. ROUTINE USES: normal personnel actions. Disclosures of information may be provided to proper authorities in actions regarding law enforcement, legal actions as a result of injury or death, and investigations of accidents resulting from such voluntary off-campus training, practical field, and high risk training. 4. MANDATORY OR VOLUNTARY DISCLOSURE AND EFFECT ON INDIVIDUAL NOT PROVIDING INFORMATION: Voluntary. Failure to complete form will disqualify JROTC cadet from participating in specific voluntary training exercises.

I,__________________________________, residing at_____________________________ (Type or Print full name)(Address)

_____________________________________,____________________________________ (City) (State)do hereby agree that in consideration for being allowed to participate in the 2nd Annual Fort Leonard Wood Extreme Raider conducted by Waynesville JROTC Instructors and cadre and members of the US Army, Fort Leonard Wood on 21-22 October 2016, an Army supervised activity, and whereas I am doing so entirely on my own initiative, risk and responsibility; and being fully aware of the risks adhering to this type of training, I do hereby RELEASE AND DISCHARGE FOREVER, the United States Army, the State of Missouri and Waynesville School District and all of its officers, agents, and employees, acting officially or otherwise, from any and all claims, demands, actions or causes of action, on account of myself or on account of any injury to me which may occur from any cause during said activity or continuances thereof, and I do Further covenant and agree to hold the said Government of the United States, State of Missouri and the Waynesville School District blameless for any and all damages I may cause either intentionally or through my negligence.

__________________________________________________________________________Typed/Printed Name of Parent or Guardian if Signature of Parent or Guardian if cadet Participant is a Minor Participant is a Minor

___________________________________________________________________________ Relationship to Cadet Date

WITNESSED BY:

___________________________________________________________________________ Age/Period Covered

________________________________________ Signature of Cadet

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Annex K– Statement of Physical Condition

2nd Annual Fort Leonard Wood Extreme Raider Challenge Fort Leonard Wood, Missouri

21 – 22 October 2016

STATEMENT OF PHYSICAL CONDITION

Cadet’s Name: School: Team:

To the best of my knowledge, my son/daughter/ward is in good physical condition. Participation in the : 2nd Annual Fort Leonard Wood Extreme Raider Challenge,in my opinion, will not have an adverse effect on his/her health and well being. I will inform his/her JROTC Instructor of any changes.OR My son/daughter/ward has a history of: (please list or if none, so state)_____________________________________________________________________

Heart problems, Asthma, Overweight, Sinus, Rheumatic Fever, Ear Infections, Headaches, Stomach Problems,_____________________________________________________________________

or other ailments, and is on _______________________________________________________________ medication.

He/she is allergic to _______________________________________________ medication.

NOTE: Students that are found to have previous history of any type of illness, past injury, and/or symptoms of suspected medical ailment, will be returned home if treatment is needed or desired.

______________________________ ______________________________(Signature of Parent/Guardian) (Signature of Senior Army Instructor)

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ANNEX L (Tentative)

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