Dear High School TEENPOWER Participant:

Congratulations! You will be spending one week of your summer at a fantastic leadership conference that’s been called

“The Happiest Place On Earth!” This year we will celebrate the 27th year of Youth Resources’ High School TEENPOWER

and the 17th year of Middle School TEENPOWER! TEENPOWER 2018 will be packed with great workshops, speakers

and tons of fun!

This year’s High School TEENPOWER is Olympics themed, and we’ll explore what ‘One world, one dream… join the

TEENPOWER team!’ means to you at this one-of-a-kind leadership conference! TEENPOWER is just weeks away, and

we need your help filling out your health form that we must have on file.

If you find any errors in your paperwork or on the mailing label, please let me know so we can correct it. Enclosed you

will find a health and history liability/photo release form printed front to back – be sure to complete both sides.

PLEASE promptly complete these forms and return them directly to Youth Resources. Late returns may affect your

eligibility to attend TEENPOWER. All forms should be submitted to Youth Resources by Thursday, May 24.

Please remember to keep the “Things to Bring List” and note that linens WILL NOT be provided in any form. Be sure to

bring sheets, towels, washcloths, blanket, and a pillow.

Check-in will take place in the center of Morton and Brentano Residence Halls, which are connected and located off

Walnut Street. Check-in will take place on Sunday, June 3 from 12-1:30 p.m. You may arrive at any point during this time

frame. Please do not arrive before NOON as staff members will be finalizing TEENPOWER details. You will need to

eat lunch before you arrive. The first meal served will be dinner on Sunday and the last will be breakfast on Thursday.

TEENPOWER will conclude at 11:00 a.m. on Thursday, June 7.

Please note that it is Youth Resources’ policy that “No participant may leave the campus for any reason during

TEENPOWER except for family emergency as approved by the TEENPOWER Coordinator.” There are no exceptions to

this policy. Please contact me as soon as possible if you think your participation at TEENPOWER will conflict

with this policy.

If you will no longer be able to attend TEENPOWER, please notify us as soon as possible so we can accommodate

someone on the waiting list. If you have any questions, please call Youth Resources at 812-421-0030 or email me at the

address below.

See you soon,

Bailey Daniels

TEENPOWER Coordinator

YR Alumna ‘14

bailey@youth-resources.org

812-421-0030 ext. 15

Return your health & liability forms by May 24:

MAIL:

Youth Resources-TEENPOWER

PO Box 3635

Evansville, IN 47735-3635

HAND DELIVER:

Our office is located in the lower level of the First

Federal Savings Bank located at 4451 N First Ave.,

Evansville, IN 47710.

SCAN & EMAIL: bailey@youth-resources.org

FAX: 812-422-9143

TEENPOWER Things to Bring List

Each participant will be responsible for safeguarding his or her personal belongings during the TEENPOWER conference. The dorm rooms at the University of Evansville do lock, and rooms should be kept locked at all times.

You will be responsible for your own room key and building entry swipe card. There is a $25 charge for lost keys AND a $25 charge for lost swipe cards (as much as $50 total). Listed below are the items you need to

bring to TEENPOWER. Youth Resources cannot be responsible for personal items brought to TEENPOWER.

Toiletries Casual Clothing Bedding Personal Money DO NOT BRING

Soap Shorts Sheets Snacks Optional (vending machines)

TV

Shampoo T-shirts Sleeping bag/blankets

Games Blue-Ray/DVD players

Deodorant Jeans Pillow Water bottle Video games/consoles

Toothbrush Athletic shoes Towel Alarm clock/cell phone

Laptops

Toothpaste Set of clothes that can get messy

Washcloth Kleenex Energy drinks

Pajamas Bug spray Belly shirts Jacket/Sweater Umbrella Short shorts

Strapless shirts or spaghetti straps

Please note that electronic devices will not be allowed at TEENPOWER and will be confiscated until the end of the

week unless special permission for use is granted by the TEENPOWER Coordinator. Cell phones are allowed but are only to be used before lights out. Any phones seen out during events, workshops, speakers, family groups or being

utilized after lights out will be confiscated until check-out on Thursday.

TEENPOWER HEALTH HISTORY FOR TEENPOWER PARTICIPANT, TO BE COMPLETED BY PARENT OR GUARDIAN

STUDENT NAME _________________________________________ BIRTH DATE ________________ AGE ______ GENDER: MALE FEMALE

HOME ADDRESS _______________________________________________________________________________________________________ STREET & NUMBER CITY STATE ZIP

HOME PHONE ______________________________________ GRADE (FALL 2018) _________ SCHOOL _______________________________

MOTHER’S NAME _________________________________________________ CELL PHONE _________________________________________ MOTHER’S WORKPLACE__________________________________________WORK PHONE__________________________________________ FATHER’S NAME _________________________________________________ CELL PHONE _________________________________________ FATHER’S WORKPLACE__________________________________________WORK PHONE__________________________________________ PARENT’S EMAIL ADDRESS _____________________________________________________________________________________________ PARENTS WHO LIVE SEPARATELY CAN USE THIS LINE TO PROVIDE THE INFORMATION FOR (CIRCLE): MOTHER FATHER HOME ADDRESS _______________________________________________________________________________________________________ STREET & NUMBER CITY STATE ZIP

IN CASE OF AN EMERGENCY, NOTIFY (SOMEONE OTHER THAN PARENT) _____________________________________________________

HOME PHONE ____________________________ CELL PHONE ___________________________ RELATIONSHIP _______________________

OPERATIONS OR SERIOUS INJURIES (DATES) _____________________________________________________________________________

DISABILITY OR CHRONIC OR RECURRING ILLNESS _________________________________________________________________________

ACTIVITIES ENCOURAGED OR LIMITED BY PHYSICIAN ______________________________________________________________________

DIETARY MODIFICATIONS/KNOWN ALLERGIES ____________________________________________________________________________

CURRENT MEDICATIONS ________________________________________________________________________________________________

NAME OF DENTIST/ORTHODONTIST ______________________________________________________ PHONE _________________________

NAME OF FAMILY PHYSICIAN ___________________________________________________________ PHONE _________________________

DATE OF PHYSICAL EXAMINATION _______________________________________________________________________________________

DO YOU CARRY FAMILY MEDICAL/HOSPITAL INSURANCE? ______ YES ______ NO

IF SO, INDICATE: CARRIER _______________________________________________ POLICY OR GROUP NUMBER _____________________

ANY ADDITIONAL HEALTH RELATED INFORMATION ________________________________________________________________________ ______________________________________________________________________________________________________________________

THIS HEALTH HISTORY IS CURRENT SO FAR AS I KNOW, AND THE PERSON HEREIN DESCRIBED HAS PERMISSION TO ENGAGE IN ALL PRESCRIBED TEENPOWER ACTIVITIES EXCEPT AS NOTED. AUTHORIZATION FOR TREATMENT: I HEREBY GIVE PERMISSION TO THE MEDICAL PERSONNEL SELECTED BY THE PROGRAM COORDINATOR TO ORDER X-RAYS, ROUTINE TESTS, TREATMENT, AND NECESSARY TRANSPORTATION FOR MY SON OR DAUGHTER. IN THE EVENT I CANNOT BE REACHED IN AN EMERGENCY, I HEREBY GIVE PERMISSION TO THE PHYSICIAN SELECTED BY THE PROGRAM COORDINATOR TO SECURE AND ADMINISTER TREATMENT, INCLUDING HOSPITALIZATION, FOR MY SON OR DAUGHTER NAMED ABOVE. EMERGENCY AUTHORIZATION VALID FROM JUNE 3, 2018-JUNE 7, 2018.

SIGNATURE OF PARENT OR GUARDIAN ___________________________________________________________________________________

I ALSO UNDERSTAND AND AGREE TO ABIDE WITH ANY RESTRICTIONS PLACED ON MY TEENPOWER ACTIVITES.

SIGNATURE OF PARTICIPANT____________________________________________________________________________________________

HIGH SCHOOL TEENPOWER LIABILITY & PHOTO RELEASE

I understand that Youth Resources of Southwestern Indiana and the University of Evansville cannot assume any liability for people attending this event. I waive, release and discharge Youth Resources of Southwestern Indiana, Inc. and the University of Evansville from any and all claims of liability from my participation in this event. I also give permission for my picture to be used in any Youth Resources promotion and for my child to participate in TEENPOWER evaluations for the continuous improvement of the program. ATTENDEE SIGNATURE __________________________________________ DATE ___________ PARENT/GUARDIAN SIGNATURE __________________________________ DATE ___________

Return your health & liability forms by May 24:

MAIL: Youth Resources - TEENPOWER

P.O. Box 3635 Evansville, IN 47735-3635

HAND DELIVER:

Our office is located in the lower level of the First Federal Savings Bank building located at 4451 N First Ave., Evansville, IN 47710.

The office is open Monday through Thursday, 8am-5pm.

Please call ahead (812-421-0030) on Fridays.

SCAN & EMAIL: bailey@youth-resources.org FAX: 812-422-9143

PERMISSION TO DISPENSE MEDICATION WAIVER Prescription medication must be held and administered by Youth Resources while your child is at TEENPOWER.

All non-emergency prescription medications must be turned in to Youth Resources at TEENPOWER check-in. Emergency prescription medication may remain on the student.

Please fill out the form below for BOTH emergency and non-emergency prescription medication.

STUDENT INFORMATION

First: _____________________________ Middle: _____________________________ Last: _____________________________ Date of Birth (mm/dd/yyyy): ____________________ Age: _________

MEDICATION

Medication name: ______________________________ Dosage (how much):_____________ Refrigeration required: Y N

Note/instructions:_____________________________________________________________________________________________________

__________________________________________________________________________________________________________________________

__________________________________________________________________________________________________________________________

Medication name: ______________________________ Dosage (how much):_____________ Refrigeration required: Y N

Note/instructions:_____________________________________________________________________________________________________

__________________________________________________________________________________________________________________________

__________________________________________________________________________________________________________________________

Medication name: ______________________________ Dosage (how much):_____________ Refrigeration required: Y N

Note/instructions:_____________________________________________________________________________________________________

__________________________________________________________________________________________________________________________

__________________________________________________________________________________________________________________________

Medication name: ______________________________ Dosage (how much):_____________ Refrigeration required: Y N

Note/instructions:_____________________________________________________________________________________________________

__________________________________________________________________________________________________________________________

__________________________________________________________________________________________________________________________

NOTES Prescription medication must be held and administered by Youth Resources while your child is at TEENPOWER, and the following procedures must be followed:

Prescription medications must be brought to TEENPOWER in the original pharmacy bottle. The label on the pharmacy bottle meets the requirements for the physician’s signature. Prescription medication requires written permission (above) from the parent/guardian stating the amount of medication, the hours for administration, and the period of time that the medication is to be continued.

Medications must be picked up at TEENPOWER check-out. Any medications left behind will be destroyed.

PRESCRIPTION MEDICATION ADMISTRATION AUTHORIZATION I herewith acknowledge that I am primarily responsible for administering medication to my child. However, in my absence, I hereby authorize Youth Resources of Southwestern Indiana and its TEENPOWER Adult Staff employees to administer to my child the medications listed on page 1. I further acknowledge and agree that when the above medication is administered, I waive any claims I might have against Youth Resources of Southwestern Indiana and its staff arising out of the administration of said medication. In addition, I agree to hold harmless and indemnify Youth Resources of Southwestern Indiana and its staff, either jointly or severally, from and against any and all claims, damages, causes of action or injuries incurred or resulting from the administration of said medication. Printed name: ______________________________________________________________

Signature: ______________________________________________________________ Date: ___________________

Cell phone: ________________________________ Work phone: ________________________________

SELF-CARRY AND SELF-ADMINISTER AUTHORIZATION FOR EMERGENCY MEDICATION ONLY Parent signature required ONLY for students who must carry EMERGENCY medication I acknowledge that my student can carry and self-administer EMERGENCY medication such as a rescue inhaler or insulin, and I have listed details of said emergency medication on page 1. I further acknowledge that my student has been instructed on how to self-administer the medication and is capable of doing so, and that the nature of the student's disease or condition may require emergency administration of this medication. I waive any claims I might have against Youth Resources of Southwestern Indiana and its staff arising out of the self-administration of said medication. In addition, I agree to hold harmless and indemnify Youth Resources of Southwestern Indiana and its staff, either jointly or severally, from and against any and all claims, damages, causes of action or injuries incurred or resulting from the self-administration of said medication. Printed name: ______________________________________________________________

Signature: ______________________________________________________________ Date: ___________________

Cell phone: ________________________________ Work phone: ________________________________

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Rev. 7/17

CAMPUS MAP

Located inRidgway University Center (27):

Campus Dining FacilitiesEykamp Hall

Student Life OfficesStudent PublicationsUniversity BookstoreWUEV Radio Station

Melvin Peterson Gallery ........................................................ 42Moore Residence Hall ............................................................ 11Morton Residence Hall .......................................................... 19 Neu Chapel ............................................................................ 20

Wesley Gallery .............................................................. 20aOlmsted Administration Hall ................................................. 36Panhellenic Center ................................................................ 62 Peters-Margedant House ...................................................... 43Phi Gamma Delta (FIJI) Fraternity ........................................ 59Phi Kappa Tau Fraternity ....................................................... 58Mary Kuehn Powell Residence Hall ....................................... 44Ramona Apartments ............................................................. 60Ridgway University Center ................................................... 27 Sampson Hall (Crayton E. and Ellen Mann Health Center) ..... 23Schroeder Family School of Business

Administration Building ............................................... 24 McCurdy Wing ............................................................... 24a

Schroeder Residence Hall ..................................................... 12Shanklin Theatre ................................................................... 25 Sigma Alpha Epsilon Fraternity ............................................. 7 Sigma Phi Epsilon Fraternity ................................................. 51Student Fitness Center ......................................................... 16Tau Kappa Epsilon Fraternity ................................................ 54Tennis Courts ........................................................................ 33University Apartments .......................................................... 57Vize House ............................................................................. 6Walnut Commons .................................................................. 3216 S. Weinbach Apartments ................................................ 50Wheeler Concert Hall ............................................................. 10Employee and Student Parking ............................................. A-QVisitor Parking ....................................................................... VMotorcycle Parking ............................................................... H

Administrative Services/Safety and Security ....................... 32Advancement Services .......................................................... 55Art Annex ............................................................................... 39Art Studio .............................................................................. 40Auxiliary Support Facility ...................................................... 2 Black Beauty Field (Soccer) .................................................. 29Bower-Suhrheinrich Library .................................................. 35Center for Adult Education.................................................... 5Charles H. Braun Stadium (Baseball) .................................. 14Brentano Residence Hall ....................................................... 18Carson Center ....................................................................... 28Central Plant ......................................................................... 26 Clifford Memorial Library ...................................................... 37 James N. and Dorothy M. Cooper Stadium (Softball) ........... 13Delta Omega Zeta Sorority .................................................... 53Diversity Resource Center ...................................................... 52Engineering Annex ................................................................. 41Facilities Department/Physical Plant ................................... 31Fehn House ............................................................................ 4 Fifth Third Bank Basketball Practice Facility ....................... 17Frederick Commons ............................................................... 49 Graves Hall ............................................................................ 34 Hale Residence Hall .............................................................. 45Hazeart Apartments .............................................................. 56 Hughes Residence Hall.......................................................... 46Hyde Hall ............................................................................... 22 John L. and Belle Igleheart Building ..................................... 8Intramural Field ..................................................................... 1 Intramural/Practice Field...................................................... 30 Jones Hall (North Hall)........................................................... 47Koch Center for Engineering and Science ................................. 38Krannert Hall of Fine Arts ..................................................... 9Lambda Chi Alpha Fraternity ................................................ 48Lincoln Park Apartments ....................................................... 61May Studio Theatre ............................................................... 21Arad McCutchan Stadium ..................................................... 15