VOBS Intercept Parent/Guardian Profile, Behavior Agreements & Cause for Dismissal

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This group of fields will be prefilled w/data from SF and ultimately hidden on the form from the form completer. Data is prefilled and then used when the form is submitted to tie it back to the Applicant/Medical record.

Applicant Record ID

Medical Record ID

Student Contact ID

Student/Participant Name

Course #

Outward Bound's Intercept program is designed for teens and young adults who need a reset and a chance to learn new skills in teamwork, communication, and conflict resolution. Outward Bound is an at-will program, so while students do not have to be excited about participating, they do have to agree to show up and participate and be prepared for the mental, emotional and physical challenges the course will bring. We encourage you to set aside time to talk about the course with your teen and review all of the materials linked in your Welcome Email, so that you can determine together if the course is a good fit for them at this time.

Parent Profile

Name of Person Completing This Form:

Relationship to Participant:

If other, please explain:

We require both the participant and parent/guardian to read the preparation information. If you have not yet read these materials, please reference your Welcome Email or Applicant Portal before proceeding. A checkbox here confirms you have read the following documents:

It is helpful to have an accurate picture of the family relationships, guardianships, custody issues, etc. Are there other adults, step-parents, or partners involved?

YesNo

Please list all below with phone and email.

Use this space to tell us about your family structure or any other relevant information. (Eg. siblings, recent deaths, divorce, moves, etc.)

Which statement best describes the applicant's living situation?

If other, please explain

All the Outward Bound Intercept courses include a Family Seminar at the end of the course. At least one parent/guardian is required to attend, but we strongly recommend that all active parents/guardians attend if possible. Who will be attending the seminar?

Describe the applicant's overall attitude and behavior

Are these behaviors new? Do you believe these behaviors are connected to a particular event, change, or trauma?

What are you hoping your child will gain from an Outward Bound course? What would you consider success for your child on this course?

What is your biggest concern for your child going on this course?

How does your child navigate new social situations? How do they relate to peers?

How does the applicant get along with adults, teachers, coaches, etc?

Is the applicant attending school? How is school going?

Outward Bound programs happen in natural areas where students may face challenging scenarios under variable weather conditions (eg. long days of hiking carrying a heavy backpack, inclement weather). How does your child handle stressful or unpredictable situations? Please provide an example of a time they faced adversity or handled a stressful or unpredictable situation.

Has the applicant ever run away? What happened?

Is the applicant experimenting with drugs, alcohol or tobacco? Do any family members use drugs or alcohol?

Has the applicant been in trouble with the law? What happened? If there was an arrest involved, please explain the outcome and any pending issues.

How would you describe the applicants role in their family?

What is the best way you have found to support your child when they are struggling or upset?

What are you most proud of about your child?

Is there any other information you feel would be helpful for our staff when working with your child?

Intercept Students may not be thrilled about participating in Outward Bound, but they do have to agree to show up and participate. As stated on the Cancellation Policies website any student who leaves the field for motivational reasons will not be eligible for any refund. Do you understand this policy and confirm that your child agrees to attend?

YesNo

TRIP INSURANCE

Airfare, related travel costs, and non-refundable tuition payments are expensive. Insurance to protect your trip and course is not required but strongly recommended. If you choose not to purchase insurance and cancel your course or leave your course early you will be held to the terms of the Cancellation Policy. VOBS tuition is non-refundable

Outward Bound offers an option for insuring these costs from the third-party provider InsureMyTrip through its Academic Explorer Program. This program has coverage options that include your travel costs and the non-refundable tuition costs. A link to that program’s insurance coverage options is below. Alternatively, you may choose to purchase trip related insurance through a different insurance provider. In either case, the amount and type of coverage you choose is your responsibility and must be discussed directly with the provider.

VOBS strictly follows the policies outlined on our Cancellation Policies website, and strongly recommends purchasing trip or travel insurance in order to protect you in the event of a cancellation or early medical departure.

I have read the policies and understand that VOBS strongly recommends purchasing trip insurance and know that researching and deciding to purchase trip insurance is my responsibility.

Yes

MEDICAL INSURANCE

Voyageur Outward Bound staff are Wilderness First Responder and CPR certified and will provide first aid to students in the field at no cost. If a student requires emergency medical care beyond what staff are trained to provide, they will be evacuated from the field and the family will be responsible for all costs as invoiced by medical or emergency service providers or evacuation support outside of VOBS. Please consider purchasing temporary medical insurance.

Does your child have medical insurance?

YesNoNot yet, but they will by course start. (Please update your course advisor when coverage is active.)

VOBS Behavior Agreements

An Outward Bound Intercept course is an opportunity to learn and grow through taking on physical and emotional challenges with a supportive group of peers and the guidance of skilled instructors. Each participant must arrive ready to participate in their own and the whole group’s safety and learning.

NON-NEGOTIABLE EXPECTATIONS

For all participants to have a positive learning experience, Outward Bound requires everyone to always follow the non-negotiable Behavior Agreements. All students are expected to:

Follow Outward Bound safety procedures and directions given by the instructors.
Be able to learn new and unfamiliar ways of doing things, be flexible in meeting personal needs, and be able to use healthy coping strategies when under stress.
Adapt their self-care skills to the new environment to take care of their own physical needs, such as drinking enough water, eating enough food, using sunscreen, insect repellent, clothing, and equipment, and applying hygiene practices and other techniques as explained by the instructors.
Alert the instructors if they see something wrong or unsafe, or if they are experiencing any physical or mental health problems.
Contribute to an inclusive and safe learning environment refrain from any behavior that harasses, bullies, intimidates, or harms others, and manage conflict without physical or verbal aggression.
Refrain from continued destructive outbursts that are harmful to self or others.
Not bring, possess, or use nicotine, alcohol, other substances, or any prescription or non-prescription drugs not approved by Outward Bound for their use on the course.
Not engage in sexual activity or romantic relationships.

I understand that the above expectations are non-negotiable which means the instructors will hold my child and all the students accountable to them. I understand that my instructors will help my child understand the rules and it is my child's responsibility to follow the rules. I also understand that if my child will not or cannot meet these expectations, they will be dismissed from the course.

Yes

Participation Expectations

To realize the learning potential of the Outward Bound experience, students are also expected to strive to do the following:

Be willing to engage in new experiences and to share and learn from different perspectives.
Engage each day as a full participant and try to achieve individual goals and support the whole crew.
Be open to making connections with all group members and refrain from exclusive behavior.
Behave respectfully toward all of the various identities of others and not discriminate based on any aspect of their identity such as race, ethnicity, citizenship, nationality, gender, gender identity, sexual orientation, religion, ability, and social or political affiliations.
Support the crew’s goals by sometimes delaying personal needs or taking on new responsibilities.
Demonstrate progress in learning & using communication tools & restorative processes to better address low frustration tolerance, outbursts, & group or individual conflict. Learn to listen to and voice opposing perspectives respectfully and manage conflict constructively.
Treat the environment and the gear with care and respect.

I understand that these expectations are both important and challenging and my child is not expected to be perfect. My child agrees to correct my mistakes and learn from the instructors and their crewmates to be a better crew member. I understand that if my child does not make consistent efforts in these areas, they may be dismissed from the course.

Yes

Our goal is to provide a positive and supportive environment for all participants. You and your child have reviewed our Behavior Agreements and Participation Expectations above. Please share any recent challenges you have seen your child have with these expectations, or concerns you have about how they might behave on course.

Dismissal from Outward Bound

Outward Bound courses are intentionally challenging, physically and mentally, to promote significant learning. Remote environments and wilderness travel require living intentionally and working thoughtfully with a diverse group of people. While fun and rewarding at times, this is not a recreational camp experience or a vacation. Each student has a responsibility for the success and safety of their own and the group’s experience.

Outward Bound strives to support all students to successfully complete our courses. Students are encouraged to review these expectations and request clarity or guidance from the instructors. Our instructors will assist students to push past doubt and discomfort, form new habits and abilities, and fully engage.

However, if a student refuses to participate, follow instructions, or abide by the Outward Bound Behavior Agreements, this indicates that our program is not a productive challenge at this time, and the student will be dismissed at the discretion of the Outward Bound staff. Guardians of minors will be required to arrange for their child’s travel home. There will be no refund of any kind.

Behaviors that result in dismissal include the examples described below, among similar actions and attitudes; Outward Bound reserves the right to dismiss students for other behaviors.

Being unwilling, unmotivated, unable, or insufficiently physically or mentally fit to participate in course activities.
Being unable or unwilling to maintain basic self-care; not adapting to the physical and social demands of the expedition; and responding to stress in self-injurious ways.
Being unwilling or unable to follow instructions.
Engaging in behavior that is harassing, or otherwise compromises the emotional or physical safety of others, including:

Psychological or physical bullying, intimidation or aggression/violence including physical or verbal outbursts.
Verbal harassment or identity-based discrimination of others, including race, gender, gender identity, sexual orientation, religion, ability, and nationality.
Repeated verbal or non-verbal actions that insult, belittle, or demean other people or their identities.
Sexual harassment, including unwelcome comments or jokes, touch or gestures.

Using or possessing nicotine, alcohol, other substances, or prescription or nonprescription drugs that are not approved for their use on course by Outward Bound.
Engaging in sexual activity
Stealing, or damage to equipment or the environment, whether careless or purposeful.

II understand that if I or my child will not or cannot meet the non-negotiable behavior expectations as listed in the Behavior Agreements, or if a condition or behavior that compromises course safety or quality emerges on course, I or my child will be dismissed from the course at the discretion of the Outward Bound staff. I have read the course information and understand the application, cancelation, and dismissal policies on the course website.
I also understand that if I or my child arrive(s) with undisclosed health conditions or medications, or if health or behavior information about the student was misrepresented during the application process, I or they may be dismissed. I confirm that the information I have provided is accurate and complete..

Yes

This group of fields contains the expected names for the signature as well as whether a parent or participant should be filling out/signing, and the course advisor email

Parent1 Name

Parent2 Name

Requires Parent/Guardian Signature

TrueFalse

Course Advisor Email

CC Emails

Parent/Guardian Signature

I am the parent/legal guardian of the above named Participant. By electronically typing my signature, I agree that it has the same legal effect as my handwritten signature. I affirm that the above information is accurate to the best of my knowledge and I accept responsibility for mistakes and omissions.

Parent/Guardian Signature

Parent Signature Valid?

Valid Parent SignatureInvalid Parent Signature

Invalid Signature Placeholder Message

If you have any questions or issues with this form, email Voyageur Outward Bound's Student Services department at student.services@vobs.org

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