Welcome to the Natural History of the

Mt Jefferson Wilderness Summer Science Class!

In this packet you will find:

1)  a gear checklist to help you pack for the trip

2)  a medical history form (2 pages)

3)  a medical release and permission to participate

4)  a CCC indemnity and release form

5) a food choices list that will help me figure out what food to bring

Everything except the gear checklist needs to be filled out and returned to Tiare Sheller as soon as possible, or now later than June 19th.

Scholarship info:  Please do not allow the $100 course fee to hold you back.  If you need a scholarship, contact Tiare and we will talk with the Department and see what can be done. 

The tentative trip dates are:

June 26-30  (Thursday – Monday) with a pre-trip class June 19^th (Thursday) from 9am to 6pm on campus

Your attendance at the pre-trip class is required in order to go on the trip.  Parents may drop in before or after class, or call Tiare with any questions. 

For more info, contact Tiare Sheller:

(503) 657-6958 x2968

(503) 810-6928 (cell phone)

tiares@clackamas.edu

http://dl.clackamas.cc.or.us/tsheller/

Gear Checklist for Trip

There are a few things to consider when packing for your trip:

• Weight – though the llamas are carrying our gear, we want to keep weight to a minimum in order to take fewer animals and decrease our environmental impact on the area we visit.  As such, each person is limited to 15 pounds of gear (excluding food, sleeping bag, sleeping pad, and tent, see below if you want to bring your own).  Weigh your items while standing on your bathroom scale.  Any additional things you want to bring that put you over this limit will need to go in your daypack that you carry.
• The summer weather in Oregon is pretty unpredictable, we could have sunshine, rain, overcast, or snow on any day!  Bring clothes that can be layered. 
• Do not bring cotton clothing!!!  When it gets wet it actually steals body heat in order to dry itself out, which will make you very cold.  You can bring cotton underwear, shorts, t-shirt, etc., but the clothing you are counting on to keep you warm must not be cotton.
• Pack all of the below things in a clean pillow case inside a waterproof garbage bag. 

The following items are recommended for this 5 day, 4 night trip.  Please do not go out and spend a lot of money to purchase everything.  Ask friends if you can borrow things, check the Goodwill, or ask Tiare if she has extras.  Contact Tiare about places you can buy used or discounted gear!

___  raincoat – This item is very important to have, but remember, it doesn’t need to be an expensive Gore-Tex coat, anything waterproof will do.

___  wool or fleece hat – something that is warm even if wet.  This is very important because over 90% of your body’s heat is lost through your head.

___  warm sweater or coat that fits under raincoat (fleece or wool are great!)

___  1 pair pants – wool, fleece, rainpants, nylon, but no cotton, and no jeans!

___  baseball hat or some hat with a visor to keep the sun off your face

___  2 pair shorts or 1 pair shorts, 1 pair jeans

___  3 t-shirts

___  underwear

___  socks – at least one pair wool; make sure to try your socks with the shoes you will be hiking in to check for fit, as wool socks are often bulky (you can get thin ones though).  Wool socks with a polypro liner are recommended if wearing hiking boots. 

___  hiking shoes – hiking boots if you have them, otherwise tennis shoes.  On rainy days, tennis shoes will get wet, so I recommend wool socks with them so your feet will at least be warm (again, check for fit!)

___  camp shoes to wear in camp to rest your feet.  I bring sandals that I can also wear in the water for swimming.

___  sunglasses

___  swimsuit – optional, or go in your clothes!

___  bowl, metal spoon, mug (please avoid breakable glass or ceramic)

___  toothbrush, dental floss (I will bring one large biodegradable toothpaste, as well as soap, sunscreen, and bug spray)

___  personal medications, contact lens solutions, feminine products, chapstick, deodorant, etc.

___  flashlight with new batteries

___ comb or hairbrush

___  small towel (like a hand towel)

___  daypack for carrying the things you want on the trail

___  2 liter capacity water bottle(s) (that don’t leak!) or platypus/camelback type bag with a long flexible tube and bite nozzle – these work GREAT for staying hydrated.  You can buy just the plastic platypus and long tube at REI or GIJoe’s for $18, you don’t need the whole backpack bag, just stick it in your regular backpack. 

___  bandana – great for bathing, sneezing, hat, neckerchief, etc.

___  pens or pencil for completing assignments

___ a watch

___  a lunch (or two) for the car-ride up on the first day!!!

Optionals:

• Camera, film, batteries
• Good book for if we are stuck in the tents
• Musical instrument, skit for the campfire, etc. 
• Fishing pole (you will need an Oregon fishing license if you plan to fish)  If you want to eat your fish, bring the proper things to clean and cook it.

I recommend putting in your daypack the following items (so don’t count them toward your 15 pound limit):

• Sunglasses or visor-type hat
• Personal medications
• Chapstick
• Flashlight
• Water bottle
• Bandana
• Pencil, pens, notebook (I will give you a notebook)

Things NOT to bring:

• Any electronic doo-dad, such as Gameboys and personal music players.  I know music is very important to some of you, but this type of item is inappropriate in a wilderness and group setting as it removes you from your environment.  Please speak with Tiare if this is a problem for you.
• Drugs, alcohol – need I say it?  Please do not ruin the trip by disrespecting this rule.  These will get you sent home at your expense very quickly, and the appropriate authorities will be notified.  Cigarettes are permitted, but you must carry a plastic bag to keep your butts in and smoke AWAY from the group at appropriate times.  If you chew tobacco, it is not OK to spit this on the ground in the wilderness area – you must carry a container to spit in and properly dispose of your waste in the garbage.
• Toilet paper, toothpaste, sunscreen, bug repellant, whistle – I will bring these for the entire group.  For example, we don’t need to pack in 8 pounds of toothpaste, we can share one tube.
• Pillow – you can stuff your clothing at night into your clean pillow case and it works mighty-fine.
• Snacks – I will bring these for everyone, if you are worried about food, please talk with Tiare.
• Have a question about something?  Call Tiare (503) 657-6958 x2968 and leave a message, or call Tiare’s cell phone at (503) 810-6928 to ask about it!!!

Return to Tiare Sheller

Personal Health and Medical Record Form

Please note: This form will only be seen by Tiare and is confidential.  Its only purpose is to protect you and keep you comfortable on the trip, so please be honest.  If you do not tell me about your needs now, I will not be able to provide for them on the trip, and you may end up miserable or worse.

Name: ________________________________ Birthdate: _________ Age: ____

Address: _________________________________________________________

                _________________________________________________________

In an emergency, notify:

Name: _______________________________ Relationship: ________________

Home phone: _________________________ Work phone: _________________

Health Insurance Information

Policy number: __________________ Insurance Company Name: ___________

Doctor’s name: ___________________________  phone number: ___________

Medical History

Allergies to food, medications, or other:

What are the symptoms of this allergy?

            What do you do to treat the allergy?

Are you currently under medical care or taking any medications? NO  YES

If yes, please write the name of medications and your dosage below:

For the questions on this page, circle “no” or “yes”.  IMPORTANT:  For any “yes” answers, give dates and full details of treatments (on an attached page if you can’t fit the answer here.)

Are you aware of any current health (include mental health) issues? NO  YES

Is there disease of, or past or present history of, the following:

Chest pain, heart murmur, high blood pressure, other disorder of the heart?    YES     NO

 

Cancer, tumor, cyst, leukemia, lymph gland, thyroid, or blood abnormalities?   YES     NO

Diabetes or other endocrine disorder, sugar, albumin or blood in urine, stones or other disorder of kidney, bladder or prostate?  YES     NO

Problems during menstruation?  YES     NO

Pain in stomach, bowels, or appendicitis?  YES       NO

A chronic respiratory disorder, asthma, emphysema, pneumonia, or tuberculosis? YES     NO

Intestinal bleeding, ulcer, hernia, hemorrhoids, or other disorder of stomach, liver, intestine or gall bladder?    YES     NO

Acquired Immune Deficiency (AIDS) or AIDS Related Complex?   YES     NO

A sexually transmitted disease such as syphilis, gonorrhea, genital herpes, genital warts, or hepatitis?       YES     NO

 

An easily transmittable disease, infection, etc., such as mono or pink eye?  YES     NO

A brain, mental or nervous disorder, epilepsy (seizures), fainting, convulsions, paralysis, depression, or attempted suicide?     YES     NO

Arthritis, gout, loss of limb or deformity, disorder of bone joint, muscle, back or spine, or skin disorder?   YES     NO
     
Disorder of eyes, ears, nose or throat?   YES     NO

Sleepwalking?  YES      NO

Been advised to take medication but not doing it?   YES     NO
     
Had surgery or been advised to have any diagnostic test, hospitalization, or surgery which was not completed?   YES  NO
     
Received advise/treatment for the use of alcohol or drugs?   YES     NO

Any illness, disease, or injury not mentioned above?  YES    NO         

Return to Tiare Sheller

Medical Release and Permission to Participate

I am aware that __________________________ (student’s name) is choosing to participate in the course ASE064 at Clackamas Community College.   I recognize and understand that such activity may involve certain dangers, including but not limited to associating with livestock, the hazards of traveling in a mountainous environment, accidents or illness in remote place that may be removed from access to medical assistance, forces of nature, the primitive state of facilities, and the actions of participants and other persons. 

I have been advised of the nature of the course ASE064 and understand what will take place and represent to you that the participant is physically and mentally able to, with my permission, participate in this activity.  In case of emergency, I understand every effort will be made to contact me.  In the event I cannot be reached, I, ___________________, (parent or guardian’s name) do hereby give written permission for qualified medical personnel to give emergency medical treatment to _______________________ (student’s name).                          

In consideration of the right to participate in this course offered by Clackamas Community College, I hereby personally assume all risks and legal responsibility in connection with the course.  I hereby release Clackamas Community College, Tiare Sheller, and the United States Forest Service from all liability, claims, demands or cause of action of any kind whatsoever arising out of or in any way connected with my participation in the course.  I knowingly and voluntarily assume all risk of injury, illness, death, loss of personal property, or damage of whatever kind arising out of or connected in any way with such participation. 

The terms of this agreement shall serve as release and assumption of risk for my heirs, personal representatives, executors, administrators and for all members of my family.  I affirm that my general health is good and that I am not under a doctor’s care for any condition which will endanger my health or the health of other participants.  In case of injury or illness, I will bear the cost of any evacuation procedures such as ambulance, helicopter, search and rescue team and professional medical care. 

In the case that the participant may break course rules or need to go home for medical reasons, ___________________________ (name of willing, reliable, person authorized to pick up student) will immediately drive, meet, and transport the participant from a location near Detroit Lake, designated by the course instructor.  This authorized person can be reached at _______________________ (phone number during day) or _________________________ (phone number during night), or ­­__________________ (cell phone if applicable).  If this person is unable to meet the participant, I will bear the cost of transporting the participant home by taxi service from Detroit Lake (upwards of $200).

Signed  _______________________ printed name: _________________ date:_______

              (Student’s signature)

Signed  _______________________ printed name: _________________ date:_______

               (Student’s parent or legal guardian if participant is under 18)

Return to Tiare Sheller

                                    CLACKAMAS COMMUNITY COLLEGE

                                                     Indemnity and Release Form

In consideration for participating in ASE064 Skills Development Science Trip (activity/dept) during summer quarter 2003 (term/month), I the undersigned, fully recognizing any potential dangers and hazards inherent in this activity, to which I may be exposed as a result of my participation, do hereby voluntarily:

1.   Agree to assume all of the risk and responsibilities associated with my participation in the activity; and if I chose to provide my own transportation, comply with local and state laws and regulations.

2.   Agree, for myself, my heirs and my personal representative, to defend, hold harmless, indemnify, release and forever discharge Clackamas Community College, its trustees, officers, employees, agents, insurers, successors and assigns, from and against any and all claims, demands, actions, or causes of action on account of any damage to real or personal property or any personal injury or death that may result form my participation in the above activity.  This Indemnity Release form does not apply to gross negligence on the part of Clackamas Community College, its officials, or employees.

I have read this release, I understand it fully, I understand that it is legally binding, and I understand that, among other things, I am agreeing to indemnify Clackamas Community College, for injuries, damages or losses I may cause and giving up rights to sue Clackamas Community College for injuries, damages or losses I may incur.

In witness whereof, I have caused this release to be executed this _____day of ________________, 2003.

__________________________              _____________________________

Printed Name                                              Signature of student

I am a parent or guardian of the above named person who wishes to participate in ASE064 Skills Development Science Trip.  I have read the above agreement.  It is my intention, in signing it, to give permission to Clackamas Community College to allow my child to participate in this activity in accordance with the terms of the agreement.

Signature of Parent or Guardian if Participant is under 18 years of age

I or my child has/have medical insurance:  __yes or __no!

If yes, name of insurer_______________________________

Policy No. _________________________________________

Known Allergies or illnesses: ____________________________________

Food Choices (return to Tiare)

Do you have any special dietary needs, requirements, or food allergies?

Are there any foods you absolutely hate?

Make an example list of what you would typically eat in one day at home:

Breakfast:                  Lunch:             Dinner:                        Snacks:

We will be eating dehydrated meals in the evening - they are actually not bad, and are very easy to cook when we are tired!  Circle at least 5 of the following dehydrated meals you would like to eat for dinner, and cross off any you would refuse to eat:

Meat Dishes (note: some people prefer vegetarian

because they don't like re-hydrated meat.)

Chicken stew                                                             rice & chicken           

Chicken Polynesian                                                  sweet & sour pork w/ rice

Teriyaki chicken                                                        noodles & chicken

Mexican chicken w/ rice                                           oriental spicy chicken

Spaghetti w/ beef sauce                                          beef stew

Beef stroganoff                                                          teriyaki beef              

lasagna with beef sauce                                          Chili mac                               

mac & cheese w/ beef                                              Potatoes & beef w/ onions  

turkey tetrazzini                                                         

Vegetarian Dishes

Wild rice & mushroom pilaf                                      Pasta primavera

Vegetable lasagna                                                   Thai peanut sauce and rice

Alfredo Pasta & Cheese                                          Black bean tamale pie        

Mac'n Cheese & Chili                                               Curry with lentils and potatoes
Mashed Potatoes                                                     Red beans and rice
Curried Lentil Soup                                                   Santa Fe Pasta
Chili                                                                            Buttered Pasta & Herbs

Ginger teriyaki stir fry                                                Spicy Sesame Pasta
 

back to Cascades Class