MILIUS Family and Friends Cruise Info Package
Content
USS MILIUS (DDG 69) FAMILY AND FRIENDS DAY CRUISE INFORMATION PACKAGE The Officers and Crew of USS MILIUS (DDG 69), welcome you aboard. MILIUS is the 19th Arleigh Burke Class Destroyer and was commissioned in 1996. She is named in honor of a courageous Naval Aviator, CAPTAIN Paul L. Milius, who gave his life for his aircrew during combat action over Laos in 1968, giving us our motto of “Alii Prae Me,” which translates to “Others Before Self.” MILIUS is built around the Aegis combat system and the SPY-1D multifunction phased array radar. A multi-mission capable ship, MILIUS is one of 21 Ballistic Missile Defense capable platforms. Her last four deployments were Ballistic Missile Defense patrols -- to detect and track ballistic missiles of all ranges – including Intercontinental Ballistic Missiles and report track data to the missile defense system. We can expect this will be a focus area for future deployments. Your Sailors have been working very hard since their last deployment. With most of the focus for the past few months on INSURV, long hours, and busy weeks; we now welcome you aboard to show you the results of your Sailors efforts. Your Sailors are truly exceptional and they are excited to show you all about what they do. Please feel free to take this day to learn from your Sailor, to follow them and to share a glimpse of what they do every day out at sea defending the freedoms of the United States of America and its people. Before you come aboard, there are some minor administrative documents we need filled out to brief our medical staff on your health background; to ensure your safety and to make sure you come prepared with the right clothing, knowledge and excitement! The three documents are: 1. Family and Friends Day Cruise Registration Form 2. USS Milius (DDG 69) Medical Questionnaire 3. USS Milius (DDG 69) Medical Waiver of Claim We need one Registration form listing each person in the family or group. If your group is larger than 4 guests, please fill out as many additional registration forms needed to cover all guests. In addition to the registration form, we need one Medical Questionnaire and one Medical Waiver of Claim for each individual guest coming aboard. Please fill these forms out and give them to your sponsor to turn in. The Registration Form and Medical Questionnaire are due by August 25th. If unable to turn in the Waiver of Claim form with the other two, the Waiver of Claim can be turned in the morning of the 29th of August. General Questions: 1. How do I get to the ship if I am not coming with my sponsor? a. Make sure to fill out your car information on the registration form. You will be entering the base via Gate 7 at the intersection of Harbor DR and Vesta Street. b. GATE 7 Hours (Wet Side - Harbor Drive and Vesta Street) 0530 2000, Monday – Friday c. From North taking I-15 South: Take I-15 South Take the I-5 N Merge onto Harbor DR via EXIT 11A toward CIVIC CENTER DR Turn left onto Vesta Street at Gate 7. d. From North taking I-5 South:
e.
f.
Take I-5 South Take the 28th St SOUTH exit Turn left onto HARBOR DRIVE (after train tracks) Turn right onto Vesta Street at Gate 7. From South: Take I-5 North Merge onto HARBOR DR via EXIT 11A toward CIVIC CENTER DR Turn LEFT onto Vesta Street at Gate 7. When you get to the gate, there will be a MILIUSrepresentative making sure you have base access and directing you to the Family and Friends Day Cruise Parking lot. Make sure all guests bring their state or government issued ID cards. Our ship is located on Pier 7.
2. What should I bring with me? What should I leave at home? a. Recommended to bring: i. Sunscreen, Water Bottle, Sunglasses, Camera, Camping/Beach Chair, Hat, Sweatshirt, State/Government issued ID Card (Drivers license/passport/military ID), seasickness medication. b. Do Not Bring: i. Knives, Guns, Ammunition, Alcohol, Laptops, USB devices, Thumb drives.
Once again, we are looking forward to having you aboard USS MILIUS. We hope your stay is exciting and safe.
FAMILY AND FRIENDS DAY CRUISE REGISTRATION DEPART: ARRIVE: Naval Station San Diego, San Diego, CA Time 0900 Monday 29 Aug 2011 Naval Station San Diego, San Diego, CA Time 1630 Monday 29 Aug 2011
Name: ___________________________________________________________ Age (Minimum age for guests is 08 years old): ____________________ Sponsor: _________________________________________________________ Car Information (If coming separately from Sponsor): Color:__________ Make:__________ Model:__________ Tag #:__________ IN CASE OF EMERGENCY CONTACT: *Please provide (2) contacts *Emergency contact cannot be sponsor, and cannot be anyone else riding MILIUS Family and Friends Day Cruise. (If you have more than 4 guests, please continue guest registration on a separate registration sheet) Guest 1: __________________________________________________________ Address: __________________________________________________________ __________________________________________________________ Phone: __________________________________________________________
Guest 2: __________________________________________________________ Address: __________________________________________________________ __________________________________________________________ Phone: __________________________________________________________
Guest 3: __________________________________________________________ Address: __________________________________________________________ __________________________________________________________ Phone: __________________________________________________________
Guest 4: __________________________________________________________ Address: __________________________________________________________ __________________________________________________________
Phone:
__________________________________________________________
RELATIONSHIP OF GUARDIAN USS MILIUS (DDG 69) DATE SIGNED
SIGNATURE OF LEGAL GUARDIAN
FAMILY AND FRIEND DAY CRUISE 2011 GUEST EMBARKATION MEDICAL QUESTIONNAIRE (MUST BE COMPLETED BY ALL PROSPECTIVE GUESTS) 1 HAVE YOU NOW OR HAVE YOU EVER HAD ANY OF THE FOLLOWING? (CIRCLE YES OR NO) YES NO SHORTNESS OF BREATH YES NO HIGH BLOOD PRESSURE YES NO DIZZINESS YES NO CHEST PAIN/HEART ATTACK YES NO HAY FEVER YES NO ASTHMA/WHEEZING YES NO STROKES YES NO WEAKNESS YES NO EASILY FATIGUED YES NO KIDNEY STONES YES NO SLEEP WALKING YES NO ARTHRITIS 2 IF YOU CLIMBED THREE FLIGHTS OF STAIRS, WOULD YOU HAVE TO STOP DUE TO CHEST PAIN, LEG PAIN, OR SHORTNESS OF BREATH? YES NO 3 DO YOU HAVE ANY OTHER MEDICAL CONDITION THAT OUR MEDICAL DEPARTMENT SHOULD BE AWARE OF THAT WAS NOT PREVIOUSLY MENTIONED? YES NO (IF YES, PLEASE EXPLAIN)
4
DO YOU REQUIRE A SPECIAL DIET? YES NO (IF YES, PLEASE EXPLAIN)
5 6
ARE YOU SUSCEPTIBLE TO MOTION OR SEA SICKNESS? YES NO ARE YOU CURRENTLY UNDER A DOCTOR'S CARE? YES NO (IF SO, WHAT CONDITION)
7 MEDICATION
WHAT MEDICATIONS DO YOU CURRENTLY TAKE AND HOW OFTEN? FREQUENCY MEDICATION FREQUENCY
IF YOU ANSWERED "YES" TO ANY QUESTIONS OR HAVE MEDICATION LISTED, OBTAIN A LETTER FROM YOUR PHYSICIAN REGARDING THE ADVISABILITY OF YOUR PARTICIPATION IN THE GUEST EMBARKATION. THE LETTER MUST ACCOMPANY THIS FORM WHEN RETURNED. 9 I HEREBY CERTIFY THAT THE ABOVE INFORMATION IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE, AND AUTHORIZE EMERGENCY MEDICAL CARE FOR MYSEL (OR APPLICANT, IF APPLICANT IS UNDER THE AGE OF 18). SIGNATURE OF APPLICANT, OR LEGAL GUARDIAN OF MINOR UNDER 18 DATE
8
*FILL OUT 1 FORM FOR EACH PERSON EMBARKING
USS MILIUS (DDG 69) WAIVER OF CLAIM AND CONSENT TO TREATMENT FORM RELATING TO EMERGENCY MEDICAL AND DENTAL CARE WHILE EMBARKED IN A U.S. NAVY SHIP *FILL OUT 1 FORM FOR EACH PERSON EMBARKING I,_________________________ request permission for myself and/or the minor,_________________________, to embark as a guest onboard USS MILIUS (DDG 69) for a Family and Friends Day Cruise in the Southern California Operation Area. Upon approval, I hereby release and discharge the government of the United States of America, the Department of the Navy, its officers, successors and assignees, from any and all claims of any nature or kind whatsoever that I or my assignees have or in the future may have against any of the aforesaid parties as the result of my embarking aboard USS MILUS (DDG 69). Knowing the dangers, events, and circumstances of the premises, I consciously, knowingly, and voluntarily accept the risk of injury or damage to property that may arise. Further, I hereby consent to all emergency medical or dental treatment which may, in the professional judgment of the Senior Medial Department Representative of USS MILIUS (DDG 69), become necessary while I and/or the above named minor are embarked aboard. I understand that emergency care is treatment to preserve life or prevent further injury, and is the only type of care available and authorized for me aboard ship. Transportation to an extended care facility may be required as an adjunct to authorized emergency medical or dental care. I realize that there is a limited range of extended care available onboard USS MILIUS (DDG 69) for people with chronic or incipient medical problems. I affirm that I do not and/or the above named minor does not require extended care. I understand that if medical or dental care is received, and if the above minor or I are not otherwise eligible to receive such care, I may be obligated to reimburse the U.S. Government per applicable U.S. Navy instructions.
_________________________ _________________________ __________ Printed Name of Adult Signature of Adult Date Or Guardian of Minor or Guardian of Minor
______________________________ ____________ Sponsor’s Last Name, First Rank/Rate
______________________________ _____________ Department/Division IVCS Ext.
e.
f.
Take I-5 South Take the 28th St SOUTH exit Turn left onto HARBOR DRIVE (after train tracks) Turn right onto Vesta Street at Gate 7. From South: Take I-5 North Merge onto HARBOR DR via EXIT 11A toward CIVIC CENTER DR Turn LEFT onto Vesta Street at Gate 7. When you get to the gate, there will be a MILIUSrepresentative making sure you have base access and directing you to the Family and Friends Day Cruise Parking lot. Make sure all guests bring their state or government issued ID cards. Our ship is located on Pier 7.
2. What should I bring with me? What should I leave at home? a. Recommended to bring: i. Sunscreen, Water Bottle, Sunglasses, Camera, Camping/Beach Chair, Hat, Sweatshirt, State/Government issued ID Card (Drivers license/passport/military ID), seasickness medication. b. Do Not Bring: i. Knives, Guns, Ammunition, Alcohol, Laptops, USB devices, Thumb drives.
Once again, we are looking forward to having you aboard USS MILIUS. We hope your stay is exciting and safe.
FAMILY AND FRIENDS DAY CRUISE REGISTRATION DEPART: ARRIVE: Naval Station San Diego, San Diego, CA Time 0900 Monday 29 Aug 2011 Naval Station San Diego, San Diego, CA Time 1630 Monday 29 Aug 2011
Name: ___________________________________________________________ Age (Minimum age for guests is 08 years old): ____________________ Sponsor: _________________________________________________________ Car Information (If coming separately from Sponsor): Color:__________ Make:__________ Model:__________ Tag #:__________ IN CASE OF EMERGENCY CONTACT: *Please provide (2) contacts *Emergency contact cannot be sponsor, and cannot be anyone else riding MILIUS Family and Friends Day Cruise. (If you have more than 4 guests, please continue guest registration on a separate registration sheet) Guest 1: __________________________________________________________ Address: __________________________________________________________ __________________________________________________________ Phone: __________________________________________________________
Guest 2: __________________________________________________________ Address: __________________________________________________________ __________________________________________________________ Phone: __________________________________________________________
Guest 3: __________________________________________________________ Address: __________________________________________________________ __________________________________________________________ Phone: __________________________________________________________
Guest 4: __________________________________________________________ Address: __________________________________________________________ __________________________________________________________
Phone:
__________________________________________________________
RELATIONSHIP OF GUARDIAN USS MILIUS (DDG 69) DATE SIGNED
SIGNATURE OF LEGAL GUARDIAN
FAMILY AND FRIEND DAY CRUISE 2011 GUEST EMBARKATION MEDICAL QUESTIONNAIRE (MUST BE COMPLETED BY ALL PROSPECTIVE GUESTS) 1 HAVE YOU NOW OR HAVE YOU EVER HAD ANY OF THE FOLLOWING? (CIRCLE YES OR NO) YES NO SHORTNESS OF BREATH YES NO HIGH BLOOD PRESSURE YES NO DIZZINESS YES NO CHEST PAIN/HEART ATTACK YES NO HAY FEVER YES NO ASTHMA/WHEEZING YES NO STROKES YES NO WEAKNESS YES NO EASILY FATIGUED YES NO KIDNEY STONES YES NO SLEEP WALKING YES NO ARTHRITIS 2 IF YOU CLIMBED THREE FLIGHTS OF STAIRS, WOULD YOU HAVE TO STOP DUE TO CHEST PAIN, LEG PAIN, OR SHORTNESS OF BREATH? YES NO 3 DO YOU HAVE ANY OTHER MEDICAL CONDITION THAT OUR MEDICAL DEPARTMENT SHOULD BE AWARE OF THAT WAS NOT PREVIOUSLY MENTIONED? YES NO (IF YES, PLEASE EXPLAIN)
4
DO YOU REQUIRE A SPECIAL DIET? YES NO (IF YES, PLEASE EXPLAIN)
5 6
ARE YOU SUSCEPTIBLE TO MOTION OR SEA SICKNESS? YES NO ARE YOU CURRENTLY UNDER A DOCTOR'S CARE? YES NO (IF SO, WHAT CONDITION)
7 MEDICATION
WHAT MEDICATIONS DO YOU CURRENTLY TAKE AND HOW OFTEN? FREQUENCY MEDICATION FREQUENCY
IF YOU ANSWERED "YES" TO ANY QUESTIONS OR HAVE MEDICATION LISTED, OBTAIN A LETTER FROM YOUR PHYSICIAN REGARDING THE ADVISABILITY OF YOUR PARTICIPATION IN THE GUEST EMBARKATION. THE LETTER MUST ACCOMPANY THIS FORM WHEN RETURNED. 9 I HEREBY CERTIFY THAT THE ABOVE INFORMATION IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE, AND AUTHORIZE EMERGENCY MEDICAL CARE FOR MYSEL (OR APPLICANT, IF APPLICANT IS UNDER THE AGE OF 18). SIGNATURE OF APPLICANT, OR LEGAL GUARDIAN OF MINOR UNDER 18 DATE
8
*FILL OUT 1 FORM FOR EACH PERSON EMBARKING
USS MILIUS (DDG 69) WAIVER OF CLAIM AND CONSENT TO TREATMENT FORM RELATING TO EMERGENCY MEDICAL AND DENTAL CARE WHILE EMBARKED IN A U.S. NAVY SHIP *FILL OUT 1 FORM FOR EACH PERSON EMBARKING I,_________________________ request permission for myself and/or the minor,_________________________, to embark as a guest onboard USS MILIUS (DDG 69) for a Family and Friends Day Cruise in the Southern California Operation Area. Upon approval, I hereby release and discharge the government of the United States of America, the Department of the Navy, its officers, successors and assignees, from any and all claims of any nature or kind whatsoever that I or my assignees have or in the future may have against any of the aforesaid parties as the result of my embarking aboard USS MILUS (DDG 69). Knowing the dangers, events, and circumstances of the premises, I consciously, knowingly, and voluntarily accept the risk of injury or damage to property that may arise. Further, I hereby consent to all emergency medical or dental treatment which may, in the professional judgment of the Senior Medial Department Representative of USS MILIUS (DDG 69), become necessary while I and/or the above named minor are embarked aboard. I understand that emergency care is treatment to preserve life or prevent further injury, and is the only type of care available and authorized for me aboard ship. Transportation to an extended care facility may be required as an adjunct to authorized emergency medical or dental care. I realize that there is a limited range of extended care available onboard USS MILIUS (DDG 69) for people with chronic or incipient medical problems. I affirm that I do not and/or the above named minor does not require extended care. I understand that if medical or dental care is received, and if the above minor or I are not otherwise eligible to receive such care, I may be obligated to reimburse the U.S. Government per applicable U.S. Navy instructions.
_________________________ _________________________ __________ Printed Name of Adult Signature of Adult Date Or Guardian of Minor or Guardian of Minor
______________________________ ____________ Sponsor’s Last Name, First Rank/Rate
______________________________ _____________ Department/Division IVCS Ext.
