4-H Clover Kid Camp

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4-H Clover Kid Camp

WHERE: Cuming County Fairgrounds, Dinklage Building

WHEN: Thursday, July 18th, 2024

8:30 - 8:45 a.m. (Check in)
8:45 a.m. - 12:00 (Camp)

WHAT TO BRING: Wear clothes that can get dirty, bookbag to take home projects, insect repellent, sunscreen, water bottle

COST: $20.00 per youth - Make checks payable to: UNL

AGES: Open to youth ages 5-7 as of January 1 of the current year

REGISTRATION DEADLINE IS THURSDAY, JULY 11 BY 4:30 P.M.

Questions? Contact the Cuming County Extension Office at 402-372-6006.

**The University of Nebraska does not discriminate based upon any protected status. Please see go.unl.edu/nondiscrimination.

Email *

Record my email address with my response

Youth First Name *

Youth Last Name *

4-H Age (As of January 1 of the current year) *

Age 5

Age 6

Age 7

Required

Are you attending as a 4-H Counselor? If so, please put your first and last name below

Address *

City *

Parent/Guardian Name
*

Parent/Guardian Phone Number
*

Emergency Contact Phone Number
*

I want to be grouped with (ONE NAME ONLY)
*

PERMISSION TO TREAT, PARTICIPATE, AND RELEASE OF CLAIMS

Nebraska Extension Staff and volunteers at Clover Kid Camp will do all within their power to ensure the safety of your child during the camp activities. To help ensure a successful 4-H experience, it is vital that we know about our participants' unique needs or concerns. Please list below anything that will better help us understand your child. List any activity restrictions, adaptations, special learning considerations or other relevant experiences below.

1. Please list below any medications your child will bring with them to Clover Kid Camp.

2. Please list any allergies below.

Please check all statements below that you agree to and sign.
*

I give permission to use my child's name / photo in publications, ads, news articles, videos, websites or other electronic media pertaining to 4-H.

My child does not take medication on a regular basis.

If deemed necessary, I (parent/guardian) give permission to administer non-prescription medications in accordance with directions on the label for headaches, upset stomach, diarrhea, menstrual cramps, and poison ivy.

In the event of a medical emergency, the Nebraska Extension staff & volunteers have my permission to take whatever measures they deem reasonable to render assistance and that I and/or family will be financially responsible for any expense involved.

Required

Payment is due Thursday, July 11 to the Cuming County Extension Office by 4:30 p.m.

Make checks payable to: UNL

I will be ...

Dropping payment off at the Cuming County Extension Office

Mailing a check to the Cuming County Extension Office (Must be postmarked by July 11)

Parent Signature

By signing, I agree to pay the $20.00 for my child to attend 4-H Clover Kid Camp.

All payment is final. No refunds.

Date *

YYYY

Send me a copy of my responses.

Submit

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