summer 2016 day camp registration - iowa state university · 2016-03-21 · summer 2016 day camp...

Summer 2016 Day Camp Registration WHO: All 1 st -6 th graders WHAT: Day camps with various themes! WHEN: Months of June, July, and August TIME: All camps run 9:00 AM – 3:30 PM. Check in starts at 8:45 AM. WHERE: Black’s Heritage Farm Story County Extension Office Ada Hayden Park 26156 530 th Avenue or 220 H Avenue or 5205 Grand Avenue Ames, IA 50010 Nevada, IA 50201 Ames, IA 50010 COST: Register by June 10 - $35 for 1 st camp and $25/additional camp Register after June 10 - $45 for 1 st camp and $25/additional camp ATTIRE: Comfortable clothing and shoes. EXTRA: Bring a sack lunch, no refrigerator available. Snacks will be provided. For more information, contact: Mica Magtoto, 4-H AmeriCorps Member, ISU Extension and Outreach, Story County, 515.382.6551, [email protected] I wish to enroll in the following summer camps: _____ Veterinary Detective _____ Parasite Sleuth _____ Fishy Adventures _____ Designing Water Filters _____ Rainforest Ecologist* _____ African Plan Explorer _____ Wobbly Buildings _____ Unstable Buildings _____ Just Passing Through _____ Ready, Set, Go Green! _____ Water Rocks! (Gr. 4-6) _____ Strong Minds and Bodies _____ Light It Up _____ Water Rocks! (Gr. 1-3) _____ Heart for Art _____ For the Love of Food (Gr. 1-3) _____ For the Love of Food (Gr. 4-6) *Food allergy notice: activity involves peanuts and tree nuts. Youth Name: ____________________________________________________________________________________ Grade: ________ Circle: Boy or Girl Are you a current Clover Kid or 4-H Member? ____ Yes ____ No Address: City: Zip Code: _________________ Are there any special needs to accommodate? _________________________________________________________ Home Phone: Parent’s Cell: ________________________________________ Parent Email: Parent or Guardian Print Name:________________________ Parent or Guardian Signature: _____________________________________________________________________ I will submit $35 for the first camp and $25 for each additional camp and registration form on or before June 10. After June 10, I will submit $45 for the first camp and $25 for each additional camp. I understand these fees will be returned to me if the camp is full or cancelled. Iowa State University Extension and Outreach programs are available to all without regard torace, color, age, religion, national origin, sexual orientation, gender identity, genetic information, sex, marital status, disability, or status as a U.S. veteran. The deadline for all summer camps is Friday, June 10 or until registration is full. Return the bottom portion of this form and payment to Story County ISU Extension and Outreach, c/o Mica Magtoto, Summer Camps, 220 H Avenue, P.O. Box 118, Nevada, Iowa 50201. Checks payable to Story County ISU Extension. You will receive an email confirmation from Mica after registration is received. Participants will be required to submit an Iowa 4-H Medical Information Release Form unless he/she is currently enrolled as a 4-H or Clover Kid Member. The fees for service will be used to off-set direct expenses and to support the 4-H Youth Development County Extension Program.

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Summer 2016 Day Camp Registration

WHO: All 1st-6th graders WHAT: Day camps with various themes! WHEN: Months of June, July, and August TIME: All camps run 9:00 AM – 3:30 PM. Check in starts at 8:45 AM. WHERE: Black’s Heritage Farm Story County Extension Office Ada Hayden Park 26156 530th Avenue or 220 H Avenue or 5205 Grand Avenue

Ames, IA 50010 Nevada, IA 50201 Ames, IA 50010 COST: Register by June 10 - $35 for 1st camp and $25/additional camp Register after June 10 - $45 for 1st camp and $25/additional camp ATTIRE: Comfortable clothing and shoes. EXTRA: Bring a sack lunch, no refrigerator available. Snacks will be provided. For more information, contact: Mica Magtoto, 4-H AmeriCorps Member, ISU Extension and Outreach,

Story County, 515.382.6551, [email protected]

I wish to enroll in the following summer camps: _____ Veterinary Detective _____ Parasite Sleuth _____ Fishy Adventures _____ Designing Water Filters _____ Rainforest Ecologist* _____ African Plan Explorer

_____ Wobbly Buildings _____ Unstable Buildings _____ Just Passing Through _____ Ready, Set, Go Green! _____ Water Rocks! (Gr. 4-6) _____ Strong Minds and Bodies

_____ Light It Up _____ Water Rocks! (Gr. 1-3) _____ Heart for Art _____ For the Love of Food (Gr. 1-3) _____ For the Love of Food (Gr. 4-6)

*Food allergy notice: activity involves peanuts and tree nuts.

Youth Name: ____________________________________________________________________________________

Grade: ________ Circle: Boy or Girl Are you a current Clover Kid or 4-H Member? ____ Yes ____ No

Address: City: Zip Code: _________________

Are there any special needs to accommodate? _________________________________________________________

Home Phone: Parent’s Cell: ________________________________________

Parent Email: Parent or Guardian Print Name:________________________

Parent or Guardian Signature: _____________________________________________________________________ I will submit $35 for the first camp and $25 for each additional camp and registration form on or before June 10. After June 10, I will submit

$45 for the first camp and $25 for each additional camp. I understand these fees will be returned to me if the camp is full or cancelled. Iowa State University Extension and Outreach programs are available to all without regard torace, color, age, religion, national origin, sexual

orientation, gender identity, genetic information, sex, marital status, disability, or status as a U.S. veteran.

The deadline for all summer camps is Friday, June 10 or until registration is full. Return the bottom portion of this form and payment to Story County ISU Extension and Outreach, c/o Mica Magtoto, Summer Camps, 220 H Avenue, P.O. Box 118, Nevada, Iowa 50201. Checks payable to Story County ISU Extension. You will receive an email confirmation from Mica after registration is received. Participants will be required to submit an Iowa 4-H Medical Information Release Form unless he/she is currently enrolled as a 4-H or Clover Kid Member. The fees for service will be used to off-set direct expenses and to support the 4-H Youth Development County Extension Program.

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