JUNIOR 4-H CAMP - Monday, July 3 (9:30 am) through Friday, July 7 (1:45 pm)

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1 Ohio State University Extension Hervida: Pirates Paradise Washington County 202 Davis Avenue Marietta, OH washington.osu.edu Phone (740) FAX (740) JUNIOR 4-H CAMP - Monday, July 3 (9:30 am) through Friday, July 7 (1:45 pm) Dear Junior Camper and Parent/Guardian: Welcome to five days of fun and friendship! Please read the following information so campers and parents/guardians are prepared for camp. TO DO NOW BEFORE CAMP 1) Return the enclosed Ohio 4-H Participant/Member Health History Form filled out (front and back) and signed by your parent or guardian. We must have a completed and signed Health History Form to admit you to camp. 2) Return the Sign-Up sheet with your preference for camp classes. Classes will be filled according to the return date of the sign-up form. There will be no guarantee of cabin mate requests after June 28 th. 3) The Health History Form, Permission to Transport Form and Sign-Up sheet are to be returned to the Extension Office by JUNE 28 th. SPECIFIC INFORMATION FOR 4-H CAMP: HEALTH AND SAFETY AT CAMP: All medications, prescriptions and non-prescription, should be turned into the nurse upon arrival at camp. They should be in a labeled bottle with complete instructions and parent signature. These will be kept in the nurse s cabin at all times. Campers are welcome to visit the nurse anytime day or night for any reason. Please include any medication instructions on the Camper Health form. Campers may be sent home for anything deemed medically necessary by the camp nurse. This may include, but not limited to fever, vomiting, diarrhea or rash. CABIN MATE REQUESTS: Campers may request one friend to stay in the same cabin with them. Normally, no more than two friends are assigned to the same cabin to foster the making of new friends. Write your friend s name on the space provided on the enclosed Sign-Up sheet. Campers will be told their cabin assignment at registration. CLASSES: You will have four classes on Tuesday, Wednesday, and Thursday. Three of the classes will be in the morning and assigned to you before camp. Everyone will be assigned a nature class as one of the three morning classes. Classes are assigned on a first in, first signed-up basis. Please indicate your preference on the enclosed sign-up sheet. Due to some classes having a limited participant size, campers may not get their first choices. A fourth free class will be offered in the afternoons and campers will sign-up at camp. PERMISSION TO LEAVE/RESTRICTED RELEASE FORM: No one is allowed to leave camp without a signed Parent Permission form, which includes the date, time leaving, time returning, who is transporting and the reason. A form is enclosed. The completed form must be turned in by registration. REGISTRATION: Arrival and registration are Monday from 9:30-10:30 AM in the Craft Hall, the large block building on the hill to the right as you enter camp. Please do not arrive before 9:30 AM. DEPARTURE: Departure is Friday at 1:45 PM. Parents should be at camp at this time to take campers home. Families are welcome to join us at 1:30 PM for camp awards and flag lowering. Due to pedestrian activities, vehicles will not be permitted beyond the canteen until after the closing ceremony and camp is dismissed. After dismissal, vehicles will be permitted to drive to the cabin area. CAMP FEE: The base cost of camp is $ for 4-H members and $ for non-4-h members, which includes four nights of lodging, meals for five days, program supplies, and staff salaries. Full payment is due at registration on the first day of camp. No refunds for partial stays. CAMP PICTURE: A camp picture will be taken during 4-H Camp. There will be a password available for a free digital download of the picture following camp. Please be sure to include an address on this form so we can you the password at the end of camp. You may also order prints from this site, including copies of the slideshow.

2 ADDITIONAL MONEY: Between $5 and $15 could be needed for crafts, classes and canteen during the week of camp. Crafts and class supplies cost from $3.00 to $ Canteen snacks cost about $1.00 per day. Campers will be issued canteen cards in exchange for cash on the first day of camp. Canteen cards are used for crafts, classes and canteen snacks. The cards eliminate loose cash around camp. Unused money on the canteen cards will be refunded on the last day of camp. The camp staff is not responsible for money and valuables that are lost or stolen. Camp Hervida items range from $6.00 to $ Items can be purchased during registration and when campers refund their canteen cards during final camp clean-up on Friday. WHAT TO BRING TO CAMP: Adequate amount of camp clothes (at least 2 outfits Soap, toothbrush and toothpaste per day, and a pair of jeans or long pants) Comb/brush Swim suit, beach towel, sun screen Other personal items Jacket or sweatshirt Sheet, blanket or sleeping bag Rain gear Pillow Flashlight Refillable Water Bottle Towels, wash cloths Camera Nice, casual clothes for Thursday Dress-up Dinner Flip-Flops for the shower Two pair of closed-toe shoes and socks, including tennis shoes Personal music devices in cabins only WHAT NOT TO BRING: Valuables Electronic games Pocket knives, firearms, fireworks, alcohol, tobacco, illegal drugs Items with offensive logos, illegal substances or inappropriate pictures CELL PHONES: Cell Phones are not allowed at camp! In case of emergencies ONLY, please call the camp at ,or the director s cell phone at Please do not require or expect campers/counselors to call home. Cell phones found at camp will be turned in to the camp director and returned to the camper at the end of camp. Adults will have their phones at all times in case of emergencies CAMP ADDRESS: Parents and friends are welcome to write campers: The address is: Camper s Name, Hervida 4-H Camp 1260 Camp Hervida Road, Waterford, OH OPTIONAL THINGS TO BRING: Talent for Talent Show Bring CD s for music if needed and Songs, Skits, Challenges, Jokes for Campfire. Pirate Apparel and fun! We are looking forward to a fun camp! See you soon! Sincerely, Martha Shea, Camp Director Enclosures: Map to Camp Hervida Camp Rules & Guidelines Permission to Leave/Restricted Release, Permission to Transport Form Health History Form Sign-Up Sheet 2

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9 4-H CAMP Permission To Leave Form I,, hereby give my permission for my child, (Name of parent/guardian), to leave 4-H Camp for the following reason(s), date(s) and time(s): (Name of camper) Reason for Leaving Departure Return Date Time Date Time I also hereby authorize the following persons to pickup my children from 4-H Camp for the reason(s) listed above: I agree not to hold Hervida 4-H Camp, Inc. Ohio State University Extension staff, or assisting 4-H Camp staff responsible for accidents or other liabilities incurred while my child is away from camp. Parent/Guardian Signature Parent/Guardian Phone Date Signed Restricted Release We understand that there are situations where parents have a right to restrict who will pick up their child at the end of a program. If you need to restrict who picks up your child, you must do so in writing on this form and return it by registration. All restricted children are to wait to be released at the Women s Staff Cabin (cabin 1). If you wish to restrict who will pick up your child, please complete the form below and return it by registration. 4-H Restricted Release Form I,, (Parent/Guardian s Name) hereby authorize person(s) listed below to pick up my child/children,, following 4-H Camp. Child s Name(s) Name(s) of person(s) who are authorized to pick up my child: If my plans change, I will call or to inform the camp staff.

10 WAIVER AND PERMISSION TO TRANSPORT CHILD/CHARGE Ohio State University Extension Child/Charge: Check which event: Cloverbud Camp June 7, 2017 Beginner Camp June 7-8, 2017 Junior Camp July 3-7, 2017 Senior Camp July 10-14, 2017 Location: Hervida 4-H Camp, Waterford, Ohio Driver: The Ohio State University Extension Employees or Volunteers I give permission for my child/charge ( child ) to be transported in a motor vehicle driven by the individuals identified during an event at the specified location on the dates indicated. I understand that my child is expected to follow all applicable laws regarding riding in a motor vehicle and is expected to follow the directions provided by the driver and/or other adult volunteers. I understand that participation in the identified event is not a requirement for participation in the county or state Extension programs. I have read, understand, and discussed with my child that: (1) They will be traveling in a motor vehicle driven by an adult and they are to wear their safety-belt while traveling; (2) They are expected to respect each other, the vehicles they ride in, and the people they travel with during the trip; (3) Riding in a motor vehicle may result in personal injuries or death from wrecks, collisions or acts by riders, other drivers, or objects; and (4) They are to remain in their seats and not be disruptive to the driver of the vehicle. I recognize that by participating in this activity, as with any activity involving motor vehicle transportation, my child may risk personal injury or permanent loss. I hereby attest and verify that I have been advised of the potential risks, that I have full knowledge of the risks involved in this activity, and that I assume any expenses that may be incurred in the event of an accident, illness, or other incapacity, regardless of whether I have authorized such expenses. As a condition for the transportation received, I, for myself, my child, my executors and assigns, further agree to release and forever discharge The Ohio State University, its Board of Trustees, The Ohio State University Extension and their agents, officers, employees and volunteers from any claim that I might have myself or that I could bring on my child s behalf with regard to any damages, demands or actions whatsoever, including those based on negligence, in any manner arising out of this transportation. I have read this entire waiver and permission form, fully understand it, and agree to be legally bound by its terms. Parent/Guardian Name (please print): Parent/Guardian Signature: Date:

11 Date Received in Office JUNIOR 4 H CAMP 2017 SIGN UP SHEET (Due June 28 th ) Name: M or F Phone # Cabin Mate (Cabin Mate is ONE Friend Who is Registered for Camp) I want a password for a Digital Download of Camp Picture CLASSES: You will have three morning classes. You will automatically be enrolled in a nature class. From the following list, select more classes that you would like to take. Mark your choices 1 st, 2 nd, 3 rd, 4 th, etc. Due to some classes having a limited participant size, campers may not get their first choices. Classes will be filled according to the return date of this sign up packet. A FREE fourth class will be offered in the afternoon, with many daily choices. Sign ups will be daily at camp. No guarantee of cabin mate request being filled after June 28 th. CLASS DESCRIPTION COST 1 st, 2 nd, 3 rd, 4 th, 5 th Cake/Cupcake Practice design techniques and then decorate cupcakes $3.00 Decorating Camp Dances Learn how to do the line and mixer dances that will be done during FREE evening recreation. Camp Newspaper Write, edit, layout and publish the official camp newspaper, The FREE Hervida Herald. Camp Slide Show Take pictures and help create the slide show for Thursday night. FREE Bring your own digital camera, which can be stored in the staff cabin when not being used for class. Or use a provided digital camera. Crafts Various crafts will be made. $3.00 Ceramics D.E.A.R. (Drop Everything and Read) Paint ceramic pieces. Learn the finer techniques of ceramic painting from a ceramic professional. Make a gift for someone special! Camp Hervida s Book Club! Bring a book you are currently reading. Have some time to read and then discuss your selection with other campers. No e books, please. $2.00 $12.00 per piece FREE Fishing Bait hooks and fish in the creek at Camp Hervida FREE Hiking Hike the beautiful trails of Camp Hervida and learn about the trees FREE and other plants on the trails. In the Creek Explore the creek and learn what is living in the camp creek, explore FREE the hidden world of wetlands, and the over lapping habitat types known as exotones. Bring old shoes or boots. Leather Tooling Decorate a piece of leather with stamps using special tools. FREE Swim Beginner Learn basic swim strokes. FREE Swim Intermediate Practice swim strokes and basic dives. FREE Volleyball Learn the basics of volleyball and play FREE

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13 Bring a friend, make new friends and enjoy summer fun at Camp Hervida. INFORMATION: OSU Extension Washington County 202 Davis Avenue Marietta OH Check out the Camp video at Summer Youth Camps Fun for Everyone! These programs are held at Hervida 4-H Camp located near Waterford, Ohio. Facilities include sleeping cabins, dining facilities, recreation and crafts halls, modern boys & girls showers and restrooms, a swimming pool, and 200 acres of trees and wildlife. Welcome all youth age 5 to 15! 2017 Summer Camps Cloverbud Camp - June 7, 2017 Youth ages 5-8 who have Completed kindergarten Beginner Camp - 7-8, 2017 Youth who have completed 2nd grade and through the age of 10 Junior Camp - July 3-7, 2017 Youth who have completed grades 3, 4, 5 or 6 Senior Camp July 10-14, 2017 Youth who have completed grades 6, 7, 8 or 9

14 Camper Registration Form Priority will be given to 4-H members until June 1, After June 1 camp will be open to anyone wanting to attend camp, including 4-H ers and non-4-h ers until camp enrollment is full. For more information call MAKE CHECKS PAYABLE TO: OSU Extension Washington County and mail to that office to the attention of Peggy Bolen, 202 Davis Avenue, Marietta, OH REQUIRED DEPOSITS: are non-refundable within 15 days of camp. No refunds for partial stays. Office Use Only Amt Amt Put On Camp DB Pd Cash Pd Check Check# Date Initial Full Camp Fee Camp Deposit From 4-H Club Other Specify Jr/Sr T-Shirt CAMPER INFORMATION: First Name: Last Name: Age: Circle Gender: M F Birth Date: Mailing Address: City: State: Zip: Grade Completed in School This Spring: Print Club Name if in 4-H: 4-H Camp is... New Friendships Crafts Dances Away From Home Outdoors Recreation Fun Singing Swimming Campfire Group Living Sports A typical resident camp day is... Rise & Shine Dawn Dip (Swim) Classes Afternoon Recreation Group Meetings Swimming Evening Recreation Dances Campfire: Group Skit, Chant & Challenge Competitions Signatures Lights Out! 4-H Camp staff includes... Camp Director, Lifeguards, Deans of Men & Women, Nature Director, Nurse in Residence, Crafts Director, and Cabin Counselors. Each camper will choose two or more special classes and be involved in the camp's outdoor study, recreation, and personal development programs. Details on what to bring, class registration, activities, etc. will be mailed to each registered camper. Between $5 & $20 could be needed for crafts and canteen during the stay at camp. Craft projects cost between $1 and $12. The canteen offers ice cream treats and drinks. It will be open only once per day to promote good nutrition. Price is $.50 per item. NOTE: Beginner and Cloverbud Camp fees include crafts, canteen items, t-shirt, and camp group picture. Contact the Extension Office at to see if you might qualify for local scholarship to help pay for camp. Cloverbud Day Camp June 7, 2017 Circle t-shirt size YS YM YL AS AM AL T-Shirt & camp picture included in camp fee. Beginner Camp June 7-8, 2017 Circle t-shirt size YS YM YL AS AM AL T-Shirt & camp picture included in camp fee. Junior Camp July 3-7, 2017 Circle t-shirt size YS YM YL AS AM AL AXL Cost is $12. Pre-paid only. Order by 6/13 Senior Camp July 10-14, 2017 Circle t-shirt size YS YM YL AS AM AL AXL Cost is $12. Pre-paid only. Order by 6/13 $ 40 Full fee for 4-H Member OR $ 50 Full fee for Non 4-H Member OR $ 10 Required deposit $ 65 Full fee for 4-H Member OR $ 85 Full fee for Non 4-H Member OR $ 10 Required deposit $ 145 Full fee for 4-H Member OR $ 200 Full fee for Non 4-H Member OR $ 30 Required deposit $ 12 *Hervida T-Shirt (must be preordered) $ 145 Full fee for 4-H Member OR $ 200 Full fee for Non 4-H Member OR $ 30 Required deposit $ 12 *Hervida T-Shirt (must be preordered) *T-shirts must be pre-ordered and will have Hervida and 2017 on the front. Fees cover lodging, meals, and program supplies. Please check one: New Camper OR Returning Camper Please check one: Yes, I do OR No, I do not give the Ohio State University permission to publish in print, electronic, or video format the likeness or image of my child with their name not being identified. I release all claims against the University with respect to copyright ownership and publication including any claim for compensation related to use of the material. Checking NO means the child cannot be in the camp s group picture. Please print Parent/Guardian Name(s) Phone(s) Parent/Guardian Signature (Required) CFAES provides research and related educational programs to clients on a nondiscriminatory basis. For more information: go.osu.edu/cfaesdiversity. Ohio State University, United States Dept. of Agriculture & Washington County Commissioners Cooperating.