The staff for camp consists of teen Camp Counselors and adult chaperones, supported by camp cooks and medical staff.

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1 Pinal County offers a unique opportunity for 4-H members. Pine Combs 4-H Camp is a residential camp experience in an outdoor educational environment. Located in the cool pines just east of Williams, AZ, Pine Combs 4-H Camp is surrounded by a wooded setting adjacent to the Kaibab National Forest. Boys and girls can live and learn, grow and contribute, while having fun and making new friends! The staff for camp consists of teen Camp Counselors and adult chaperones, supported by camp cooks and medical staff. Youth ages 9-13 are eligible to attend camp. The preliminary program for this year s camp includes arts and crafts, shooting sports, astronomy, orienteering/scavenger hunts, team building, hiking and more. The University of Arizona is an equal opportunity, affirmative action institution. The University does not discriminate on the basis of race, color, religion, sex, national origin, age, disability, veteran status or sexual orientation in it programs and activities. Persons with a disability may request a reasonable accommodation, such as a sign language interpreter, by contacting the Pinal County Cooperative Extension Office at 820 E. Cottonwood Lane, #C, Casa Grande, AZ ( ). Requests should be made as early as possible to allow time to arrange the accommodation.

2 Attention Parents! Transportation to and from camp will be provided. It is your responsibility to have your children at the Cooperative Extension Office by 9:00 am on Monday, June 25 th. You will also be required to pick up your children at the same place, on Friday, June 29 th, between 12:00 and 1:00 pm. Camper Checklist The following items must be submitted for your camp application to be accepted: Camp Fee (cash, checks or money orders only) Registration Form Recommendation Letter Code of Conduct Medical History Form Copy of Insurance Card Photo Release Form Scholarship Application* (June 1, 2018) *Application is to be used only by Pinal County 4-H members who are in good standing. Include the Registration form, Recommendation letter, Medical History form and Photo Release form with the Scholarship application. Do not submit camp fee until notified that you have been selected for a Camp Scholarship. Camp Fee Overview Payment Options: Cash, Checks or Money Orders (Payable to Pinal County 4-H) Single Camper Fee: Early Registration Fee Late Registration April 20 th June 1 st (June 2 nd June 15 th ) Single Camper $125 Single Camper $150 2 nd Camper or more $100 ea 2 nd Camper or more $125 ea Fee Non-4-H Members: Not a 4-H member? That s ok! You are welcome to come to camp too. Children who are not currently 4-H members will be assessed an additional $25 enrollment fee and will be enrolled in Pinal County 4-H. Camp Refund Policy Campers will be able to get a 50% refund up to June 15 th, if unable to attend due to conflict. After June 15 th, no refunds will be available.

3 Camper Registration Form Name: Phone #: I have ( ) have not ( ) attended Pinal County 4-H Camp. No. of years attended camp: As the parent/guardian of, I have read the Arizona 4-H CODE OF CONDUCT and will support the 4-H YD Representative in charge of maintaining appropriate behavior and in the development of good character. We agree to assume financial responsibility for additional transportation costs if it deemed necessary to send our child home due to discipline problems, illness, or injury that might occur. We release the County Extension Programs and personnel, University of Arizona and those affiliated from liability should my child accidentally be injured during 4-H Camp, including all travel time. I also acknowledge that he/she is physically able to make this trip and take part in all activities. PARENT/GUARDIAN CONSENT: I give permission for to participate in the Pinal County 4-H Camp Program from June 25-29, I understand that may also include travel time while in custody of the 4-H Youth Development Representative. In the event of an emergency, I authorize the Chaperons/Directors/Supervisor to arrange for necessary and appropriate medical treatment which may be required during our absence. I agree to assume financial responsibility for additional transportation should my child be sent home because of discipline problems, illness, or injury that might occur. Parent/Guardian(s) Signature Date Telephone Numbers where to reach Parent/Guardian during Camp: The following guidelines represent the Arizona 4-H Youth Development Youth & Adult 4-H Code of Conduct: The University of Arizona Cooperative Extension s 4 H program is committed to providing a safe, fun, and healthy learning environment for youth and adults involved in activities and events sponsored by Arizona 4 H. The personal behavior of each participant is important to the success of all Arizona 4 H events. Each participant must accept their responsibility to represent themselves, their club, their county, Arizona 4 H, and the University of Arizona Cooperative Extension with dignity and pride. Individual behavior shall reflect a healthy respect for self and others in use of language and action. Group behavior shall include safe and appropriate use of public space in a manner respectful of all individuals, including participants and sponsoring organizations or entities. Participation in 4 H activities is a privilege, not a right. Participation may be terminated at the discretion of authorized 4 H officials pursuant to rules and regulations established by 4 H. All youth participants agree to: 1. Work cooperatively with other 4 H participants, youth, volunteer leaders, families, Cooperative Extension faculty and staff, and others in a courteous, respectful manner. 2. Obey the local laws as well as the laws of the state and federal government. 3. The use of any tobacco, alcohol, and illegal drugs/substances at all 4 H events is prohibited. 4. Use of firearms is prohibited, except when part of an approved shooting sports educational program. 5. Present yourself as an appropriate model in dress, manners, conduct, appearance, and actions during all 4 H events. 6. Use, respect and care for all property used. Charges will be assessed for any misuse or damage. 7. Attend planned events as may be required. 8. Know and follow established rules and expected behaviors for all programs and activities in which I participate. 9. Use appropriate language at all times. Abusive or profane language is prohibited. 10. Never resort to the use or threat of physical or emotional violence. 11. Represent the Arizona 4 H Youth Development program with pride and dignity. PARTICIPANT S AGREEMENT: I have read the Arizona 4-H Youth Development 4-H Code of Conduct and will abide by them. I realize my failure to do so could result in a loss of privileges during the event and/or in the future. Additionally, I understand and agree to dismissal from the campgrounds, at my parent s expense, if necessary. Participant s Signature: Date:

4 Camper Recommendation Letter All potential campers are required to turn in a recommendation letter. 4-H Members A recommendation letter must come from a Certified 4-H Adult Leader who can comment on the campers character, overall behavior, and conduct during various 4-H settings. Non 4-H Members A recommendation letter must come from an adult (who is not a family member) that can comment on the campers character, overall behavior, and conduct during various settings. Campers Name: Club Name: Signature: Date: Phone No.

5 UNIVERSITY OF ARIZONA, COOPERATIVE EXTENSION ~ PINAL COUNTY PINE COMBS 4-H CAMP Medical History Form Attach a copy of the health insurance card for the child listed in case of a hospital or clinic visit. If you are bringing medication, make sure your name and phone number is on them; the nurse must be advised of the direction for administration upon check-in at camp. If you have a disability for which you seek an accommodation please notify us prior to the event. Please fill out this form completely Name: DOB: / / Sex: M F Age: Parent/Legal Guardian: Home Address: City: Zip: Address: Where can you (parents/legal guardians) be reached during the camp period? Relatives or friends you authorize to act in your behalf in case of an emergency and your parent/legal guardian cannot be reached: Name: Address: Phone:( ) Name: Address: Phone:( ) In the event I cannot be reached in an emergency, I hereby give permission to the physician selected by Cooperative Extension Faculty/ Staff to hospitalize, secure proper treatment for and to order injections, anesthesia and surgery for my child as named above: Parent/Legal Guardian Date If you have been exposed to any communicable disease within a week before going on the trip, explain fully in a note to the nurse. Name of Home Town Family Physician: Phone: Insurance Company: Policy #: Health History: (Check and give approximate dates) Ear Infection Allergies Diseases Rheumatic Fever Hay Fever Chicken Pox Convulsions Insects Stings Measles Diabetes Penicillin Mumps Behavior Plants German Measles Other Drugs Asthma Food Detailed description of prescription medications: Give dates of last tetanus immunization or booster: Give dates of operations or serious injuries: Any drug allergies (other than above): Chronic or recurring illnesses: Other diseases or details of above: Any specific activities to be encouraged? Any specific activities to be discouraged?

6 Photo Release Form I grant permission to The Arizona Board of Regents, on behalf of the University of Arizona and its agents or employees, to use photographs taken of me on the date and at the location listed below for use in university publications such as recruiting brochures, newsletters, and magazines, and to use the photographs on display boards, and to use such photographs in electronic or other media, without notifying me. I hereby waive any right to inspect or approve the finished photographs or printed or electronic matter that may be used in conjunction with them now or in the future, whether that use is known to me or unknown, and I waive any right to royalties or other compensation arising from or related to the use of the photograph. I hereby agree to release, defend, and hold harmless The Arizona Board of Regents, on behalf of the University of Arizona and its agents or employees, including any firm publishing and/or distributing the finished product in whole or in part, whether on paper or via electronic media, from and against any claims, damages, or liability arising from or related to the use of the photographs, including but not limited to any misuse, distortion, blurring, alteration, optical illusion, or use in composite form, either intentionally or otherwise, that may occur or be produced in taking, processing, reduction, or production of the finished product, its publication, or dissemination. If I am 18 years of age and I am competent to contract in my own name, I have read this release before signing below, and I fully understand the contents, meaning, and impact of this release. I understand that I am free to address any specific questions regarding this release by submitting those questions in writing prior to signing, and I agree that my failure to do so will be interpreted as a free and knowledgeable acceptance of the terms of this release. LOCATION OF PHOTO: Pine Combs 4-H Camp, Williams, AZ June 25-29, 2018 Name (please print): Signature: Signature of Guardian (if under age 18):

7 Camp Scholarship Application NOTE: This application is to be used only by Pinal County 4-H members who are in good standing, having paid their program management fee and also meet the age requirements of 4-H policies; Community Club Leaders must verify members applying for scholarship support as having been active in club activities during the past year. Please complete the following questions and mail it to the 4-H office with your completed camp paperwork by the June 1, 2018, deadline. Scholarships are valued at $50 each. Name: Club Name: How long have you been in 4-H? How long in Pinal County 4-H? Have you been to 4-H Camp before? If yes, what years? What project/activities were you enrolled in for the 4-H year ? What have you learned or gained by being a 4-H member? If you have been to camp before, what was your favorite activities/events about camp last time? Why do you want to attend Pinal County 4-H Camp? What do you hope to learn during camp? Why do you need a 4-H Camp scholarship? Will you be able to go even if you do not get the scholarship award? Circle one: YES NO

8 Pine Combs 4-H Camp Information Sheet Note: Only ONE Duffle Bag or Suitcase and ONE bedroll per camper! It also includes your pillows & shoes! Packing List: You must have name tags with YOUR NAME on all luggage/bags, etc. DON T FORGET... Sleeping Gear: Sleeping Bag OR 3 Blankets & 2 Sheets Pillow Personal Items: Towels Wash Cloths Soap in Container Toothbrush & Toothpaste Shampoo-Conditioner Sun Screen Other Personal Items Spending Money ($20) Chap stick/lip Balm Clothing: Shorts Shirts Jeans Shoes (NO flip flops/sandals) Underwear Jacket (evenings are cool) Old Hat Socks Sweatshirt or Sweater Pajamas Swimming Suit and Towel Plain White T-Shirt for Tie-Dye Workshop Optional Items You May Want To Bring (at your own risk): Flashlight and Batteries Compass Whistle Softball Glove (optional) Disposable Cameras Cards or other small games Cell phone this must be checked in with Misti Todd upon arrival at 4-H Camp and you will get it back when we leave camp. If parents need to contact a camper during camp they should call the 4-H office to relay messages. Please Leave at Home all electrical appliances - our 4-H Camp is an unplugged camp so no blow dryers, electric curlers, or electric razors. Jewelry, firearms, matches, knives, or shaving cream are also prohibited items. Campers are NOT allowed to bring candy, snacks, or food to camp! Instructions to Pinal County 4-H Camp 1. Travel west from Flagstaff towards Williams on I Exit Interstate 40 at the Pittman Valley Exit, also called the Deer Farm Road Exit. This exit is approximately 25 miles west of Flagstaff and 6 miles east of Williams. 3. The Pittman Valley Road exit ramp climbs onto the overpass. At the stop sign from this exit, turn left (south) and cross over the freeway on the overpass. 4. Stay on Pittman Valley Road (do not take the access road to the Quality Inn) heading south. Travel a short distance (approximately 1/4 mile) on the road which takes a gentle curve which results in heading due east. Turn right on Good Lane and travel south for approximately 1/4 mile. At this point you see a stock pond and small access road which travels west for approximately 1/4 mile. Take this access road and WELCOME! It may be helpful to label items you are bringing to camp. Others may bring items that are similar or the same as yours labeling will help assure that your items go home with you. Attention Parents! It is your responsibility to get your children to the drop off/pick up location (820 E. Cottonwood Lane, Casa Grande, AZ) at the appropriate times. June 25 th by 9:00 am / June 29 th between 12:00-1:00 pm

9 4-H Dress Code The following guidelines are designed to make everyone s experience at 4-H events enjoyable. All campers, counselors, volunteers, and 4-H YD staff, shall adhere to the core values of the University of Arizona, 4-H Youth Development Program, respect the individual rights, safety, and property of others. The following dress code was developed to prevent participants from becoming offended or uncomfortable during 4-H events. If you choose to dress inappropriately, you will be asked to change, or be required to leave until dress code is followed. By planning ahead you will save yourself the inconvenience of changing your attire to ensure that you contribute to a pleasant atmosphere. Please be advised that the following dress code will be enforced. 1. Clothing: All clothing shall be neat, clean, acceptable in repair and appearance, and shall be worn within the bounds of decency and good taste as appropriate for 4-H events. 2. Articles of clothing which display profanity, products, or slogans which promote tobacco, alcohol, drugs, sex or are in any other way distracting, are prohibited. 3. Excessively baggy or tight clothing, and clothing which advertises gang symbols or affiliation is prohibited. 4. Items of clothing which expose bare midriffs, bare chests, undergarments, or that are transparent (see through) are prohibited. Tank tops with straps wider then one inch are permitted. Please be advised that spaghetti straps, shirts which expose bare back, halter tops, and tube tops are prohibited. 5. Swimming (for all water recreation): Swimsuits for men: swim trunks only (no shorts, cut-off pants, or Speedos). Swimsuits for women: One-piece suits recommended, however, two-piece suits are allowed as long as they are modestly cut. No string, thong, crochet suits will be allowed. Swimsuits may only be worn while in the swimming pool area.