Napa County 4-H Families LET S GO TO SUMMER CAMP Week I: June 9-14, 2019 Week II: July 21-26, 2019

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1 Napa County 4-H Families LET S GO TO SUMMER CAMP Week I: June 9-14, 2019 Week II: July 21-26, 2019 ACTIVE 4-H MEMBERS (Youth currently enrolled in a 4-H Club) WHEN IS CAMP? 4-H Summer Camp will be held at Las Posadas State Forest near Angwin in Napa County. Week I Camp will begin with registration at 1:00 p.m., on Sunday, June 9 th with pick up at 7:00 p.m. and closing ceremonies to follow, Friday evening, June 14 th. Registration for Week II Camp will begin at 1:00 p.m., on Sunday, July 21 st with pick up at 7:00 p.m. and closing ceremonies to follow, Friday evening, July 26 th. Camp must be cleared by 10:30 p.m. on Friday. WHERE IS CAMP? Las Posadas is a state experimental forest in a beautiful canyon filled with Redwood, Pine and Oak trees. The camp is about a 45 minute drive from Napa. The camp is directed by a team of adult counselors and teen staff. A qualified lifeguard and nurse are on duty at all times. Three professional cooks, experienced in preparing nutritional and well-balanced menus, do the cooking. Three meals a day are served from a central kitchen, and nutritional snacks will be offered at different times during the day. WHO GOES TO CAMP? All Napa County 4-H members, leaders and parents are invited to participate. Campers need to be 9 years old by January 1, One chaperone is needed for each 8 campers or a fraction thereof attending camp (no exceptions). Napa County 4-H Council requires that before it may send a young adult counselor (18-20 years of age); it must send an adult chaperone (over 21 years of age). Adults attending camp will be recognized as adult 4-H Leaders/Chaperones. Camp counselor or chaperone training and information is provided. Applications are available. Men are especially needed as camp chaperones to provide a balanced and wholesome camp. WHAT WILL YOU DO AT CAMP? The camp program provides for learning experiences in nature, hiking, outdoor cooking, crafts, and many other activities. Ping-pong, volleyball, and swimming are available during the day. Campfire programs include: songs, skits, and recreation. The purpose of the camp is to enjoy learning, respect and responsibility for ourselves, others and the environment. Rules for acceptance and participation in the program are the same for everyone without regard to race, color, national origin, age or handicap. It is the policy of the University of California (UC) and the UC Division of Agriculture & Natural Resources not to engage in discrimination against or harassment of any person in any of its programs or activities (Complete nondiscrimination policy statement can be found at ) Inquiries regarding ANR s nondiscrimination policies may be directed to John I. Sims, Affirmative Action Compliance Officer/Title IX Officer, University of California, Agriculture and Natural Resources, 2801 Second Street, Davis, CA 95618, (530)

2 4-H SUMMER CAMP INFORMATION When can I mail my camp application? Please send your application via US mail with a postmark of Monday, March 11, 2019 through Saturday, March 30, Active 4-H members will be mailing their application in before non-active members if they want to guarantee getting a spot at camp (if space is available). Active members can continue to mail their application through Saturday, April 13, 2019, the closing date for all applications, but will be accepted first come, first served along with the non-active 4-H members. New Camper Meeting Those attending camp for the first time MUST attend a new camper s meeting. The meeting will be held at the UCCE Meeting Room (4-H Office), 1710 Soscol Avenue, Napa. Week I New Campers Meeting 6:45 pm, Wednesday, May 15, 2019 Week II New Campers Meeting 6:45 pm, Wednesday, June 26, 2019 Camp Fees $ per camper. There is no additional discount for multiple family members. Fee includes T-shirt, Snack Shack and Camp picture. Checks will not be cashed until your child is accepted into camp. Refunds There will be no refunds after Friday, May 24, There will be a $25 processing fee for any refunds requested before Friday, May 24, H Camp Confirmation Letters Camp acceptance letters will be mailed by Friday, April 26, H Camp Booklet Week I camp booklet will be mailed by Friday, May 17, Week II camp booklet will be mailed by Friday, June 28, Questions napa4hcamp@hotmail.com and the Camp Registrar will do her best to answer any questions you may have. Donations Donations allow us to keep camp fees to a minimum so that as many children as possible may attend camp. If you would like to make a tax deductible donation to the 4-H camp program you can remit to the Napa County 4-H Camp, P O Box 4221, Napa, CA Thank you for your support. $10 $25 $50 $ (other) Checks payable to 4-H Summer Camp 2

3 PACKET #1 Active 4-H members (those currently enrolled in 4-H). US Mail only - postmarked from March 11 through March 30, Napa County 4-H Summer Camp 2019 Camper Application Open to Napa County youth (must be 9 yrs. old by 1/1/19) Week I: June 9-14, 2019 (Check-in: June 9) Week II: July 21-26, 2019 (Check-in: July 21) Complete one application per camper. First come, first served. Choose one: WEEK I WEEK II Have you been to 4-H camp before? Yes No Camper s name Name on name tag Date of Birth Gender: Male Female T-shirt size: Adult S M L XL XXL Address Street City/Zip Code Parent s phone Cell Work Adult contact address Name of 4-H Club (must be enrolled in club year) Parent/Guardian s signature Print name CODE OF CONDUCT AGREEMENT (read pages 4 and 5 before signing.) I have read the Code of Conduct and agree to abide by its rules. I understand that infractions of this code will result in any or all of the penalties listed in the Code of Conduct. Member Signature Date Parent/Guardian Signature Date Please let us know if any special accommodations are necessary for your child to attend camp. INCOMPLETE APPLICATIONS OR APPLICATIONS RECEIVED BEFORE THE POSTMARK DATE WILL NOT BE ACCEPTED. COMPLETE CAMP APPLICATION PACKET includes: 2019 Camper application completed and signed by a parent and member. Payment for the full camp fee (make check payable to Napa County 4-H Camp) (Checks will not be cashed until child is accepted into camp). Your photograph attached to the application Signed Youth Treatment Authorization & Health History Information Signed Code of Conduct agreement (see above) All camp application forms must be mailed to: Napa County 4-H Camp P O Box 4221 Napa, CA CAMP FEES FOR ACTIVE 4-H MEMBERS $ per camper. Fee includes T-shirt, Snack Shack & Camp picture Check payable to: Napa County 4-H Camp No refunds after Friday, May 24, Place a current photograph here. No line drawings please.

4 4-H CAMP CODE OF CONDUCT The following guidelines are designed to make your experience at 4-H Camp satisfying to you and to all others attending. This means that all participants members, leaders, and staff shall respect the individual rights, safety, and property of others. While you are attending 4-H events, you are representing all of 4-H. THINGS THAT WILL NOT BE TOLERATED AT CAMP Any person at camp that violates either of the following two (2) rules will be returned home at their own or parent s expense for the duration of the event and may not be allowed to participate in future 4-H events. All offending materials will be confiscated. Law enforcement will be called if laws are suspected broken. Possessing or consuming alcoholic beverages and/or drugs other than prescription medication is PROHIBITED. Possession or use of firearms, flammable materials including fireworks, knives, slingshot, axes and other items that can cause harm is PROHIBITED. BEHAVIOR REQUIRED FOR HEALTH AND SAFETY 1. The ground is uneven and rough at camp, therefore: Closed-toed shoes are required footwear at camp. Going barefoot is never allowed except in the shower or pool. Wearing thongs or flip-flop type shoes other than in the shower may result in confiscation. Running other than in planned organized activities is not allowed H Camp is a smoke-free and tobacco-free environment in which smoking, the use of smokeless tobacco products, and the use of unregulated nicotine products (e-cigarettes) is prohibited. 3. Camp participants are not allowed to bring snacks or other food items to camp! Food attracts rodents (mice and rats). Rodents cause health and safety problems. Nutritious snacks will be provided all days. 4. Due to low wattage wiring, hair dryers and other electrical equipment may not be used by anyone at camp. Electrical equipment will be confiscated. 5. Cars are to be parked only in the assigned parking lot areas. The only vehicle allowed to be parked in the central camp area are vehicles used for ambulance, trash removal, delivery or maintenance. All keys will be turned into Camp Dad upon arrival and will be kept in a secured locked box for the duration of camp. BEHAVIOR REQUIRED FOR RESPECT AND CIVILITY All fights (food, fist, etc.) are PROHIBITED. Hitting, slapping, pinching and physical contact of any kind if PROHIBITED. Deliberate destruction of property, plants and animals is PROHIBITED. Campers, Teen Staff and Counselors/Chaperones must obey dress code at all times. Each participant is to be in his/her assigned area at curfew and to comply with quiet hours, lights out and other rules of camp. Only camp participants may be in the camp sleeping areas (these are your bedrooms). Parents and workers may enter the sleeping area only after special permission and public announcements. No one is allowed in the sleeping area of members of the opposite sex (see parent and worker exceptions above). 4

5 BEHAVIOR REQUIRED FOR RESPECT AND CIVILITY - continued All who attend camp must be accountable to the Camp Director, Camp Mom and/or Camp Dad or their designee. No youth or adult may leave camp without permission from Camp Director or Camp Mom and Camp Dad. All Campers and Teen Staff must be accompanied by an Adult Counselor/Chaperones on all hikes. A hike sign out/in sheet must be posted on the camp bulletin board for each hike leaving the central area of camp. Sign out sheets must list all hikers, destination and time left and return time. Gambling at camp is PROHIBITED. Obscene and discriminating language and insubordination is not acceptable at any 4-H event. Youth and adults should demonstrate respect for one another. Overly affectionate displays of attention between camp participants is not appropriate behavior at camp. GENERAL SUPERVISION AND ENFORCEMENT The adults at camp are responsible for the health, safety and well-being of all at camp. They are authorized and empowered to insure that these rules will be observed by all at camp. The adults responsible for Camp reserve the right inspect 4-H members possessions if PROHIBITED substances or items are suspected. Campers, Teen Staff and Adult Counselors/Chaperones are expected to aid in the enforcement of these rules. Therefore, all are charged with: correcting minor infractions on the spot reporting observed infractions promptly to an adult and ASAP to the Camp Director, Camp Mom and Camp Dad for final disciplinary actions. Penalties may include any or all of the following: Sending a member home; possible recommendation to 4-H Council that the member be barred from future 4-H events; assessing the number the cost of damages and repairs in the event of damage/destruction of property; releasing the member to the nearest law enforcement agency and/or proper authorities; and termination of 4-H membership (youth or adult). Parents and the county UCCE (4-H) office will be notified of action taken. If a member is to be sent home, parents will be called to pick up the child and will be sent home at the parents expense; fees will not be refunded. CELL PHONES Campers are not allowed to bring cell phones to camp. In the event a camper brings a cell phone to camp, it will be put in a locked box and returned to the campers parents on Friday night when they check out of camp. It is strongly suggested that Teen Staff do not bring their cell phones to camp. In the event that Teen Staff wish to bring their cell phone it may be used to play music or to take pictures, however, no pictures taken may be posted on social media of any kinds. 5

6 Youth Treatment Authorization Form Print all information clearly. (PAGE SUBMITTED TO AND RETAINED BY THE 4-H CLUB/UNIT LEADER) This Treatment Authorization Form is authorized for all 4-H Youth Development meetings and activities during the dates specified below (Please Note: This information must be updated annually). First Name Last Name Club/Unit Name Napa/California From: June 1, 2019 August 1, 2019 County and State PARENT(S)/GUARDIAN(S) First & Last Home/Work/Other Name Phone: Cell Phone: EMERGENCY CONTACT INFORMATION (must be an adult other than Parent/Guardian) First & Last Name: Home/Work/Other Phone: Relationship: Cell Phone: While my child is attending or traveling to or from this 4-H function, I HEREBY AUTHORIZE THE 4-H ADULT VOLUNTEER OR 4-H STAFF MEMBER, or in his/her absence or disability, any adult accompanying or assisting him/her, TO CONSENT TO THE FOLLOWING MEDICAL TREATMENT FOR SAID MINOR: Any x-ray examination, anesthetic, medical or surgical diagnosis or treatment, and hospital care which is deemed advisable by, and is to be rendered under the general or special supervision of any physician and/or surgeon licensed under the provisions of the Medical Practices Act, California Business and Professions Code Section 2000 et seq.; or any x-ray examination, anesthetic, dental or surgical diagnosis or treatment, and hospital care to be rendered by a dentist licensed under the provisions of the Dental Practices Act, California Business and Professions Code Section 1600 et seq. This authorization is given pursuant to the provisions of California Family Code Section This authorization shall remain effective until my child completes his/her activities in this program unless sooner revoked in writing. I understand that as a parent/guardian, I will be responsible for the cost of any service or treatment provided not covered by the 4-H Accident/Sickness Insurance Program sponsored by UC Cooperative Extension. AUTHORIZATION AND CONSENT AND RELEASE I hereby certify that my child is in good health and can travel to and participate in all functions of the 4-H Youth Development Program as described above. I am the parent/guardian having legal custody of the youth member named above as stated under California Family Code Section I understand it is my responsibility to keep the information on this form updated (including Health History) by contacting the County 4-H Office. Signature of Parent/Guardian Date NON-CONSENT I do not desire to sign this authorization and understand that this will prohibit my child from receiving any non-life threatening medical attention in the event of illness or accident. Signature of Parent/Guardian Date University policy and the State of California information Practices Act of 1977 require the following information be provided when collecting personal information from you. The information entered on this form is collected under the authority of the Smith-Lever Act. Submission of the medical data is voluntary. However, a signature is required on one or the other of the two signature lines above. Failure to provide the medical information and authorization may result in our inability to provide the necessary medical treatment. You have the right to review University records containing personal information about you, with certain exceptions as set forth in policy and statute. Copies of University policies pertaining to the collection, use, or release of personal data are available for your examination from the local UCCE County Director, 4-H Youth Development Advisor, 4-H Program Representative or the Statewide 4-H Director at University of California, Division of Agriculture and Natural Resources/ California State 4-H Office, 2801 Second Street, Davis, CA , (530) ca4h@ucan.edu. Only your own records are open for review. 6

7 Health History Information Print all information clearly. (PAGE SUBMITTED TO AND RETAINED BY THE 4-H CLUB/UNIT LEADER; SHRED AFTER THE PROGRAM YEAR) (please attach extra page if more space is needed). NAPA First Name Last Name County Date of Birth Date of last Tetanus Vaccination: Not Sure None Please check over-the-counter medications that may be administered: Tylenol Ibuprofen Cough Syrup Decongestant Dramamine Antacid Polysporin Hydrocortisone Benadryl Other Please identify if this participant has any health conditions that are important for program staff to know in order to maximize participation and ensure safety and well-being: OR check here if no information needs to be shared Please list all current medications: Name of Medication Dosage Times Taken Please identify any allergies including allergies to food, medications and drug reactions. Please include any additional remarks and special instructions to better assist emergency service personnel. Please list any additional assistance the youth will need in order to participate in this program or activity. Note: In some cases, a Doctor s note may be required to confirm the request. Does the youth have any current emotional or behavioral difficulties that would be helpful for us to know about? Are there any ways of responding to the youth s negative moods or feelings that you found to be effective? Would you like to share any significant life or family events that will help us support the youth s current emotional state? Yes No Please explain any Yes answers on this page. 7