Who Can Attend Camp: All youth who have graduated 3rd grade are eligible to attend 4-H Camp in the summer of 2018.

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2 Thank you so much for your interest in attending 4-H Camp! We are excited for another great week this summer and are looking forward to you joining us! Some great changes have taken place since last summer including air conditioning in the cabins and in the dining hall as well as some new staff led classes! Who Can Attend Camp: All youth who have graduated 3rd grade are eligible to attend 4-H Camp in the summer of Where: North Central 4-H Camp 260 St-1035, Carlisle, KY Cost: Camp cost is $235 which covers all transportation to and from camp, all meals and snacks, all class fees and a t-shirt. Limited half scholarships are available on a need basis by application. NEW THIS YEAR - Help a 4-H Youth Attend Camp! Families with the ability are invited to contribute to the 4-H Camp Scholarship General Fund by paying over the minimum $235. Any additional money would go towards offering camp scholarships for those who apply. When: Monday, July 16th - Friday, July 20th, 2018 We will be hosting a mandatory camper orientation on Thursday, June 28th at 6:00pm at the Woodford County Extension Office. During this time we will go over camp rules, packing information, schedule and cabin assignments. Deadline: Camp applications are due no later that June 1st, 2018 and spots are filled on a first come, first served basis. This year we are offering a unique camping experience for male campers. Staying at Outpost offers a more traditional camping experience where campers spend their week in an open-air shelter rather than a cabin and enjoy a more rustic experience including making campfires at night. If you would be interested in staying at Outpost, please check the box below. Outpost (Males only) Campers staying in the Outpost will still participate in all camp activities including classes and will still be chaperoned by adult and junior counselors according to camp policies.

3 Received by: Date: Cabin Assignments What makes 4-H Camp the best is that you get to enjoy it with all of your friends! In the space below, please indicate two other campers that you would like to bunk with in the same cabin. We ll use these names to fill classes as well. While cabin and class spots are limited and we can t make any guarantees, we will do our best to place everyone with their friends! Class Sign-ups Classes at camp are a great opportunity to learn a new skill or try something new! Each camper takes four classes that each last an hour, and they take the same four classes on Tuesday, Wednesday and Thursday. We are doing class sign-ups prior to heading to camp, which will free up even more time for great activities once we get there! Below is a list of classes we are offering this summer at 4-H Camp. Please rank each class 1-21, with #1 being your absolute favorite class and #21 being the class you want to take the least. Please refer to the next page for class descriptions! Classes are filled on a first-come, first-served basis and spots are divided evenly among the three counties. Keep in mind that while not everyone is guaranteed their four favorite classes, we will do our best to make sure you end up in as many top-ranked classes that you like! Beginning Swimming Advanced Swimming Archery Riflery Nature Recreation Outdoor Living Canoeing Low Ropes High Ropes Kayaking Ultimate Frisbee Soccer Photography Gaga Ball Leadership Fishing Basketball Volleyball Foods Crafts

4 Class Descriptions Advanced Swimming Participate in water activities/games; Use diving board Archery Learn archery safety and basic skills; Use archery equipment at range Basketball Learn basic skills and participate in games Beginning Swimming Learn basic swim techniques; Participate in water activities/games Canoeing Learn canoeing safety, basic skills, and water games; Use canoes on lake Crafts Make various crafts during the week Fishing Learn fishing safety and basic skills; Fish at the lake Foods Learn basic food preparation skills and create your own snack foods Gaga Ball Learn basic skills and participate in games (The game is played within a ring with short panels, and uses a playground ball that is bounced so that players attempt to tag another player in the lower leg with the ball in order to get them out) High Ropes Learn rock climb wall safety and skills for climbing; Learn zipline safety; Climb 40 foot mock rock wall and zipline down on the other side Kayaking - Learn kayaking safety, basic skills, and water games; Use kayaks on lake Leadership This is open to older youth that want to lear n mor e about leader ship, in pr epar a- tion to being a camp counselor in the future (Counselors in Training must sign up for this class) Low Ropes Participate in low rope elements not far from the ground, while working as a team to complete challenges (examples: rope bridge crossing, bridge balance, rope spider web activity, and many more) Nature Learn about nature as you take hikes on the trails around camp Outdoor Living Skills Learn how to build and cook over campfires; How to build shelters; Get an intro to wilderness first aid Photography Learn basic photography skills and techniques; Take photos during camp week Recreation Learn and participate in various games and camp dances Riflery Learn rifle safety and basic skills; Use equipment at range Soccer Learn basic skills and participate in soccer games Ultimate Frisbee Learn basic skills and participate in games (The game uses a Frisbee that is passed from team members using only a few steps at a time in an effort to get the Frisbee over the goal line) Volleyball Learn basic skills and participate in games

5 Kentucky 4-H Camping Program 2018 Camp Participant Registration Camper/Teen (Ages 5 to 17) Last Name: Legal First Name: Middle Name: Preferred Name: Attended camp before? Yes - # years: No School grade entering: What school does the camp participant attend? Gender: M F Shirt Size: (Circle One) YS YM YL AS AM AL AXL A2XL A3XL A4XL Birthdate: / / How old will the participant be on the first day of camp? Participant s home address: Race (check all that apply) American Indian Asian Pacific Islander White Black Hispanic Non-Hispanic Participant s LEGAL Custodial Parents/Guardians #1 Full Name: Home Address: Address: Cell/Home Number: #2 Full Name: Home Address: Address: Cell/Home Number: Emergency Contact if above individuals are unavailable Full Name: Relationship to participant: Cell/Home Phone: Participant s Family Physician Name: Address: Phone Medical and Dietary Restrictions (list all known and reaction management):

6 CAMP USE ONLY (Healthcare Staff Review Stamp) Had any recent injury, illness, or infectious disease? Have a chronic or recurring illness/condition? Ever been hospitalized? Ever had surgery? Have frequent headaches? Ever been knocked unconscious? Wear glasses, contacts, or protective eyewear? Ever had frequent ear infections? Ever passed out, dizzy, or chest pain during exercise? Ever had an eating disorder? Had problems with sleepwalking? Ever had seizures? Ever had emotional difficulties? Carry an epi-pen or inhaler? Explanation of YES answers: YES NO Ever had high blood pressure? Ever been diagnosed with a heart murmur? Ever had back problems? Ever had problems with joints, knees, or ankles? Have an orthodontic appliance brought to camp? Have any skin problems (rash, acne)? If female, any abnormal menstrual history? Had problems with diarrhea or constipation? Had mononucleosis in the past 12 months? Have diabetes? Have asthma? Have a history of bed wetting? Have severe allergies? YES NO Behavior or Medical History Are there any other behavior needs, accommodations, or information which the staff should be made aware of to provide a better camp experience for the participant? Immunization Records Is the camp participant up-to-date on immunizations as outlined by Kentucky law required for enrollment in public school, based upon the grade the participant will be enrolled for the upcoming school year? YES NO (If marked NO, check with your 4-H agent for a waiver of liability form.) Does the participant have health insurance coverage? YES (Attach a copy front and back of the insurance card in the boxes below.) NO (No worries! Camp provides an excess medical insurance coverage in the event of injuries or illnesses.) FRONT OF INSURANCE CARD BACK OF INSURANCE CARD Do you want to buy your camper/teen some camp gear? Is your camper looking for more camping opportunities?

7 CAMP PARTICIPANT S NAME: AUTHORIZATIONS/RELEASES This is a legal document. You must read and understand it before signing it. Consent to Treat: The health history reported on page one and two are correct and complete to the best of my knowledge. The person herein described has permission to engage in all camp activities except as noted. I hereby permit the camp to provide routine health care, administer over the counter medication, assist in administering participant s prescription medications as needed, and seek emergency medical treatment including ordering x-rays and routine tests. I agree to the release of any records necessary for treatment, referral, billing, or insurance purposes. I permit the camp to arrange necessary related transportation for my child. In the event I cannot be reached in an emergency, I hereby permit the physician selected by the camp to secure and administer treatment, including trips out of camp. Media Release: I grant the Kentucky 4-H Program and the University of Kentucky, and persons acting through them, the right to use, reproduce, assign, and/or distribute photographs, films, videotapes, and sound recordings of my minor child without compensation for use in promotion/advertising, educational publications, electronic publishing, and personal memorabilia. Participant names may be published. Yes. I grant permission for media releases. No. I do not grant permission for media releases. Code of Conduct: I have read and discussed the Code of Conduct with my participant. We (parent/guardian and participant) understand and agree to comply with the guidelines. Violations may result in the loss of privileges, removal from camp with no refund, assessment of a damage fee I will be responsible for paying, and/or ineligibility to participate in future 4-H events. An incident report will be completed for major violations Permission to Participate: I understand that my child s participation in the Kentucky 4-H Summer Camping Program is based on the challenge by choice philosophy. I recognize that programs are designed to use experiential, engaging teaching techniques, but that my child s participation is purely voluntary, always, and my child will choose his or her level of participation in any activity. The camp activities listed below require acknowledgement of the risks involved and permission to participant from the parent/guardian. Place a check indicating YES or NO next to each activity, and then sign below. YES NO YES NO High Ropes Horses (WKY only) Low Ropes Cave (LC only) Archery Firearms Pick-up Release: It is my responsibility to arrange to pick up my child/children upon return from camp. There will be no exceptions to this policy regardless of relationship to the child. Please inform everyone approved by you on this release that he/she must present a driver s license or photo ID before the child will be released. Parents, Guardians, and Emergency Contacts listed on page 1 are automatically assumed to have pick up authorization. In addition to the parents/guardians listed on page 1, the following individuals are granted permission to pick up my child NAME: RELATIONSHIP Phone/Cell# NAME: RELATIONSHIP Phone/Cell# NAME: RELATIONSHIP Phone/Cell# Assumption of Risk and Release of Liability: I acknowledge that there are certain risks, hazards, and dangers, including the risk of physical injury, disability, or death and risk of loss of use or damage to my personal property as a result of allowing participation in the camping program. Risks include but are not limited to recreational games and traditional camp activities, transportation accidents, weather-related hazards and natural disasters, infectious diseases, the possibility of slips and falls, pinches, scrapes, twists, and jolts that could result in scratches, bruises, sprains, lacerations, fractures, concussions, or even more severely debilitating or life-threatening hazards. I understand that injury or loss may result from unknown or unexpected risks and the use of equipment, materials, or facilities recommended by the University of Kentucky; environmental conditions; from the acts or omissions of others; or from the unavailability of immediate and adequate emergency medical care. I understand that the University of Kentucky does not guarantee the personal health or safety of participants, nor does it protect against the risk of loss of personal property. In consideration for allowing my child to participate in the camping program, I do hereby release Kentucky 4-H Camp, the University of Kentucky, and its members, trustees, officers, employees, independent contractors, volunteers and extension staff from any and all liability, damages, cost, and expenses arising out of or relating to bodily or psychological injury, loss of life, or personal property that may occur as a result of participating in the camping program. Participant Signature: Date: Parent/Guardian Signature: Date: