Money: Please do not allow participants to bring money or valuables.

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1 Jefferson County Cooperative Extension Service 4-H Youth Development Program 275 North Mulberry Street Monticello, FL Office Phone: Cell Phone: Fax: March 20, 2018 TO: FROM: Day Camp Participants & Parent/Guardian John G. Lilly Sr., 4-H Coordinator RE: Wildlife Camp, July 9 13, 2018 Starting on July 9, we are going on a fascinating journey that will take all of our participants for the 4-H Outdoor Wildlife and Recreation expedition. This fantastic adventure will help to provide a basic understanding of environmental conservation, safety, and fun in the woods! Expert instructors will begin each day providing hands-on activity sessions in Forestry, Conservation, Wildlife, Aquatics, and in the afternoon youth will participate in the 4-H Shooting Sports sessions lead by 4-H State and National Certified Instructors in archery, and air rifle. Camp Location: Jefferson County Extension Office Cost & Registration: The cost for the camp is $ Make check or money order payable to Jefferson County 4-H Association. There is a limit of 30 participants for the camp. Please complete all attached forms and return to the 4-H Office. The deadline to pay fee and register is Monday, July 2. Camp will begin at 8:30am each morning and end each day at 4:30. Please make sure you have arranged for drop off and pick up each day. All youth must be picked up at the Extension Office by 5:00pm each day. Food: All participants will need to bring snacks each day to the camp. Lunch will be provided. Friday afternoon we will have a cookout, and the menu will consist of hamburgers, hotdogs, chips, drinks, and cookies. If you child has certain dietary restrictions, please let me know ASAP. Money: Please do not allow participants to bring money or valuables. Aquatics: Thursday we will spend the day at Pinney Z Sub-division at Lake Lafayette located in Tallahassee. Youth will be fishing, canoeing, and collecting water specimen. Please make sure youth wear clothes and shoes they do not mind getting wet.

2 Items To Bring: Insect spray and sunscreen Items not to bring: Cell phones or other electronic devices. Recommended Attire: Participants will need to wear pants a comfortable shirt and comfortable shoes (closed toe and closed heel shoes). No flip flops or open toe shoes. Camp Behavior: Please complete the enclosed 4-H participation form. Camp rules and regulations will be discussed the first day of camp. All campers will be expected to abide by these rules during the full content of the week. If for some reason the camp participant chooses not to abide by the rules, they will be sent home and will not be allowed to return. The objective of the camp teaches you to teach participants how to become environmental stewards by respecting and protecting our environment. We will also have youth participants from Leon County in attendance at this camp experience; therefore it is crucial that everyone is on his or her best behavior. We look forward to seeing everyone on the morning of July 9th, 8:30am sharp.

3 4-H Camper Registration Form 2018 Jefferson County Wildlife Outdoor Recreation Camp July 9-13, 2018 Name Age Race Sex Address City Zip Parents Name(s) Camper Birth Date: / / (Must be 10 by September 1, 2017) (Month, Date, Year) Home Phone Number Work Phone Number Do you have any special Dietary needs? If yes, explain below. Free Breakfast will be provided during the day camp for those who register. My child plans to eat breakfast at day camp. My child does NOT plan to eat breakfast at day camp and will eat breakfast before arriving at camp. Free Lunch will be provided during the day camp for those who register. My child plans to eat lunch at day camp. My child does NOT plan to eat the free lunch at day camp and will pack a sack lunch to bring to camp every day except for Friday. Friday there will be a cook out. Parent Signature: Date: CAMP FEE IS $35.00 TO BE PAID AT THE TIME OF REGISTRATION. THERE IS LIMIT OF 30 CAMPERS FOR THIS CAMP.

4 PERMISSION FORM FOR ADMINISTRATION OF MEDICATION (PRESCRIPTION & NON-PRESCRIPTION) Jefferson County Please list child s name and turn in form whether or not any medication is listed. Thank you! Child s Name: 1. Name of Medication Dosage Time to be Administered Purpose of medicine Possible side effects/special instructions 2. Name of Medication Dosage Time to be Administered Purpose of medicine Possible side effects/special instructions 3. Name of Medication Dosage Time to be Administered Purpose of medicine Possible side effects/special instructions Emergency Phone Numbers: Parent s Name: Work Home Other Work Home ALL MEDICINES (prescription and non-prescription) ARE TO BE TURNED IN UPON CAMP ARRIVAL AND WILL BE KEPT BY THE HEALTH SUPERVISOR AND IN A CENTRALIZED LOCATION. I Certify the Necessity of the above Medication (S) and it Is Understood by the Undersigned That There Shall Be No Liability for Civil Damages as a Result of the Administration of Such Medication Where the Person Administering Such Medication Acts as a Reasonably Prudent Person Would Have Acted under the Same or Similar Circumstances. Date Parent/guardians Signature

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