Dubuque County Conservation Board Summer Camp Schedule The following camps will be offered the summer of 2016 at the Swiss Valley Nature Center. Please pay close attention to the details of the camps ages, fees and quantity limits. Toddling into Nature Age 3 Butterflies Session 1: Thursday & Friday, June 9 & 10 9:00 am to 11:00 am Session 2: Thursday & Friday, June 16 & 17 9:00 am to 11:00 am Your toddler will enjoy learning about the most noticed insect known as the butterfly! They will learn about their adaptations, native butterflies and where to find these pollinators. Your child will explore the outdoors through games, books, and hands-on activities. Parents should plan to stay and play with the toddlers. This camp will be limited to 12 participants and registration is required by June 6, 2016. *Program Fee $5.00 per camper Sapling Camp Ages 4-6 Dino Camp Session 1: Monday & Tuesday, June 13 & 14 9:00 am to 12:00 pm - FULL Session 2: Monday & Tuesday, June 20 & 21 9:00 am to 12:00 pm - FULL This camp is designed for preschool age and first year school students. The two day schedule will include activities involving outdoor recreation, reading, snacks, songs, crafts, games, hiking all associated with DINOSAURS. Nature is full of wonder and our 4, 5, and 6 year olds will have no problem embracing the awesome world Prehistoric critters! Parents are encouraged to stay during camp but are not required. Snack is provided during this camp, pack a lunch for your child as one will not be provided. This camp will be limited to 15 participants at each session and requires registration by June 6, 2016. *Program Fee: $10.00 per camper Maple Camp Ages 7-9 Birding Camp Session 1: Tuesday-Thursday July 5-7 9:00 am to 1:00 pm - FULL Session 2: Tuesday-Thursday July 12-14 9:00 am to 1:00 pm This camp is made for those children who cannot get enough of the outdoors. Children ages 7 to 9 will love the hands on activities focused on the environment and how they fit into it. Birding camp will have the kids learning the about magic that exists every day in our many habitats! We will hike, read, explore and more! Snack is provided during this camp, pack a lunch for your child as one will not be provided. This camp will be limited to 20 participants at each session and requires registration by June 28, 2016. *Program Fee: $15.00 per camper Oak Camp Ages 10-12 Watersheds Tuesday-Friday, July 19-July22 9:00 am to 2:00 pm - FULL This camp is taking the next step into the outdoors. Participants will discover local resources that make NE Iowa special! We will explore different habitats and get a chance to try outdoor sports. (Parents, locations of camp may change, we will email the locations after registration, and pack your child a lunch, we are providing snacks only.) This camp will be limited to 20 participants and requires registration by July 6, 2016. *Program Fee $15.00 per camper T.E.A. (Teen Extreme Adventures) Ages 13-16 Tuesday-Wednesday, July 26 & 27 (Overnight) This camp will be an opportunity for participants to practice team building, learn about outdoor skills, camping, fire starting, and water recreation. Participants will canoe, picnic, hike, and learn about Aldo Leopold. This camp will be limited and requires registration by Wednesday, July 13, 2016. *Program Fee: $35.00 Day Camps Ages 5-12 Adventures at Swiss Tuesday, August 2nd 9-11 am Tuesday, August 9 th 9-11 am These two day camps will allow children to hike and learn about the treasures of NE Iowa through hands on activities. Preregistration by July 21, 2016 *Program Fee: $5.00
Summer Camp Registration Full Name of Camper Parent or Guardian of Camper Address Email Address (for confirmation and quick share of info.) Phone Number (home, work, and cell) Please circle the camp(s) you wish to attend. (If you have multiple children who wish to attend different camps indicate that on this sheet, only one registration form is necessary.) Additional registration items will be mailed or emailed to you, and will need to be filled out and returned to our office to make registration complete. Toddling into Nature Age 3 Butterflies Session 1: Thursday & Friday, June 9 & 10 9:00 am to 11:00 am Session 2: Thursday & Friday, June 16 & 17 9:00 am to 11:00 am Sapling Camp Ages 4-6 Dino Camp Session 1: Monday & Tuesday, June 13 & 14 9:00 am to 12:00 pm Session 2: Monday & Tuesday, June 20 & 21 9:00 am to 12:00 pm Maple Camp Ages 7-9 Birding Camp Session 1: Tuesday-Thursday July 5-7 9:00 am to 1:00 pm Session 2: Tuesday-Thursday July 12-14 9:00 am to 1:00 pm Oak Camp Ages 10-12 Watersheds Tuesday-Friday, July 19-July22 9:00 am to 2:00 pm T.E.A. (Teen Extreme Adventures) Ages 13-16 Tuesday-Wednesday July 26 & July 27 overnight (Parent letter will be sent with registration providing more times, meals, details, and locations.) Day Camps Ages 5-12 Adventures at Swiss Tuesday, August 2nd 9-11 am Tuesday, August 9 th 9-11 am (choose one or the other) Camps will be filled on a first come first serve basis. After this informational form, registration packet (found on www.dubuquecounty.org/conservation) and the program fee are received at our office via mail or email then your child is completely registered. Address: Swiss Valley Nature Center, Summer Camps, 13606 Swiss Valley Road, Peosta, IA 52068 Email: jenny.ammon@dubuquecounty.us, Attn Line: Summer Camps Thank you for taking part in Dubuque County Conservation s Summer Programming!
DUBUQUE COUNTY CONSERVATION BOARD 13606 Swiss Valley Road Peosta, IA 52068 563.556.6745 563.589.7885 fax Jenny.ammon@dubuquecounty.us www.dubuquecounty.org On the opposite side of this page is a waiver of liability and indemnification. In this day and age, these types of forms are becoming fairly commonplace and necessary for almost all extra-curricular activities. We realize that this is a difficult subject, but without this form we could not be able to offer these activities to the community. The waiver must be signed by both parents and or guardians in order for registration to be complete. Upon completion, please return the form by email or mail to our office. The safety of your child is of primary importance to us. We would like you to aware of some of the preparations we have made to provide a safe camp experience for all those involved. The most important aspect of risk reduction in any situation is prevention. In our situation, prevention means easy to understand, well defined rules, the most important of which are: 1) All campers will remain with their group and each group with their leader, campers will be supervised at all times. 2) Campers are to stay on trails and in mowed area, unless lead by a program leader. Other measures that have been taken to ensure the safety of all those involved include: Adult supervisors certified in first aid and CPR Vehicles with police band radio on site in case of bad weather or other emergency communication A cell phone will be available for emergency use Please read over the waiver carefully.
DUBUQUE COUNTY CONSERVATION BOARD 13606 Swiss Valley Road Peosta, IA 52068 563.556.6745 563.589.7885 fax Jenny.ammon@dubuquecounty.us www.dubuquecounty.org RELEASE OF LIABILITY AND INDEMNIFICATION AGREEMENT The undersigned parents and natural guardians of, a minor, do hereby request that the Dubuque County Conservation Board and Dubuque County, Iowa, permit said minor to participate in the Dubuque County Summer Camp, activities to be conducted by representatives of said Board and County, including, but not limited to hiking, campfire basics, fishing, canoeing, playing games, and crafts. In consideration of permission being granted by said Board and County to the said minor to participate in the Summer Camp activities, the undersigned, for themselves and said minor, so waive and release any and all claims and right for claims for damages that the undersigned and/or said minor may have against the Dubuque County Conservation Board and/or Dubuque County, Iowa, their officers, employees and/or agents, for any and all injuries that said minor may suffer as a result of the minor s participation in said Summer Camp or in connection with the minor s participation in the same. The undersigned further agree to protect, indemnify and hold harmless the Dubuque County Conservation Board, Dubuque County, Iowa and their officers, employees and agents against any claim for damages, compensation, or otherwise on the part of the said minor, or any other party, growing out of or resulting from any injury that may be suffered by the said minor while participating in the camp or in connection with the minor s participation in the same. The undersigned further agree to reimburse the Dubuque County Conservation Board, Dubuque County, Iowa, their officers, employees and agents for any loss, damage or cost that they may have to pay if litigation arises from any injury to said minor. The undersigned realizes it is a privilege to participate in DCCB Summer Camps, the undersigned realizes that photos from this event could be used for promotional purposes for this organization. The undersigned state they have read this agreement and understand its terms. Date: CAUTION: READ THIS AGREEMENT BEFORE SIGNING. Signature of Parent/Guardian Relationship to Minor Signature of Parent/Guardian Relationship to Minor
DUBUQUE COUNTY CONSERVATION BOARD 13606 Swiss Valley Road Peosta, IA 52068 563.556.6745 563.589.7885 fax Jenny.ammon@dubuquecounty.us www.dubuquecounty.org NOTICE OF REASON FOR NEW HIPAA FORMS Because of the information received on the Emergency Medical Forms we are now required by law to give you the Dubuque County Hipaa privacy report. Along with that we will need a signed notice that you have received and read this report. The notice basically says we will not give out any personal information to the public. We hope that these new forms will not hinder your efforts to send your child to our camps, as these are becoming common when working with any medical information. The medical information we collect for out camps is minimal but necessary for any emergencies if they arise, as well as knowing any allergies for the food we provide. If you have any questions or concerns please don t hesitate to give us call 563.556.6745. Please sign and detach and return to our office with your medical forms. This form will only need to be signed once, not every year and we only need one signed copy per family. We thank you for your cooperation. I, (please print) have received the Dubuque County s notice of privacy practices. Date Signature
MEDICAL AND EMERGENCY INFORMATION The following medical and emergency information will be held in the strictest confidence. Please fill out completely and return to our office. Full Name of Camper Age Camper s Address & Phone Parent/Legal Guardians Address & Phone & Email If Applicable: Name of adult who will be staying with child during camp Who should we contact in case of emergency Where this person can be reached during camp hours Family Doctor Allergies or other medical conditions we should be aware of before camp (This is important as we plan snack/food items) Additional Comments Interested in Carpooling? If yes, list your phone number and best times to reach you. We will send all interested parents a list of names and numbers so that plans can be made prior to the camp you choose.