H Alumni Camp Application

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2018 4-H Alumni Camp Application Due May 18, 2018 Camp Registration $75 Make checks payable to Boone County 4-H Sr.

1 H Alumni Camp Application Due May 18, 2018 Camp Registration $75 Make checks payable to Boone County 4-H Sr. Council Name County of Alumni Membership Age Date of Birth Male Female Address City State/Zip Phone Cell Phone T-Shirt Size Small Medium Large X-Large 2X-Large Emergency Contact: Name Relationship Day Phone Night Phone List years you attended 4-H Camp: Have you been a 4-H Camp Counselor before? List years attended: Describe any special needs/accommodations officials should be aware of in making this program safe and accessible. Camp Registration Fees: $75 Individual Make checks payable to: Boone County Sr. 4-H Council Paid: Cash Check Please return applications to: Boone County Extension Office 1012 N Hwy UU Columbia, MO Camp registration fees must be postmarked or received by Friday, May 18, H camp programs are, as you recall, conducted by 4-H teen counselors under the supervision of MU Extension 4-H Youth Staff. The Alumni Camp, this camp will be much more relaxed for adults. Staff will be there to enjoy getting to know you as an adult, however, some rules will still apply. Refund Policy: All cancellations must be in writing. Cancellations before June 1 will receive a full refund, half refund if cancellation is before June 15, and no refund if member fails to show up to camp. If there is not enough interest in Alumni Camp, you will be notified by June 1 and will receive a full refund. Camp applications are accepted until camp fills, so apply now! 1

2 4-H ACTIVITY ACCEPTANCE FORM Educational events and activities are coordinated by the University of Missouri 4-H Youth Development Programs. All participants (adults and youth) must observe the following guidelines for conduct: Participate fully in all sessions Show respect for property and facilities used during the activity and assume financial responsibility for any damage they cause. Observe the established schedule, including being in their own cabin at the announced curfew. Appropriate and courteous behavior is expected. Swearing and obscene gestures are not permitted. All other participants, guests, chaperons and visitors should be treated with respect and common courtesy. Clothing and apparel should be appropriate and modest. No garments with alcohol, tobacco, insensitive or sexually suggestive phrases or artwork permitted. This event should bring about a natural high. No alcohol, tobacco, stimulants, or non-prescribed drugs will be allowed. We understand and accept the responsibility for following the above guidelines, and understand that failure to do so may result in dismissal from the event or activity. Further, we accept financial responsibility for damages to property or materials, travel costs, and/or program costs which might result from violation of this agreement. Both as to myself and my heirs and personal representatives, I release all 4-H officials, leaders, or dealers affiliated from any and all liabilities and right of action that may arise from any damage or injury which I may receive while attending or participating in this event. I will be bound by all rules and regulations while participating in said event. I agree I DO NOT agree. Sgnature Date 4-H CAMP TRADITIONS What camp traditions would you like to see at Alumni Camp? Suggestions for craft projects: What camp meals do your remember that could be incorporated? What songs did you sing during 4-H Camp? What were the popular line dances always played at 4-H events? 2

3 CODE OF CONDUCT 4-H Guidelines: All who participate in Missouri 4-H Youth Development programs, which are planned, conducted, and supervised by University of Missouri Extension, are responsible for their own conduct. Youth participating in 4-H programs are expected to demonstrate the character traits of trustworthiness, respect, responsibility, fairness, caring, and citizenship. Specifically, 4-H youth are expected to abide by the following behavior guidelines. 1. Be courteous and respect others. 2. Obey all rules established by the University of Missouri Extension 4-H Youth Development program and those of the local club/group as well as local and state laws. 3. Treat all people fairly and animals humanely. 4. Respect the property of others. 5. Respect the authority of adult or youth volunteers, paid Extension staff, and others in leadership roles. 6. Use appropriate language and wear acceptable clothing at 4-H activities and events. 7. Show kindness to others and give assistance when needed. 8. Be honest and honor commitments. 9. Strive for personal best and keep trying to improve. 10. Accept responsibility for personal choices. We understand and accept the responsibility for following the 4-H behavior guidelines. We further understand that failure to do so may result in disciplinary action and forfeiture of participation privileges. I agree I DO NOT agree. Signature Date PHOTO AUTHORIZATION I authorize the University of Missouri to make pictures and sound recordings of me and use the same in any form for its purposes and consent that the pictures and recordings may be copied, published, telecast or broadcast for such purposes together with descriptions and editorial statements. The University of Missouri is not responsible for third party photographs. I agree I DO NOT agree. It will be my responsibility to not participate in group photos and other occasions where pictures are being taken. Signature Date LODGING ARRANGEMENTS Lodging in non air conditioned cabins at Camp Clover Point is included with the registration fee. Individuals are premised to stay in their own camper at Lake Ozark State Park and come to Camp Clover Point to enjoy the festivities. YOU ARE RESPONISBLE FOR YOUR OWN RV RESERVATIONS. I plan to stay in the cabins at Camp Clover Point I will make my own camper/rv or hotel reservations at Lake Ozark State Park. I want to participate in Camp Clover Point Alumni Camp, but will not be in attendance on Friday night. 3

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6 CAMPER DATA Ethnicity Are you of Hispanic or Latino ethnicity? Yes No Race (check all the races that apply to you. If you selected Not Hispanic, you must select at least one option.) White Black or African American American Indian or Alaskan Native Native Hawaiian or Pacific Islander Asian Residence Farm Town under 10,000 & rural non-farm Town/City 10,000 50,000 and its suburbs Suburb of city more than 50,000 Central city more than 50,000 Military Service of Family No one in my immediate family is serving in the military I have a parent serving in the military I have a sibling serving in the military If yes on Military Service, Branch of Service Air Force Army Coast Guard DOD Civilian Marines Navy If yes on Military Service, Branch Component Active Duty National Guard Reserves 6

Arkansas 4 H Activity Application For Youth Leadership Roles

Arkansas 4 H Activity Application For Youth Leadership Roles 1 FY4-H-657 01/10/2017 Name County Read Carefully. This application should be filled out in detail. Please print or type.contact your local