2024 Decatur County 4-H Summer Programs
We are excited to have you join us for Summer Programs this summer! Please note space is limited for each camp. Payment is due before youth attend the Program. If a camp is full please contact Cassie Martin at cmartin4@iastate.edu to be added to the waitlist. Please complete one form per child! Click here to see the full list of camps and descriptions
Parent or Guardian Name
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First Name
Last Name
Youth Name
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First Name
Last Name
Contact Number
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Please enter a valid phone number.
Email Address
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example@example.com
Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Grade Youth JUST Completed for the 2023-24 school year.
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Gender Information
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Male
Female
Prefer Not to Say
Emergency Contact Information
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First and Last Name
Relationship
Emergency Contact Phone Number
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Please enter a valid phone number.
Emergency Contact Phone Number
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Please enter a valid phone number.
Health Information
Does your youth have any known allergies?
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Yes
No
If Yes, Please list below
Does your youth have any known medical conditions?
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Yes
No
If Yes, Please list below
4th Grade and Above Workshop Options
Please select what workshop(s) you would like your youth to participate in. Please see age range and cost associated with each individual camp. If camp becomes full, you will be added to a wait listed and contacted by our staff
Which summer program is the youth planning to attend?*
Babysitting Basics: (5-7th Grade) May 30, 9am-3pm, North Elementary: Cost: $15 (need to bring own lunch)
Astro Camp: (4-8th Grade), June 6: 9am-3pm, The Alley in Lamoni Cost: $10 (need to bring own lunch)
Fizz, Bubble, Goo: (4-6th Grade) June 20: 9am-3pm, Decatur County Extension Office Cost: $10 (need to bring own lunch)
Leaders League Camp: (7-10th Grade) August 1: 9am-3pm, Decatur County Extension Office: $10 (need to bring own lunch)
Kindergarten-Third Grade Workshop Options
Please select what workshop(s) you would like your youth to participate in. Please see Cost Associated with each individual camp. If camp becomes full, you will be added to a wait listed and contacted by our staff
Which summer program is the youth planning to attend?*
Kids in the Kitchen: (Kinder-3rd Grade) June 13, 9am-3pm, Decatur County Extension Office, Cost: $15 (Lunch Provided)
Up, Down, Spin Around: (Kinder-3rd Grade) July 30: 9am-3pm, The Alley in Lamoni, Cost: $10 (need to bring own lunch)
Art Exploration: (Kinder-3rd Grade), July 31: 9am-3pm, Decatur County Extension Office Cost: $10 (need to bring own lunch)
4-H Assumption of Risk and Release of Liability
I give my permission for__________________ to participate in the Iowa 4-H program. I understand that 4-H club project activities/events may involve certain risks of physical activity and possible injury and that Iowa State University and its4-H program will provide each participant with reasonable care, but that ISU cannot guarantee that I or my child will remain free of injury. In addition, some 4-H projects including but not limited to: shooting sports, horse or livestock projects, water activities, and other sporting activities have a higher degree of risk. I nonetheless wish to have myself or my child participate as an Iowa 4-H club member in the 4-H club program and ASSUME the RISK of participating. I hereby RELEASEFROM LIABILITY AND COVENANT NOT TO SUE, the State of Iowa; the Board of Regents for the State of Iowa; Iowa State University; ISUEO, and the County Agricultural Extension District, and all of their respective officers, employees, agents, and volunteers (the “Releasees”) from any and all liability, claim and/or cause of action arising out of or related to any loss, damage or injury, including death, that may be sustained by myself or my child, or to my property resulting, in whole or in part, from my own or my child’s participation in the Program, to the fullest extent permitted by law. In addition, the undersigned, on behalf of themselves and any personal representatives, heirs, assigns, and next of kin, HEREBY AGREES TOINDEMNIFY AND HOLD HARMLESS the Releasees from any and all liability for injury, including illness, disability, and death, and property loss or damage that may result from, arise out of, or be related to my own or my child’s participation in the Program, to the fullest extent permitted by law.
I HAVE READ THIS AGREEMENTIN FULL, AND I UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UPSUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUTANY INDUCEMENT.
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Yes
No
Publicity/Image/Voice Permission
The Iowa State University Extension and Outreach 4-H Program normally takes photographs, video, and/or tape recording of our programs. During activities, a photograph or video/audio recording may be taken of you. Unless you request otherwise, your consent below will be considered permission for Iowa State University, the County Agricultural Extension District, and the 4-H Program to photograph, film, audio/video tape, record and/or televise your image and/or voice for use in any publications or promotional materials, in any medium now known or developed in the future without any restrictions.*
I give permission
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Yes
No
I understand that workshops are limited capacity and I may be put on a waitlist. (You will be notified).
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Yes
No
By typing my name below give permission for my child to attend this camp
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