2025 Clover Kids Summer Programs
Our 2025 Clover Kids Summer Programs are open to all youth in Warren County who have completed K-3rd Grade. All camps will take place at the Warren County Extension Office in Indianola.
Name of Parent/Guardian
*
Name of Child (One per form)
*
Email
*
Phone Number
*
Grade just Completed
*
Kindergarten
First Grade
Second Grade
Third Grade
Gender Information
*
Male
Female
Non-binary
Prefer not to say
Gender Identity Not Listed
Emergency Contact Information
Name
*
Relationship
*
Phone Number
*
Health Information
Does your child have any allergies (food, medications, etc.)
*
Yes
No
If yes:
Does your child have any medical conditions?
*
Yes
No
If yes:
Workshop List
Please select what workshop(s) you would like your youth to participate in. Please note there is a separate registration for the 2025 Jr. Master Gardeners Program.
All workshops are held at the Warren County Extension Office.
*
Animal Learning Camp - ON A WAITLIST, CALL TO BE ADDED
Creativity in the Arts - June 12th, 9:00 AM - 12:00 PM, $20 to attend
Is this youth a current Warren County Clover Kids member? - Enrollment is not required to attend.
*
Yes
No
4-H assumption of Risk and Release of Liability:
I give my permissionfor__________________ to participate in the Iowa 4-H program. Iunderstand that 4-H club project activities/events may involve certain risks ofphysical activity and possible injury and that Iowa State University and its4-H program will provide each participant with reasonable care, but that ISUcannot guarantee that I or my child will remain free of injury. Inaddition, some 4-H projects including but not limited to: shootingsports, horse or livestock projects, water activities, and other sportingactivities have a higher degree of risk. I nonetheless wish to havemyself or my child participate as an Iowa 4-H club member in the 4-H clubprogram and ASSUME the RISK of participating.I hereby RELEASEFROM LIABILITY AND COVENANT NOT TO SUE, the State of Iowa; the Board ofRegents for the State of Iowa; Iowa State University; ISUEO, and the CountyAgricultural 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 orinjury, including death, that may be sustained by myself or my child, or to myproperty resulting, in whole or in part, from my own or my child’sparticipation in the Program, to the fullest extent permitted by law. Inaddition, the undersigned, on behalf of themselves and any personalrepresentatives, heirs, assigns, and next of kin, HEREBY AGREES TOINDEMNIFY AND HOLD HARMLESS the Releasees from any and all liabilityfor injury, including illness, disability, and death, and property loss ordamage that may result from, arise out of, or be related to my own or mychild’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.
*
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.
*
Yes
No
I understand that workshops are limited capacity and I may be put on a waitlist. (You will be notified).
*
Yes
By signing below, I give my child permission to attend Warren County Extension and Outreach workshop.
*
Submit
Should be Empty: