Join us on - Nebraska Extension 4-H Camp...Culinary Creations Session 402, Saturday, July 18 – State Are you ready to get creative in the kitchen? Join us for making, baking, and

AGES 5-18 • OPEN TO ALL YOUTH • 4H.UNL.EDU/CAMP

Join us on

Dear Parents:

Welcome to Nebraska 4-H Summer Camps! The summer programs offered at

both of our 4-H camping locations, as well as our destination camps, provide

all youth a place to discover, learn, and grow. Also, your child does not have

to be a member of 4-H to attend. At Nebraska 4-H Camps and Centers, we

believe strongly in promoting the mission of Nebraska 4-H, which encourages

all young people to reach their full potential, by working and learning in

partnership with caring adults. Amidst the beauty of the Nebraska National

Forest, Schramm State Park and beyond, we are able to do what we do best:

provide a life-changing summer camp experience for all youth! 4-H is education

for life and focuses on helping young people explore the science in their

everyday lives, grow leadership and citizenship skills, explore future career

opportunities, and make healthier decisions.

The Nebraska 4-H Camps are American Camp Association (ACA) accredited,

meaning that we care enough to undergo a thorough review of over 300

standards related to operations, staffing, and emergency management. We

recruit an experienced and caring staff that receives training in first-aid/CPR,

water safety, camping skills, and positive youth development. As directors, we

share more than 50 years of combined experience in working with youth and

continue to be leaders among our peers in the youth development field. Campers’

safety, security, health, and growth are our primary concerns. Nebraska 4-H

Camps’ unparalleled, experienced leadership provides a well-supervised and

supportive environment. We believe there is no better investment than your

child attending camp! No matter which 4-H Camp your child goes to, camp is

a great place to meet new friends, try something for the first time, and to build

cherished memories to last a lifetime! If you have any questions, please do not

hesitate to call one of us. See you at camp!

Sincerely,

Jared Parker, Director

[email protected]

402-332-4496Eastern Nebraska 4-H

Center, Gretna

Connie Cox, Director

[email protected]

308-533-2224 Nebraska State 4-H

Camp, Halsey

Lindsay Shearer, RN,

4-H Camp Operations

Coordinator, Director

(Destination camps)

[email protected]

402-472-2846 (off season)

Jared Parker Connie Cox Lindsay Shearer, RN

Eastern Nebraska 4-H Center, Gretna Nebraska State 4-H Camp, Halsey

OUR MISSIONIt is the mission of Nebraska 4-H Camps and Centers to provide unique educational opportunities that empower people of all ages to be active in the pursuit of self-improvement in a safe, inclusive, and fun environment.

Welcome to 4-H Summer CampThe 2015 Summer Season is approaching fast! We are thrilled to invite all youth to enjoy summer camp with the Nebraska 4-H Camps and Centers at our two sites – Gretna and Halsey, and at our Destination Camps across Nebraska!

Culinary CreationsSession 402, Saturday, July 18 – State

Are you ready to get creative in the kitchen? Join us for making, baking, and creating some fun foods you can recreate at home! We’ll also take a ride on the zip line and the camp waterslide. Lastly, no day would be complete without creating your own custom cupcake!

Summer Fun 101Session 401, Saturday, June 20 - State

It’s your turn to experience the awesomeness of summer camp! Join us for an introductory camp that is just for you. You will be river stomping with the staff, playing “Capture the Flag” and cruising down the zip line and waterslide. Before you go, you will be able to sing and dance around the campfire. You won’t want to miss out on the fun!

Wet N’ Wild Day CampSession 501, Saturday, June 6 – Eastern – I Session 502, Saturday, July 18 – Eastern – II

This camp lets you indulge in your wild side! Wildlife experts join us with live animals in an interactive presentation that allows the campers to get up-close and personal with some cool wild animals. Then, we head down to the Ak-Sar-Ben Aquarium to check out the animals that live there before fishing and canoeing in the ponds. Make sure to pack a swimsuit because in the afternoon you’ll be making a splash during the water party and taking trips down our gigantic waterslide!

Parents are invited to join our enthusiastic University of Nebraska - Lincoln Master Gardeners for an instructional tour of our gardens and arboretum after you have checked your child in for their day camp session. 1

Kids Day CampsAges 5-8 • Open to all Youth

4H.UNL.EDU/CAMP

Introduce your 5-to 8- year-old to just how much fun 4-H Camp can be! Your camper will begin to learn communication skills, teamwork, and begin building relationships. Exposure to key lifetime skills such as confidence, cooperation, and decision making are features of attending camp. Campers will be encouraged to take healthy risks in a supportive environment by trying new activities and learning new skills that encourage independence. Utilizing outdoor activities and challenges helps stimulate campers’ curiosity about science in the environment. Camp is a meeting place where the seeds of lasting friendships are sown! Chaperones are encouraged but not required to attend. Lunch is included for one chaperone in the camp fee. Additional chaperones will be charged $5.00 upon arrival.

DAY CAMPS

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Explorer Camps Ages 8-11 • Open to all Youth

Tank & Tube the Loup Session 404, June 3-6 – State

Cattle tanks aren’t just for the cows! This trip down the Middle Loup River in an eight-foot cattle tank will take you on the summer adventure you will be talking about all year. We will stomp in the creek and end the day with an unforgettable campfire before we settle down in tents under the stars for the night. Cooking breakfast over the fire before heading back to camp to take a ride down the zip line or sail across the high wires will keep us busy. Not enough? Cool off while tubing down the river during the hot afternoon and zoom down our waterslide!

Ultimate Girls Rock Session 407, July 26-29 – State

Join the girls for a slumber party at camp. Talk about a camp that will rock! We’ll experience outdoor adventure in style! How will we ever get that hairdo to last in a trip down the river or a ride down the zip line? (No hints!) There will be outdoor movies on the big screen around the campfire one night with star gazing and, of course, our famous dress-up slumber party. It’s always a camp full of surprises!

Sandhillz Sampler Session 406, June 28-July 1 – State

Sample the best of what State 4-H Camp has to offer! Plan your customized camp schedule from a list of many possibilities, including canoeing, tubing, kayaking, rappelling, climbing, fishing arts and shooting sports. Be ready to sing camp songs, play games, and get muddy playing Gau-Gau. Nights will be filled with skits, evening parties, outdoor movies, and campfires with s’mores. You have the freedom to choose what activities you want to do! Tis camp is truly what you make it!

Crazy Camp Challenges Session 408, July 26 – 29 – State

Do you have the competitive edge? How does four days of zany and fun challenges with wacky prizes sound? Will you be the one that gets slimed? Polish your silly talents and be ready for anything during this crazy session. During “half-time” we’ll take a relaxing float down the river, cruise down the zip line and more. If you’re interested in outrageous fun, this this camp is for you!

Summer Fun Session 403, May 31-June 3 – State – I Session 405, June 17-20 – State – II Session 503, June 7-11 – Eastern – I Session 507, June 28-July 3 – Eastern – II Session 514, July 26-August 1 – Eastern – III Session 516, August 2-6 – Eastern – IV Session 601, June 2-4 – Destination Camps (Hosted at Camp Comeca)

Don’t get the summertime blues! Come to camp and have a blast! Discover what camp is all about. You’ll get to experience fishing, canoeing, archery, riflery, swimming, crafts, the T.R.U.S.T. Course, campfires, and so much more! If you’re new to camp or looking for a great time, this is the session for you! Be ready to be a kid, be a little goofy, and be a camper. It’s EVERYTHING camp’s all about!

Summer Fun Mini Session 506, June 28-July 1 – Eastern – II Session 513, July 26-29 – Eastern – III-A Session 515, July 29-August 1 – Eastern – III-B

This session is perfect for first-time campers or for those with a busy summer schedule. You get to experience everything we have to offer at camp and have all the fun that the full-length Summer Fun has but get you home before your parents even notice you’re gone!

Explorer Camps are designed for elementary ages. These sessions allow your younger camper the chance to explore many 4-H Camp activities and traditions. 4-H Camp increases self-esteem, fosters a love for the outdoors, and aids in the development of social skills needed in the real world through a variety of activities and experiences. Camp creates an atmosphere conducive to expanding interest, appreciation, and knowledge of the natural environment and natural sciences. Your camper will have an opportunity to learn about living, working,

and playing together, as well as gaining respect for nature. At camp, the foundation to become a leader is established as campers have the opportunity to discover, learn, and grow! Your camper will have an opportunity to try out the zip line and work as a team on the T.R.U.S.T. Course. Building lasting relationships, fostering friendships, and positive adult interactions are key elements of camp as each camper leaves with a lifetime of memories!

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Zoo Bound Session 504, June 9-11 – Eastern – I Session 510, July 7-9 – Eastern – II

We’re not “lion” when we say this is the best camp ever! You’ll spend a night at the Henry Doorly Zoo and go on two “tortoisly” awesome guided tours to check out all the animals. Back at camp, our zipline will “giraffe” you crazy and our giant waterslide will get your “seal” of approval! You “otter” sign up today!

Aquatic Blast Session 509, July 5-11 – Eastern – I Session 517, August 2-6 – Eastern – II

We know that summer can get too hot, so come make a splash at Aquatic Blast! Dive right into fun at our own private water party at Mahoney State Water Park where there is a stellar wave pool and huge slides! You’re “shore” to love swimming and building sand castles at Louisville State Park. Back at camp, be prepared to jump right into playing water-based games all week and even zoom down our very own, huge waterslide! How much fun can YOU have at camp? Guess you’ll just have to “wade” and “sea”!

Aquatic Blast Mini Session 508, July 5-8 – Eastern – I Session 511, July 8-11 – Eastern – II

This is the perfect session for those campers who can’t spend a full week at camp but still want to experience all the best water activities we have to offer. You’ll do the same activities that you would at the full length Aquatic Blast, but we’ll have you home in half the time.

Sky’s the Limit I Session 512, July 12-15 – Eastern

Calling all space cadets! This camp is for those who love all things aerospace. You will be spending a night at the Strategic Air and Space Museum and go on a personal, interactive tour where you can actually touch all of the air and spacecraft! Participate in other cool activities like building and launching your very own rocket and gazing through telescopes at the night sky. Don’t forget about all the traditional camp activities like ziplining, fishing, canoeing, the giant waterslide, and so much more! So reach for the stars - after all the sky is the limit - and sign up today!

Creativity Camp Session 505, June 15-19 – Eastern

Campers will get a chance to learn acting, dancing, music, photography, and explore the world of creative arts! You will also get all of the camp experiences when you zip down the zipline or slide down our gigantic waterslide! This brand-new camp will have lots of opportunities to show off your creative side! Come join us for a week to be inspired!

4H.UNL.EDU/CAMP

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Discovery CampsAges 11–15 • Open to all Youth

River Adventures Session 411, June 8 – 12 - State

You are invited to come on a trip down the Middle Loup River. We will be traveling in kayaks and canoes on a two-day trip. Experience everything camping has to offer – from sleeping in tents to cooking our meals on the river bank. We will complete our journey back at the Nebraska National Forest, but the adventures won’t end there. You will sail down our zip line and take on the challenge of the T.R.U.S.T. course too. Don’t miss out on this river adventure.

Outdoor Skills – Top Shot Session 412, June 14-19 – State

Are you an experienced marksman? Co-sponsored with the Nebraska Game and Parks Commission, this camp will help you improve your skills. You will receive instructions right here at camp in shotguns, rifles, muzzle loading, archery, fishing, hunting, canoeing, trapping, and more. You will also be able to sign up for our Top Shot challenges. As challenges get harder in each division, you might find yourself squaring off with your cabin mate to stay in the challenge. Along with all of the outdoor fun, you will experience the many activities camp has to offer. Shoot to put this camp on your summer schedule.

Outback Halsey Session 414, June 22-26 – State

Are you tough enough to survive a night in the Sandhills? You will be roughing it at the Calamus Reservoir for a night where we will camp in tents, cook over the open fire, and learn how to live off of the land. Teams will be put to the test as they compete for prizes, accept challenges, and more. Back at camp be ready for adventure on the zip line, high wires, and giant waterslide. Will you be a survivor and join us at camp?

Discovery camps are designed for your middle school-age campers and are loaded with more advanced adventures! Each session features camp favorites like the waterslide, Gau-Gau, campfires, and creek stomping, and provides opportunities for campers to create lasting friendships. Your camper will learn to work as part of a team while working through the elements on the T.R.U.S.T. Course. We foster confidence, responsibility, and healthy conflict resolution, and provide campers authentic leadership opportunities. Campers discover practical relationships between science and nature, which can be applied to their real world. Our activities and trips provide a fun and safe experience for all – one that leaves campers with lasting feelings of accomplishment, pride, and a lifetime of memories! Discover MORE during these longer sessions and be a part of camp traditions with added discoveries for ALL!!

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Niobrara Kayaking & Tubing Session 417, July 5-9 – State

Here is the SUMMER adventure you are looking for. Experience the adventure of kayaking & tubing down the beautiful Niobrara River. Don’t forget the camera. The scenery is something you won’t want to miss. We’ll spend two nights camping under the stars at Smith Falls. We will play in Nebraska’s largest waterfall in the mornings, and sing and dance at the campfires at night. This will be a trip you won’t soon forget. Don’t let this memory maker pass you by.

Outdoor Skills Session 529, July 12-17 – Eastern

Whether you’re a beginner or an advanced outdoors person, you’ll have a blast at Outdoor Skills. Co-sponsored by the Nebraska Game and Parks Commission, this camp helps those passionate about the outdoors build and improve your skills. We will travel to the Platte River State Park where experts will teach you about shotguns, rifles, muzzle loading, archery, fishing, hunting, canoeing, camping, trapping, and more! This will be alongside all your favorite camp activities like infiltration, creek stomping, zip lining, and much more! So sign up today, sharp shooter!

Extreme Robotics/GPS/GIS – Year 1.0 Session 524, June 28-July 2 – Eastern

This extreme session incorporates hands-on and self-guided learning in conjunction with the 4-H SET GEAR-Tech-21 curriculum and robotics program. The camp experience includes LEGO MindstormsTM NXT robotics and activities to gain knowledge of Global Positioning Systems (GPS) and Geographical Information Systems (GIS). Build and program a robot and learn how to operate a handheld GPS receiver for navigation and map making. You will also get to experience all kinds of fun camp activities, including the waterslide, shooting sports, zip lines, and campfires.

Outpost Camp Session 519, June 10-13 – Eastern - I Session 533, July 29-August 1 – Eastern - II

This camp is for the toughest of the tough who have a passion for the outdoors. Camping outside and cooking meals over an open fire that you help build are just a few of the cool outdoor-based activities you will enjoy. Every day will be jam-packed with fun camp activities like fishing, canoeing, T.R.U.S.T. Course, and waterslide, to name just a few! So if you think you’re tough enough, come rough it with us at Outpost Camp.

continued

4H.UNL.EDU/CAMP

Boldly Bound Session 520, June 14-19 – Eastern

Daredevils wanted! This camp is for the brave adventurers out there. Discover our Odyssey Course, which has eight high ropes team events. Test your limits at the UNL Outdoor Adventures Challenge Course just outside Lincoln. There, you can scale a 50-foot Alpine Tower, free fall from the 30-foot Giant Swing, or participate in many other high ropes challenges. We’ll end our daring trip with a stop at the UNL Dairy Store to get some of the best ice cream in town! When you get back to camp you’ll realize the adventure is far from over as you whiz down the zip line, conquer the high wires, master the rock wall, and repel down the tower. When your nerves are at their limit, you can hang out with your new friends swimming at Louisville State Park. Are you bold enough for Boldly Bound?

Shooting Skills Session 602, July 6-9 – Destination Camp (Hosted at Camp Comeca)

In partnership with Nebraska Game and Parks, this camp is for anyone wanting to practice, improve, and excel in shooting sports. Trained instructors will provide technical assistance and education in the following areas: muzzle loader, bow and arrow, shotgun, .22 rifle, air rifle, hunting skills, and environmental awareness. Campers who successfully complete this camp will graduate with their Hunter Safety Education certificate administered by Nebraska Game and Parks Commission. Take advantage of this great opportunity.

Sky’s The Limit 2 Session 528, July 12-17 – Eastern

Calling all space cadets! This camp is for those who love all things aerospace. You will be staying a night at the Strategic Air and Space Museum and go on a personal, interactive tour where you can actually touch all of the air and spacecraft! Participate in other cool activities like building and launching your very own rocket and gazing through telescopes at the night sky. Don’t forget about all the traditional camp activities like zip lining, fishing, canoeing, the giant waterslide, and so much more! So come discover with us-after all, the sky is the limit!

Discovery Camps continued ...

Camp Counselor TrainingSession 400 – May 27-30 – State Session 500 – May 31-June 5 – Eastern

Calling all teen leaders, role models, and former campers who want stay involved with camp! We want you to help us shape the camp experience for hundreds of kids this summer. This training teaches you how to be a responsible counselor, respond in an emergency, and help conduct camp programs. UNL faculty and 4-H summer camp staff will share valuable information on learning styles, youth development, and leadership. Upon completion of this camp, you will be eligible to sign up and volunteer as a counselor for 4-H summer camp sessions throughout the 2014 season. We want YOU as part of our team! Note: Returning counselors do not have to pay the registration fee.6

Sandhillz Sampler Session 415, June 28-July 2 – State

See description on page 2.

Tank & Tube the Loup Session 410, June 3-6 – State


Crazy Camp Challenges Session 416, July 5-9 – State


Summer FunSession 409, May 31-June 3 – State – I Session 413, June 17-20 – State – II Session 518, June 7-11 – Eastern – I Session 523, June 28-July 3 – Eastern – II Session 531, July 26-August 1 – Eastern – III Session 534, August 2-6 – Eastern IV


Summer Fun Mini Session 522, June 28-July 1 – Eastern – II Session 530, July 26-29 – Eastern – III-A Session 532, July 29-August 1 – Eastern – III-B


Aquatic Blast Session 526, July 5-11 – Eastern – I Session 535, August 2-6 – Eastern – II


Aquatic Blast Mini Session 525, July 5-8 – Eastern – I Session 527, July 8-11 – Eastern – II


Creativity Camp Session 521, June 15-19 – Eastern


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4H.UNL.EDU/CAMP

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The Nebraska 4-H FoundationSponsor a child to attend 4-H camp!The benefits of the 4-H Camp experience to a young student are life-enhancing. 4-H Camp has a rich history of helping young people develop their full potential. Today, Nebraska 4-H continues to build a legacy of developing caring, community-minded citizens who offer vibrant, strong leadership for the future. Your investment in Nebraska 4-H helps supports these efforts and will impact youth from all across Nebraska.

To help a young Nebraskan go to 4-H camp!

Make your check payable to: Nebraska 4-H Foundation

Nebraska 4-H Foundation P.O. Box 830719 Lincoln, NE 68583-0719

For more information regarding special 4-H Camp fundraising projects, and memorial and naming opportunities, contact the Nebraska 4-H Foundation at 402-472-1178 or visit www.ne4hfoundation.org

CampershipsWe believe that every young life should be enriched by the camp experience and we want to make camp an opportunity for all youth. Daycamps are not eligible for camperships. Please contact Lindsay Shearer for more information on Camperships at the State 4-H office. Contact Lindsay by email at [email protected] or by phone (402) 472-2846. Camperships are supported by the Nebraska 4-H Foundation.

4H.UNL.EDU/CAMP

How to Register for CampIf registering online:Register online at 4h.unl.edu/campFollow the instructions on the website.Note: Only Visa and MasterCard are accepted for online payments.

If registering by mail:Permission and Health Form: Complete the attached registration form titled “Nebraska 4-H Participant Permission and Health Form” that both the parent/guardian and camper need to sign to attend camp.

Cabin Requests: Campers who want to room together should list each other’s name on their registration forms on the line: “I want to room with.” Please try to send their registrations together in the same envelope, if possible. Every effort will be made to place campers in the same cabin if requested, but there is no guarantee. We will do our BEST. It is our policy to try to keep campers in each cabin within a two-year age span, if possible.

Payment: Pay by check, money order, cashier’s check, Visa, or MasterCard ONLY. The full camp fee is required at the time of registration.

Confirmation: You will receive a confirmation package once we receive your registration. PLEASE provide an email address (clearly PRINTED) so that we can confirm receipt immediately to your email address and save postage to help keep camp costs down.

• If you provide an email address, the only confirmation that you will receive will be via email.

• Registrations without an email address will receive their confirmation package in the mail approximately two weeks after the registration is processed. If you do not receive confirmation after two weeks, please call the appropriate camp.

Notes to parents/guardians:Cancellations: All cancellations are subject to a $25 processing fee. No fees will be returned if the camp is not notified at least 14 days prior to the session commencing. If you paid by credit card, refunds can be credited back to your credit card account within 24 hours. If you paid by check, refund checks must be processed and issued by the University of Nebraska–Lincoln. This process takes up to six weeks.

For more information about our partners please visit 4h.unl.edu/camp.

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ot b

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ache

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call:

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Page

1 o

f 4

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iste

r on

lin

e at

4h

.un

l.edu

/cam

p

____

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____

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plet

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Hal

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If pa

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ardi

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ache

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call:

2nd CONTACT

Page

1 o

f 4

Reg

iste

r on

lin

e at

4h

.un

l.edu

/cam

p

____

____

____

____

__D

ate

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plet

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Stat

e 4-

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8322

2 4-

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amp

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Hal

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Dat

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____

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____

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____

____

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____

____

____

____

____

____

____

____

____

____

____

____

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ave

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been

to th

is c

amp

loca

tion

befo

re?

q Y

es

q N

o

Are

you

a m

embe

r of

a 4

-H C

lub?

q

Yes

q

No

q I

give

per

mis

sion

to u

se m

y ch

ild’s

nam

e/ph

otog

raph

in p

ublic

atio

ns, a

dver

tisem

ents

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Web

pag

e, s

ocia

l med

ia o

r new

s ar

ticle

s pe

rtai

ning

to 4

-H a

ctiv

ities

.q

I do

NO

T gi

ve p

erm

issio

n to

use

my

child

’s na

me/

phot

ogra

ph in

pub

licat

ions

, adv

ertis

emen

ts, 4

-H W

eb p

age,

soci

al m

edia

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rtic

les p

erta

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act

iviti

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q E

aste

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E 4-

H C

ente

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Des

tinat

ion

4-H

Cam

p

21

520

W. H

wy.

31

Stat

e 4-

H O

ffice

, 114

Ag

Hal

l

Gre

tna,

NE

6802

8 Li

ncol

n, N

E 68

583-

0700

Sess

ion

# __

____

__ S

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____

____

____

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Prim

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Stat

e Zi

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If pa

rent

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ardi

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cann

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ache

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call:

2nd CONTACT

Page

1 o

f 4

Reg

iste

r on

lin

e at

4h

.un

l.edu

/cam

p

____

____

____

____

__D

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Form

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plet

edq

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Stat

e 4-

H C

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8322

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amp

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____

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ctro

nic

confi

rmat

ion

____

____

____

____

____

____

____

____

_

I wan

t to

room

with

: ___

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

__H

ave

you

been

to th

is c

amp

loca

tion

befo

re?

q Y

es

q N

o

Are

you

a m

embe

r of

a 4

-H C

lub?

q

Yes

q

No

q I

give

per

mis

sion

to u

se m

y ch

ild’s

nam

e/ph

otog

raph

in p

ublic

atio

ns, a

dver

tisem

ents

, 4-H

Web

pag

e, s

ocia

l med

ia o

r new

s ar

ticle

s pe

rtai

ning

to 4

-H a

ctiv

ities

.q

I do

NO

T gi

ve p

erm

issio

n to

use

my

child

’s na

me/

phot

ogra

ph in

pub

licat

ions

, adv

ertis

emen

ts, 4

-H W

eb p

age,

soci

al m

edia

or n

ews a

rtic

les p

erta

inin

g to

4-H

act

iviti

es.

q E

aste

rn N

E 4-

H C

ente

r q

Des

tinat

ion

4-H

Cam

p

21

520

W. H

wy.

31

Stat

e 4-

H O

ffice

, 114

Ag

Hal

l

Gre

tna,

NE

6802

8 Li

ncol

n, N

E 68

583-

0700

Sess

ion

# __

____

__ S

essi

on _

____

____

____

____

____

____

____

____

____

____

____

_ C

amp

Dat

e __

____

____

__ C

ost _

____

____

Sess

ion

# __

____

__ S

essi

on _

____

____

____

____

____

____

____

____

____

____

____

_ C

amp

Dat

e __

____

____

__ C

ost _

____

____

Sess

ion

# __

____

__ S

essi

on _

____

____

____

____

____

____

____

____

____

____

____

_ C

amp

Dat

e __

____

____

__ C

ost _

____

____

Insu

ranc

e In

form

atio

nIs

the

4-H

par

ticip

ant c

over

ed b

y fa

mily

med

ical

/hos

pita

lizat

ion

insu

ranc

e? q

Yes

q

No

As

Pare

nt/G

uard

ian

of th

e 4-

H p

artic

ipan

t, I u

nder

stan

d th

at h

ealth

insu

ranc

e co

vera

ge is

the

pare

nt’s

/gua

rdia

n’s

resp

onsi

bilit

y.

Med

ical

Insu

ranc

e C

ompa

ny _

____

____

____

____

____

____

____

____

__ P

olic

y N

o. _

____

____

____

____

____

____

____

____

____

_

Nam

e of

Insu

red

____

____

____

____

____

____

____

____

___

Rel

atio

nshi

p to

Par

ticip

ant _

____

____

____

____

____

____

____

____

__

____

____

____

____

____

____

____

____

____

____

____

____

____

____

___

____

____

____

____

____

____

____

____

____

__M

edic

al C

are

Prov

ider

-Nam

e of

Fam

ily P

hysi

cian

or H

ealth

Car

e Fa

cilit

y Te

leph

one

Paym

ent I

nfor

mat

ion

(Ple

ase

chec

k bo

x th

at a

pplie

s.)

q

Che

ck e

nclo

sed

q V

ISA

q

Mas

terC

ard

q P

aid

onlin

e

Cre

dit C

ard

# _

_ _

_ _

_ _

_

__

__

__

__

_

_ _

_ _

_ _

_

__

__

__

__

Expi

ratio

n D

ate

____

____

____

____

____

____

____

____

____

____

____

Nam

e on

Car

d: _

____

____

____

____

____

____

____

____

____

____

___

Tota

l cos

t for

all

cam

ps _

____

____

____

__

For

Offi

ce U

se O

nly

Emer

genc

y C

onta

cts

(We

mus

t hav

e tw

o di

ffer

ent c

onta

cts

with

bot

h da

y an

d ni

ght p

hone

num

bers

.)

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

___

Prim

ary

Pare

nt/G

uard

ian

Phon

e #1

Ph

one

#2

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

___

Add

ress

C

ity

Stat

e Zi

p

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

__N

ame

Day

Pho

ne

Nig

ht P

hone

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

__Ad

dres

s C

ity

Stat

e Zi

p

If pa

rent

/gu

ardi

an

cann

ot b

e re

ache

d,

call:

2nd CONTACT

Page

1 o

f 4

Reg

iste

r on

lin

e at

4h

.un

l.edu

/cam

p

____

____

____

____

__D

ate

Form

Com

plet

edq

NE

Stat

e 4-

H C

amp

8322

2 4-

H C

amp

Road

Hal

sey,

NE

6914

2

Ethn

icity

(Ple

ase

sele

ct o

ne)

His

pani

c or

Lat

ino

N

ot H

ispa

nic

or L

atin

oRa

ce (P

leas

e se

lect

one

)

Whi

te

Bla

ck o

r A

fric

an A

mer

ican

A

mer

ican

Indi

an

Asi

an

Haw

aiia

n or

Pac

ific

Isla

nder

Visa

, Mas

terC

ard

and

chec

ks a

ccep

ted.

Mak

e ch

ecks

pay

able

to th

e fa

cilit

y th

e pa

rtic

ipan

t will

be

atte

ndin

g. M

ail t

his

form

and

you

r pay

men

t to

that

loca

tion.

Pl

ease

che

ck o

nly

one

box.

Plea

se fi

ll ou

t a c

ompl

ete

heal

th fo

rm fo

r eac

h ca

mpe

r. Re

gist

ratio

n in

stru

ctio

ns o

n pa

ge 8

.

2015

Neb

rask

a 4-

H P

arti

cip

ant

Per

mis

sion

an

d H

ealt

h F

orm

Describe the condition, restriction or allergy and how

to manage (attach additional pages if necessary)

Dietary N

eeds

Allergies

(food, medicine, latex, etc.)

Conditions

(diabetic, asthma, etc.)

Restrictions(ear plugs w

hile swim

ming)

Swim

ming ability

q non-sw

imm

er q

beginner q

swim

mer

Imm

unizations (A copy of the applicant’s im

munizations record can replace this section)

Which of the follow

ing has the participant had? q

Measles

q C

hicken Pox q

Germ

an Measles

q M

umps

q H

epatitis

Please give date for last imm

unization for:

______ / ______ / ______ DTP

______ / ______ / ______ Hepatitis B

______ / ______ / _____ Varicella Zoster

______ / ______ / ______ Rubella______ / ______ / ______ TD

( Tetanus/diphtheria)______ / ______ / ______ Polio

______ / ______ / ______ Measles (hard or red m

easles or rubeola)______ / ______ / ______ H

aemophitus influenza (H

iB)

______ / ______ / ______ Last TB mantoux test

_______________ Result

If yes, please give details (i.e., reactions, special instructions, special equipment, procedures): (attach additional pages if necessary)

________________________________________________________________________________________________________

Date of last physical exam

____________________________________________________________________________________

Yes N

o

1. Had recent injury, illness or infectious disease?

____ ____

2. Have a chronic or recurring illness or condition?

____ ____

3. Been hospitalized/had surgery within the past 2 years?

____ ____

4. Have frequent headaches?

____ ____

5. Had a head injury and/or been knocked unconscious?

____ ____

6. Has passed out, been dizzy, and\or had chest pain

during or after exercise? ____ ____

7. Had heart-related problem

(high/low blood pressure,

shortness of breath, murm

urs, etc.)? ____ ____

8. Had m

uscular/skeletal problems (arthritis, hernia,

recent fractures, back/joint problems)?

____ ____

9. Had stom

ach/intestinal problems (ulcers, jaundice,

indigestion, diarrhea/constipation)? ____ ____

10. Have any skin problem

s (itching, rash, acne)? ____ ____

Does the participant currently have (or had) any of the follow

ing? Check “yes” or “no” to each question. Please explain any “yes” answ

ers(noting the num

ber of the question) in the space below or on an additional sheet of paper, if necessary.

Health H

istory Information

Yes N

o

11. Have diabetes or hypoglycem

ia? ____ ____

12. Have asthm

a? ____ ____

13. Had m

ononucleosis in the past 12 months?

____ ____

14. Had seizures?

____ ____

15. Had frequent ear infections?

____ ____

16. Wear glasses, contacts or protective eyew

ear? ____ ____

17. Have an orthodontic appliance?

____ ____

18. Have problem

s with sleepw

alking? ____ ____

19. If female, have an abnorm

al menstrual history?

____ ____

20. Have a history of bed w

etting? ____ ____

21. Had an eating disorder?

____ ____

22. Had em

otional difficulties for which professional help

was sought?

____ ____

Conditions, Restrictions or A

llergies (Please list all)

Page 2 of 4



Dietary N

eeds

Allergies


Conditions



hile swim

ming)

Swim

ming ability

q non-sw

imm

er q

beginner q

swim

mer

Imm



Which of the follow


Measles

q C

hicken Pox q

Germ

an Measles

q M

umps

q H

epatitis


unization for:

______ / ______ / ______ DTP

______ / ______ / ______ Hepatitis B


______ / ______ / ______ Rubella______ / ______ / ______ TD





iB)


_______________ Result


________________________________________________________________________________________________________


____________________________________________________________________________________

Yes N

o


____ ____


____ ____


____ ____


____ ____


____ ____






urs, etc.)? ____ ____

8. Had m



____ ____

9. Had stom







ers(noting the num


Health H

istory Information

Yes N

o


ia? ____ ____

12. Have asthm

a? ____ ____

13. Had m


____ ____

14. Had seizures?

____ ____


____ ____


ear? ____ ____


____ ____

18. Have problem

s with sleepw

alking? ____ ____



____ ____


etting? ____ ____


____ ____

22. Had em


was sought?

____ ____



Page 2 of 4

Health H

istory Information



ers(noting the num


Yes

No

1. H

ad recent injury, illness or infectious disease? ____ ____

2. H

ave a chronic or recurring illness or condition? ____ ____

3. Been hospitalized/had sur gery w

ithin the past 2 years? ____ ____

4. H

ave frequent headaches? ____ ____

5. H

ad a head injury and/or been knocked unconscious? ____ ____

6. H

as passed out, been dizzy, and\or had chest pain during or after exercise?

____ ____7.

Had heart-related problem



urs, etc.)? ____ ____

8. H

ad muscular/skeletal problem

s (arthritis, hernia, recent fractures, back/joint problem

s)? ____ ____

9. H

ad stomach/intestinal problem

s (ulcers, jaundice, indigestion, diarrhea/constipation)?

____ ____10. H

ave any skin problems (itching, rash, acne)?

____ ____

Yes

No


ia? ____ ____

12. Have asthm

a? ____ ____

13. Had m


____ ____14. H

ad seizures? ____ ____


____ ____16. W

ear glasses, contacts or protective eyewear?

____ ____17 . H

av e an orthodontic appliance? ____ ____

18. Have problem

s with sleepw

alking? ____ ____



____ ____20. H

ave a history of bed wetting?

____ ____21 . H

ad an eating disorder? ____ ____

22. Had em

otional difficulties for which professional

help was sought?

____ ____


___________________________________________________________________________________________________________________D

ate of last physical exam _______________________________________________________________________________________________



Dietary N

eeds

Allergies


Conditions



hile swim

ming)

Swim

ming ability

non-sw

imm

er beginner

swim

mer

Conditions, R

estrictions or Allergies (Please list all)



Dietary N

eeds

Allergies


Conditions



hile swim

ming)

Swim

ming ability

q non-sw

imm

er q

beginner q

swim

mer

Imm



Which of the follow


Measles

q C

hicken Pox q

Germ

an Measles

q M

umps

q H

epatitis


unization for:

______ / ______ / ______ DTP

______ / ______ / ______ Hepatitis B


______ / ______ / ______ Rubella______ / ______ / ______ TD





iB)


_______________ Result


________________________________________________________________________________________________________


____________________________________________________________________________________

Yes N

o


____ ____


____ ____


____ ____


____ ____


____ ____






urs, etc.)? ____ ____

8. Had m



____ ____

9. Had stom







ers(noting the num


Health H

istory Information

Yes N

o


ia? ____ ____

12. Have asthm

a? ____ ____

13. Had m


____ ____

14. Had seizures?

____ ____


____ ____


ear? ____ ____


____ ____

18. Have problem

s with sleepw

alking? ____ ____



____ ____


etting? ____ ____


____ ____

22. Had em


was sought?

____ ____



Page 2 of 4

Perm

issi

on to

Tre

at, P

artic

ipat

e an

d Re

leas

e of

Cla

ims

The

wai

ver

and

rele

ase

of li

abili

ty w

as e

xecu

ted

this

___

____

day

of

____

____

___,

20_

___

by _

____

____

____

____

(Par

ent/

Gua

rdia

n)

of (A

ddre

ss) _

____

____

____

____

____

____

____

____

____

____

,

City

of _

____

____

____

____

_, C

ount

y of

___

____

____

____

___,

Stat

e of

___

____

____

____

, ind

ivid

ually

and

as

Pare

nt/G

uard

ian

of

____

____

____

____

____

____

____

____

____

____

____

____

___

in fa

vor

of th

e Bo

ard

of R

egen

ts o

f the

Uni

vers

ity o

f Neb

rask

a (U

NL)

(r

efer

red

to in

this

doc

umen

t as

Part

icip

ant)

.O

ffice

rs, E

mpl

oyee

s, In

stru

ctor

s, S

taff

, age

nts,

ope

rato

rs, s

ucce

ssor

s,

and

assi

gns.

Pare

nt/G

uard

ian,

her

eaft

er k

now

n as

Rel

easo

r, w

ishe

s th

e Pa

rtic

ipan

t to

part

icip

ate

in th

e 4-

H e

vent

nam

ed o

n th

is d

ocum

ent

and

part

icip

ate

in a

ll ac

tiviti

es e

xcep

t as

note

d on

this

form

.

1. In

con

side

ratio

n fo

r th

e pa

rtic

ipat

ion

in 4

-H c

amp

and

UN

L C

ampu

s Re

crea

tion

Act

iviti

es, R

elea

sor

here

by R

ELEA

SES

and

cove

nant

s no

t-to-

sue

UN

L or

4-H

for

any

and

all p

rese

nt a

nd fu

ture

cl

aim

s re

sulti

ng fr

om o

rdin

ary

negl

igen

ce o

n th

e pa

rt o

f UN

L or

4-H

fo

r pr

oper

ty d

amag

e, p

erso

nal i

njur

y, o

r w

rong

ful d

eath

ari

sing

as

a re

sult

of e

ngag

ing

in, u

sing

Uni

vers

ity fa

cilit

ies

and

equi

pmen

t, or

rec

eivi

ng in

stru

ctio

n fo

r 4-

H c

amp

and

UN

L C

ampu

s Re

crea

tion

Act

iviti

es o

r ac

tiviti

es th

eret

o, w

here

ver,

whe

neve

r, or

how

ever

the

sam

e m

ay o

ccur

.

2. R

elea

sor

here

by v

olun

tari

ly w

aive

s an

y an

d al

l cla

ims

or a

ctio

ns

resu

lting

from

ord

inar

y ne

glig

ence

, bot

h pr

esen

t and

futu

re, t

hat

may

be

mad

e by

Rel

easo

r’s

fam

ily, e

stat

e, p

erso

nal r

epre

sent

ativ

e,

heir

s, o

r as

sign

s. F

urth

er, R

elea

sor

real

izes

that

par

ticip

atio

n in

4-H

ca

mp

and

UN

L C

ampu

s Re

crea

tion

Act

iviti

es in

volv

es c

erta

in r

isks

an

d da

nger

and

is a

vig

orou

s ac

tivity

invo

lvin

g se

vere

res

pira

tory

an

d ca

rdio

vasc

ular

str

ess.

3. R

elea

sor

has

here

by b

een

mad

e aw

are

that

par

ticip

atio

n in

4-H

ca

mp

and

UN

L C

ampu

s Re

crea

tion

Act

iviti

es h

as th

e fo

llow

ing

non-

excl

usiv

e lis

t of c

erta

in r

isks

whi

ch I

acce

pt: d

eath

; hea

d, e

ye, n

eck,

an

d sp

inal

inju

ry r

esul

ting

in c

ompl

ete

or p

artia

l par

alys

is; b

rain

dam

-ag

e; h

eart

att

ack;

blis

ters

; cut

s; la

cera

tions

; abr

asio

ns; c

oncu

ssio

ns;

cont

usio

ns; s

trai

ns; s

prai

ns; d

islo

catio

ns; f

ract

ures

; col

d an

d he

at

inju

ries

; wat

er im

mer

sion

; dro

wni

ng; l

ight

ning

str

ikes

; inj

ury

to b

ones

, jo

ints

, mus

cles

, int

erna

l org

ans;

and

env

ironm

enta

l con

ditio

ns.

4. In

add

ition

, I u

nder

stan

d an

d ac

cept

the

inci

dent

al r

isks

of t

rave

l to

and

from

the

site

of a

ctiv

ity; p

artic

ipat

ion

at s

ites

that

may

be

rem

ote

from

ava

ilabl

e m

edic

al a

ssis

tanc

e; a

nd th

e po

ssib

le r

eckl

ess

cond

uct o

f oth

er p

artic

ipan

ts.

5. In

the

even

t of a

med

ical

em

erge

ncy,

the

4-H

cam

p or

Uni

vers

ity o

f N

ebra

ska

or it

s re

pres

enta

tives

hav

e m

y pe

rmis

sion

to ta

ke w

hate

ver

mea

sure

s th

ey d

eem

rea

sona

ble

to r

ende

r as

sist

ance

and

that

I an

d/or

my

fam

ily w

ill b

e fin

anci

ally

res

pons

ible

for

any

expe

nse

invo

lved

.

6. I

have

rea

d an

d un

ders

tand

that

this

WA

IVER

is in

tend

ed to

be

as

broa

d an

d in

clus

ive

as p

erm

itted

by

the

law

s of

the

Stat

e of

N

ebra

ska

and

agre

e th

at if

any

par

t is

held

inva

lid, t

he r

emai

ning

pa

rts

of th

is W

AIV

ER A

ND

REL

EASE

will

con

tinue

in fu

ll fo

rce

and

effe

ct a

s in

tend

ed. I

furt

her

agre

e th

at th

e ve

nue

for

any

lega

l pro

-ce

edin

g sh

all b

e in

the

Stat

e of

Neb

rask

a.

____

____

____

____

____

____

____

_ __

____

____

___

Pa

rent

/Gua

rdia

n Si

gnat

ure

Dat

e

Med

icat

ions

Med

icat

ions

mus

t be

give

n to

the

4-H

lead

er/s

taff

in c

harg

e of

the

even

t at r

egis

trat

ion.

Ple

ase

list a

ll pr

escr

iptio

n an

d no

n-pr

escr

iptio

n m

edic

atio

ns. A

ll m

edic

atio

ns m

ust b

e br

ough

t in

the

orig

inal

con

tain

er th

at id

entifi

es th

e m

edic

atio

n’s

nam

e,

the

dosa

ge a

nd fr

eque

ncy

of a

dmin

istr

atio

n an

d th

e pr

escr

ib-

ing

phys

icia

n (if

app

licab

le).

Pro

vide

eno

ugh

med

icat

ion

for

the

entir

e 4-

H e

vent

.

This

per

son

does

not

take

med

icat

ion

on a

reg

ular

bas

is. q

Med

icat

ion

____

____

____

____

____

____

____

____

____

_

____

____

____

____

____

____

____

____

____

____

____

___

Dos

age

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

___

Spec

ific

times

take

n ea

ch d

ay _

____

____

____

____

____

___

____

____

____

____

____

____

____

____

____

____

____

___

Rout

e (e

ye, e

ar, o

ral)

____

____

____

____

____

____

____

___

____

____

____

____

____

____

____

____

____

____

____

___

Reas

on fo

r ta

king

___

____

____

____

____

____

____

____

__

The

follo

win

g m

edic

atio

n is

take

n du

ring

the

scho

ol y

ear

but i

s no

t tak

en n

ow.

____

____

____

____

____

____

____

____

____

____

____

___

q If

dee

med

nec

essa

ry, I

(par

ent/

guar

dian

) giv

e pe

rmis

sion

to

adm

inis

ter

non-

pres

crip

tion

med

icat

ions

in a

ccor

danc

e w

ith

dire

ctio

ns o

n th

e la

bel f

or h

eada

ches

, ups

et s

tom

ach,

dia

rrhe

a,

men

stru

al c

ram

ps a

nd p

oiso

n iv

y.

4-H

Par

ticip

ant A

gree

men

tW

ith m

y Pa

rent

/Gua

rdia

n, I

have

com

plet

ed th

is fo

rm a

nd

will

ass

ume

resp

onsi

bilit

y fo

r ta

king

my

med

icat

ion

and

for

rest

rict

ing

any

activ

ities

agr

eed

upon

and

list

ed o

n th

is fo

rm.

I will

exe

rcis

e go

od ju

dgm

ent i

n re

gard

to m

y ow

n he

alth

, sa

fety

and

wel

l-bei

ng w

hile

at 4

-H e

vent

s an

d ac

tiviti

es.

I hav

e re

ad t

he 4

-H C

ode

of C

ondu

ct a

nd a

gree

to

follo

w

thes

e ex

pect

atio

ns.

____

____

____

____

____

____

____

____

__

____

____

__

4-H

Par

ticip

ant S

igna

ture

D

ate

Oth

er In

form

atio

nTo

hel

p en

sure

a s

ucce

ssfu

l 4-H

exp

erie

nce,

it is

vita

l tha

t we

know

abo

ut o

ur p

artic

ipan

ts’ u

niqu

e ne

eds

or s

peci

al c

once

rns.

Ple

ase

expl

ain

anyt

hing

that

w

ill h

elp

us b

ette

r und

erst

and

your

chi

ld. F

or e

xam

ple,

car

e by

a p

hysi

cian

or c

ouns

elor

in th

e pa

st y

ear.

List

any

act

ivity

rest

rictio

ns, a

dapt

atio

ns, s

peci

al

lear

ning

con

side

ratio

ns, f

amily

circ

umst

ance

s or

oth

er re

leva

nt e

xper

ienc

es o

n an

atta

ched

sep

arat

e sh

eet (

exam

ple:

wal

ks in

his

/her

sle

ep).

Sign

Sign

Part

icip

ant m

ay b

e re

leas

ed to

:

q A

nyon

e lis

ted

on th

e he

alth

/reg

istr

atio

n fo

rm

q _

____

____

____

____

____

____

____

____

____

____

____

__

____

____

____

____

____

____

____

____

____

____

___

Nam

e (s

)

q O

R:

Exte

nsio

n Pe

rson

nel

Page

3 o

f 4

Nebraska 4-H

Participan

t Code of C

ondu

ct

Character D

evelopment is the cornerstone of the 4-H

program. Your participation in 4-H

carries the responsibility of exhib-iting behaviors that reflect the positive traits of trustw

orthiness, respect, responsibility, fairness, caring and citizenship. Your contribution to a 4-H

program is as im

portant as what you receive from

it. The following guidelines m

ay not be exhaustive or exclusive. In the spirit of these guidelines, you are expected to prom

ote Nebraska as “the good life,” and exhibit good

character at all times.

As a 4-H

participant, I will:

1. Treat all people and property with respect, courtesy, consideration and com

passion. Avoid put-dow

ns, insults, name

calling, swearing and other language or nonverbal conduct likely to offend, hurt or set a bad exam

ple.

2. Act in a responsible m

anner at all times.

A. Participate in all sessions related to the 4-H

program, event and contest. I w

ill not leave the assigned program

area without perm

ission of the paid or volunteer staff.

B. Respect roomm

ates by creating a quiet atmosphere during sleeping hours and by rem

aining within m

y assigned sleeping quarters after curfew

to ensure the safety/well-being of m

yself and others.

C. A

void sexual displays of personal affection. Females are not perm

itted in males’ room

s, nor males in fem

ales’ room

s at any time. M

inors are not allowed in staff quarters. Room

s will be m

onitored in accordance with 4-H

Policy.

3. Keep noise to a minim

um out of respect to others outside of the 4-H

group who could be using the sam

e facility.

4. Use good m

anners, dress appropriately for the occasion and not wear clothing that m

ay be offensive and disrespect-ful to others.

5. Practice fair-mindedness by being open to ideas, suggestions and opinions of others.

6. Obey law

s and rules as an obligation of being a good citizen. I accept responsibility for the proper treatment and

care for other youth and adults, animals, the environm

ent, the program facilities and/or equipm

ent.

7. Not possess or use: tobacco products, alcoholic beverages, controlled or uncontrolled m

ood-altering substances, pocket/hunting knives, lighters/m

atches, fireworks or firearm

s during 4-H events. A

ll prescription and non-prescrip-tion m

edications will be listed on m

y health form. I w

ill follow the specific 4-H

event/program guidelines and w

ill possess only the acceptable item

s as dictated by the specific event. Staff have reserved the right to check luggage, storage areas and/or living quarters prior to and during an event.

I understand that if I do not follow the above code of conduct I m

ay expect:

1. To explain my actions to 4-H

staff in charge.

2. A letter describing the infraction and/or inappropriate behavior w

ill be sent to my parent/guardian and/or county

4-H C

ouncil or sponsoring group.

3. To be dismissed from

the event and sent home early at parent/guardian expense.

4. If applicable, further disciplinary action as determined by the county 4-H

Council, w

hich may include becom

ing ineli-gible to participate in further 4-H

activities.

5. To reimburse the proper entity for any property dam

age or for liability resulting from inappropriate actions. In the

case of vandalism, I m

ay be required to reimburse 4-H

or the facility for trip expenses and/or any additional clean-up fees.

___________________________________________ ___________________________________________

Parent/G

uardian Signature 4-H

Participant Signature

Make a copy of this form

for your records.

Page 4 of 4

SignSign

Nebraska Extension is a D

ivision of the Institute of Agriculture and N

atural Resources at the University of N

ebraska–Lincoln cooperating with the C

ounties and the United States D

epartment of A

griculture.

The 4-H Youth D

evelopment program

abides with the nondiscrim

ination policies of the University of N

ebraska–Lincoln and the United States D

epartment of A

griculture.

Character D


program. Your

participation in 4-H carries the responsibility of exhibiting behaviors that

reflect the positive traits of trustworthiness, respect, responsibility, fairness,

caring and citizenship. Your contribution to a 4-H program

is as important

as what you receive from



ote N

ebraska as “the good life,” and exhibit good character at all times.

As a 4-H


1. Treat all people and property with respect, courtesy, consideration and

compassion. A

void put-downs, insults, nam

e calling, swearing and other

language or nonverbal conduct likely to offend, hurt or set a bad example.

2. Act in a r esponsible m

anner at all times.


program, event and

contest. I will not leave the assigned program

area without perm


B. Respect r oomm

ates by creating a quiet atmosphere during sleeping

hours and by remaining w

ithin my assigned sleeping quarters after

curfew to ensure the safety/w

ell-being of myself and others.

C. A

v oid sexual displays of personal affection. Females are not perm

itted in m

ales’ rooms, nor m

ales in females’ room

s at any time. M

inors are not allow

ed in staff quarters. Rooms w

ill be monitored in accordance

with 4-H

Policy.

3. Keep noise t o a minim


group w

ho could be using the same facility.

4. Use good m

anners, dr ess appropriately for the occasion and not wear

clothing that may be offensive and disrespectful to others.

5. Practice fair-mindedness by being open to ideas, suggestions and opinions

of others.

6. Obey la w

s and rules as an obligation of being a good citizen. I accept responsibility for the proper treatm

ent and care for other youth and adults, anim

als, the environment, the program

facilities and/or equipment.

7. Not possess or use: tobacco products, alcoholic beverages, controlled or

uncontrolled mood-altering substances, pocket/hunting knives, lighters/

matches, firew

orks or firearms during 4-H

events. All prescription and non-

prescription medications w

ill be listed on my health form

. I will follow

the specific 4-H





ay expect:

1. To e xplain my actions to 4-H

staff in charge.

2. A lett er describing the infraction and/or inappropriate behavior w

ill be sent to m

y parent/guardian and/or county 4-H C



the event and sent home early at parent/guardian

expense.


C

ouncil, which m

ay include becoming ineligible to participate in further

4-H activities.


age or for liability resulting from

inappropriate actions. In the case of vandalism, I m

ay be required to reim

burse 4-H or the facility for trip expenses and/or any

additional clean-up fees.

Un

iversity of Nebraska - Lin

coln You

th A

ctivity Safety Policy

Paren

t/Gu

ardian

Inform

ationThe U

niversity of Nebraska-Lincoln has im

plemented a Youth A

ctivity Safety Policy to provide a safe environm

ent for youths participating in UN

L sponsored activities, clinics or conferences.

Our policy includes safe interaction guidelines as w

ell as background and sex registry checks for A

ctivity Workers. This policy w

ill help to protect participating youths from

potential misconduct incidents and help provide a

safe, educational and enjoyable activity/program experience.

Activity W

orkers

1. All A

ctivity Workers m

ust successfully pass a sex offender registry search for N

ebraska and the state(s) they reside.

2. All A

ctivity Workers driving activity vehicles m

ust successfully pass a D

riving Record Check.

3. In the case of an emergency or accident involving your youth, parents/

guardians will be notified, follow

ing notification of the appropriate em

ergency personnel.

4. All U

NL activities w

ill comply w

ith UN

L’s Youth Activities Safety G

uidelines.

5. As parent(s) or legal guardian(s) you give perm

ission to this activity to use photos of your child in prom

otional media.

Disciplinary A

ction

The activity directors of University-sponsored activities, clinics and

conferences reserve the right to imm

ediately dismiss any youth from

the activity, clinic or conference w

ho is found to have violated behavioral expectations. D

ismissed youth w

ill be sent home at their expense and w

ill be responsible for all other expenses associated w

ith their dismissal. Parent(s)/

Nebraska 4-H

Particip

ant C

ode of C

ond

uct

Nebraska 4-H

Participan

t Code of C

ondu

ct

Character D





program is as im






As a 4-H




ns, insults, name


ple.


anner at all times.




area without perm


B. Respect roomm


aining within m



yself and others.

C. A



s, nor males in fem

ales’ room

s at any time. M


s will be m


Policy.




e facility.

4. Use good m




6. Obey law




ent.







y health form. I w






ay expect:


staff in charge.



4-H C





Council, w



activities.






___________________________________________ ___________________________________________

Parent/G




for your records.

Page 4 of 4

SignSign






epartment of A

griculture.

The 4-H Youth D

evelopment program




epartment of A

griculture.

Nebraska 4-H

Participan

t Code of C

ondu

ct

Character D





program is as im






As a 4-H




ns, insults, name


ple.


anner at all times.




area without perm


B. Respect roomm


aining within m



yself and others.

C. A



s, nor males in fem

ales’ room

s at any time. M


s will be m


Policy.




e facility.

4. Use good m




6. Obey law




ent.







y health form. I w






ay expect:


staff in charge.



4-H C





Council, w



activities.






___________________________________________ ___________________________________________

Parent/G




for your records.

Page 4 of 4

SignSign






epartment of A

griculture.

The 4-H Youth D

evelopment program




epartment of A

griculture.

Date

Cal

end

arC

ampe

r re

gist

rati

on f

ees

paid

on

or

befo

re A

pril

15,

201

5, w

ill

rece

ive

a 10

per

cen

t ea

rly

bird

dis

cou

nt.

Aft

er A

pril

15,

pay

th

e st

and

ard

fee

.

2015

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4-H

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May

26

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Jun

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Eastern Nebraska 4-H Center 21520 W. Highway 31 Gretna , NE 68028

Within a 30-minute drive of Omaha and Lincoln, the Eastern Nebraska 4-H Center is located next to Schramm State Park, eight miles south of Gretna, Nebraska.

In addition to the natural beauty of the oak/hickory forest, natural tall grass prairie, and hiking trails, our spacious lodge has plenty of room for inside games, crafts, skits, and dining. Each cabin is air-conditioned with bathrooms and showers. The grounds also contain shooting ranges, challenge courses, rec courts, campfire rings and a waterslide.

Driving Directions: From the north, east, and west: Take Highway 31 south from Interstate 80, Exit 432 (Gretna) to the 4-H Center (5 miles). From the south: Follow Highway 50 north from Louisville across the Platte River. Turn left on Highway 31 and go 6 miles to the 4-H Center.

Destination 4-H Camps Camp Comeca - Cozad, NE

For the 3rd year, Nebraska 4-H Camps will partner with Camp Comeca and Nebraska Game and Parks Commission to expand the 4-H camping opportunities in Nebraska. These sessions will offer the rich traditions and value of the Nebraska 4-H Camping program. They continue to focus of the mission of providing unique educational opportunities in a safe, inclusive, and fun environment. See the session descriptions for more details or contact Lindsay Shearer at [email protected] or (402) 472-2846.

Driving Directions: Take Highway 21 south from Interstate 80, Exit 222 (Cozad) to Road 759. Turn west on Road 759, to Road 417 (approximately 3 miles). Turn south on Road 417. Follow Road 417 until your reach the Camp Comeca parking lot.

Nebraska State 4-H Camp83222 4-H Camp RoadHalsey, NE 69142

Located within the Nebraska National Forest, the State 4-H Camp has been serving the youth of Nebraska since 1959. The Eppley Lodge is one of the most endearing main lodge

facilities in the state with air-conditioned spaces and a grand ballroom with a surrounding balcony.

The campgrounds contain sleeping cabins with bathrooms in or near each cabin. The grounds include: a T.R.U.S.T Course, waterslide, rec fields, shooting ranges, and a breathtaking zip line. State camp is ideally located between the Dismal and Loup rivers, perfect for tubing, canoeing, or kayaking. Be part of State 4-H Camp’s traditions, history, and fun.

Driving Directions: From the east: Go 1 mile west from Halsey on Highway 2 until you reach the Nebraska National Forest entrance. From the west: Go 15 miles east from Thedford on Highway 2 until you reach the Nebraska National Forest entrance. Enter the forest and follow the 4-H signs until you reach the Nebraska State 4-H Camp.)

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Coming Soon – in 2015! Join us at the Nebraska State 4-H Camp to soar above the trees in our three-stop canopy zip line. It’s sure to offer a thrilling ride, breathtaking views, and a one-of-a-kind adventure!

Nebraska Extension is a Division of the Institute of Agriculture and Natural Resources and the University of Nebraska–Lincoln cooperating with the Counties and the United States Department of Agriculture. The 4-H Youth Development program abides with the nondiscrimination policies of the University of Nebraska–Lincoln and the United States Department of Agriculture.The Nebraska State 4-H Camp operates under a special use permit in partnership with the U.S. Forest Service.

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Documents

Join us on - Nebraska Extension 4-H Camp...Culinary Creations Session 402, Saturday, July 18 – State Are you ready to get creative in the kitchen? Join us for making, baking, and