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
402-332-4496Eastern Nebraska 4-H
Center, Gretna
Connie Cox, Director
308-533-2224 Nebraska State 4-H
Camp, Halsey
Lindsay Shearer, RN,
4-H Camp Operations
Coordinator, Director
(Destination camps)
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
2
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!
3
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
4
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!!
5
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
See description on page 2.
Crazy Camp Challenges Session 416, July 5-9 – State
See description on page 2.
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
See description on page 2.
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
See description on page 2.
Aquatic Blast Session 526, July 5-11 – Eastern – I Session 535, August 2-6 – Eastern – II
See description on page 3.
Aquatic Blast Mini Session 525, July 5-8 – Eastern – I Session 527, July 8-11 – Eastern – II
See description on page 3.
Creativity Camp Session 521, June 15-19 – Eastern
See description on page 3.
7
4H.UNL.EDU/CAMP
8
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.
Dat
e Re
ceiv
ed _
____
/__
____
/__
____
_
Cos
t of A
ctiv
ity__
____
____
__ T
otal
Rec
eive
d__
____
____
__
Paid
by
Who
m _
____
____
___
Che
ck N
umbe
r __
____
____
__q
Hea
lth in
form
atio
n ve
rifie
d at
reg
istr
atio
n
Sign
atur
e of
per
son
pick
ing
up p
artic
ipan
t
____
____
____
____
____
____
____
____
____
____
____
___
Neb
rask
a 4-
H P
arti
cipa
nt
Per
mis
sion
an
d H
ealt
h F
orm
Plea
se p
rint
or
type
.
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
_Pa
rtic
ipan
t’s F
irst
Nam
e M
iddl
e In
itial
La
st N
ame
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
_St
reet
Add
ress
C
ity
Stat
e Zi
p Ph
one
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
_A
ge
Dat
e of
Bir
th
Gra
de in
Sch
ool
4-H
Cou
nty
Nam
eG
ende
r q
Mal
e q
Fem
ale
Pare
nt/G
uard
ian
emai
l for
ele
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
Dat
e Re
ceiv
ed _
____
/__
____
/__
____
_
Cos
t of A
ctiv
ity__
____
____
__ T
otal
Rec
eive
d__
____
____
__
Paid
by
Who
m _
____
____
___
Che
ck N
umbe
r __
____
____
__q
Hea
lth in
form
atio
n ve
rifie
d at
reg
istr
atio
n
Sign
atur
e of
per
son
pick
ing
up p
artic
ipan
t
____
____
____
____
____
____
____
____
____
____
____
___
Neb
rask
a 4-
H P
arti
cipa
nt
Per
mis
sion
an
d H
ealt
h F
orm
Plea
se p
rint
or
type
.
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
_Pa
rtic
ipan
t’s F
irst
Nam
e M
iddl
e In
itial
La
st N
ame
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
_St
reet
Add
ress
C
ity
Stat
e Zi
p Ph
one
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
_A
ge
Dat
e of
Bir
th
Gra
de in
Sch
ool
4-H
Cou
nty
Nam
eG
ende
r q
Mal
e q
Fem
ale
Pare
nt/G
uard
ian
emai
l for
ele
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
Dat
e Re
ceiv
ed _
____
/__
____
/__
____
_
Cos
t of A
ctiv
ity__
____
____
__ T
otal
Rec
eive
d__
____
____
__
Paid
by
Who
m _
____
____
___
Che
ck N
umbe
r __
____
____
__q
Hea
lth in
form
atio
n ve
rifie
d at
reg
istr
atio
n
Sign
atur
e of
per
son
pick
ing
up p
artic
ipan
t
____
____
____
____
____
____
____
____
____
____
____
___
Neb
rask
a 4-
H P
arti
cipa
nt
Per
mis
sion
an
d H
ealt
h F
orm
Plea
se p
rint
or
type
.
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
_Pa
rtic
ipan
t’s F
irst
Nam
e M
iddl
e In
itial
La
st N
ame
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
_St
reet
Add
ress
C
ity
Stat
e Zi
p Ph
one
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
_A
ge
Dat
e of
Bir
th
Gra
de in
Sch
ool
4-H
Cou
nty
Nam
eG
ende
r q
Mal
e q
Fem
ale
Pare
nt/G
uard
ian
emai
l for
ele
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
Dat
e Re
ceiv
ed _
____
/__
____
/__
____
_
Cos
t of A
ctiv
ity__
____
____
__ T
otal
Rec
eive
d__
____
____
__
Paid
by
Who
m _
____
____
___
Che
ck N
umbe
r __
____
____
__q
Hea
lth in
form
atio
n ve
rifie
d at
reg
istr
atio
n
Sign
atur
e of
per
son
pick
ing
up p
artic
ipan
t
____
____
____
____
____
____
____
____
____
____
____
___
Neb
rask
a 4-
H P
arti
cipa
nt
Per
mis
sion
an
d H
ealt
h F
orm
Plea
se p
rint
or
type
.
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
_Pa
rtic
ipan
t’s F
irst
Nam
e M
iddl
e In
itial
La
st N
ame
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
_St
reet
Add
ress
C
ity
Stat
e Zi
p Ph
one
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
_A
ge
Dat
e of
Bir
th
Gra
de in
Sch
ool
4-H
Cou
nty
Nam
eG
ende
r q
Mal
e q
Fem
ale
Pare
nt/G
uard
ian
emai
l for
ele
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
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
Health H
istory Information
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.
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
(high/low blood pressure,
shortness of breath, murm
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
11. Have diabetes or hypoglycem
ia? ____ ____
12. Have asthm
a? ____ ____
13. Had m
ononucleosis in the past 12 months?
____ ____14. H
ad seizures? ____ ____
15. Had frequent ear infections?
____ ____16. W
ear glasses, contacts or protective eyewear?
____ ____17 . H
av e an orthodontic appliance? ____ ____
18. Have problem
s with sleepw
alking? ____ ____
19. If female, have an abnorm
al menstrual history?
____ ____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?
____ ____
If yes, please give details (i.e., reactions, special instructions, special equipment, procedures): (attach additional pages if necessary)
___________________________________________________________________________________________________________________D
ate of last physical exam _______________________________________________________________________________________________
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
non-sw
imm
er beginner
swim
mer
Conditions, R
estrictions or Allergies (Please list all)
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
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
evelopment is the cornerstone of the 4-H
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
it. The following guidelines m
ay not be exhaustive or exclusive. In the spirit of these guidelines, you are expected to prom
ote N
ebraska 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
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.
A. Participate in all sessions related to the 4-H
program, event and
contest. I will not leave the assigned program
area without perm
ission of the paid or volunteer staff.
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
um out of respect to others outside of the 4-H
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
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 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
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
C
ouncil, which m
ay include becoming ineligible 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 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
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.
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.
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
Neb
rask
a S
tate
4-H
Cam
pD
ate
s #
Ca
mp
Ses
sion
Tit
le
Da
ys
Nig
hts
A
ges
Arr
ive/
Dep
art
E
arl
y B
ird
* S
tan
da
rd
May
26
- 29
40
0 C
amp
Cou
nse
lor
Tra
inin
g 4
3 15
-18
10 a
m/ 3
pm
$1
00
$100
Jun
e 20
40
1 S
um
mer
Fu
n 1
01
1 0
5 -
8 10
am
/4 p
m
$40
$45
July
18
402
Cu
lin
ary
Cre
atio
ns
1 0
5 -
8 9
am/5
pm
$5
5 $6
0M
ay 3
1 -
J un
e 3
403
Exp
lore
r -
Su
mm
er F
un
1
4 3
8 -
11
3 pm
/10
am
$200
$2
20Ju
ne
3 -
6 40
4 E
xplo
rer
- Tan
k &
Tu
be t
he
Lou
p 4
3 8
- 1
1 3
pm/1
0 am
$2
05
$225
Jun
e 17
- 2
0 40
5 E
xplo
rer
- S
um
mer
Fu
n I
I 4
3 8
- 1
1 3
pm/1
0 am
$2
00
$220
Jun
e 28
- J
uly
1
406
Exp
lore
r -
San
dhil
lz S
ampl
er
4 3
8 -
11
3 pm
/10
am
$200
$2
20Ju
ly 2
6 -
29
407
Exp
lore
r -
Ult
imat
e G
irls
Roc
k 4
3 8
- 1
1 3
pm/2
pm
$2
20
$240
July
26
- 29
40
8 E
xplo
rer
- C
razy
Cam
p C
hal
len
ges
4 3
8 -
11
3 pm
/2 p
m
$220
$2
40M
ay 3
1 -
J un
e 3
409
Dis
cove
ry -
Su
mm
er F
un
I
4 3
11 -
15
3 pm
/10
am
$200
$2
20Ju
ne
3 -
6 41
0 D
isco
very
- T
ank
& T
ube
th
e L
oup
4 3
11 -
15
3 pm
/10
am
$205
$2
25Ju
ne
8 -
12
411
Dis
cove
ry -
Riv
er A
dven
ture
s 5
4 11
- 1
5 10
am
/2 p
m
$305
$3
35Ju
ne
14 -
19
412
Dis
cove
ry -
Ou
tdoo
r S
kill
s - T
op S
hot
5
4 11
- 1
5 3
pm/2
pm
$3
40
$375
Jun
e 17
- 2
0 41
3 D
isco
very
- S
um
mer
Fu
n I
I 4
3 11
- 1
5 3
pm/1
0 am
$2
00
$220
Jun
e 22
- 2
6 41
4 D
isco
very
- O
utb
ack
Hal
sey
- S
urv
ivor
5
4 11
- 1
5 10
am
/ 2 p
m
$310
$3
40Ju
ne
28 -
Ju
ly 2
41
5 D
isco
very
- S
andh
illz
Sam
pler
5
4 11
- 1
5 3
pm/2
pm
$2
85
$315
July
5 -
9
416
Dis
cove
ry -
Cra
zy C
amp
Ch
alle
nge
s 5
4 11
- 1
5 3
pm/1
0 am
$2
70
$300
July
5 -
9
417
Dis
cove
ry -
Nio
brar
a K
ayak
& T
ubi
ng
5 4
11 -
15
3 pm
/10
am
$270
$3
00
2015
Eas
tern
Neb
rask
a 4-
H C
ente
r S
ched
ule
Da
tes
# C
am
p S
essi
on T
itle
D
ays
N
igh
ts
Age
s A
rriv
e/D
epa
rt
Ea
rly
Bir
d*
Sta
nd
ard
May
31
- Ju
ne
5 50
0 C
amp
Cou
nse
lor
Tra
inin
g 6
5 15
- 2
1 3
pm/1
0 am
$1
00
$100
Jun
e 6
501
Wet
N’ W
ild
Day
Cam
p I*
* 1
0 5
- 8
10 a
m/4
pm
$4
0 $4
5Ju
ly 1
8 50
2 W
et N
’ Wil
d D
ay C
amp
II**
1
0 5
- 8
10 a
m/4
pm
$4
0 $4
5Ju
ne
7 -
11
503
Exp
lore
r -
Su
mm
er F
un
I
5 4
8 -
11
3 pm
/10
am
$280
$3
10Ju
ne
9 -
11
504
Exp
lore
r -
Zoo
Bou
nd
I 3
2 8
- 1
1 10
am
/3 p
m
$230
$2
55Ju
ne
15 -
19
505
Exp
lore
r -
Cre
ativ
ity
Cam
p 5
4 8
- 1
1 3
pm/1
0 am
$2
85
$315
Jun
e 28
- J
uly
1
506
Exp
lore
r -
Su
mm
er F
un
Min
i II
4 3
8 -
11
3 pm
/10
am
$205
$2
25Ju
ne
28 -
Ju
ly 3
50
7 E
xplo
rer
- S
um
mer
Fu
n I
I 6
5 8
- 1
1 3
pm/1
0 am
$3
50
$385
July
5 -
8
508
Exp
lore
r - A
quat
ic B
last
Min
i I
4 3
8 -
11
3 pm
/10
am
$220
$2
40Ju
ly 5
- 1
1 50
9 E
xplo
rer
- Aqu
atic
Bla
st I
7
6 8
- 11
3
pm/1
0 am
$4
55
$500
July
7 -
9
510
Exp
lore
r -
Zoo
Bou
nd
II
3 2
8 -
11
10 a
m/3
pm
$2
30
$255
July
8 -
11
511
Exp
lore
r - A
quat
ic B
last
Min
i II
4 3
8 -
11
3 pm
/10
am
$220
$2
40Ju
ly 1
2 -
15
512
Exp
lore
r -
Sky
’s t
he
Lim
it I
4
3 8
- 1
1 3
pm/1
0 am
$2
20
$240
July
26
- 29
51
3 E
xplo
rer
- S
um
mer
Fu
n M
ini I
II-A
4
3 8
- 1
1 3
pm/1
0 am
$2
05
$225
July
26
- Au
g 1
514
Exp
lore
r -
Su
mm
er F
un
III
7
6 8
- 1
1 3
pm/1
0 am
$4
20
$460
July
29
- Au
g 1
515
Exp
lore
r -
Su
mm
er F
un
Min
i III
-B
4 3
8 -
11
3 pm
/10
am
$205
$2
25A
ug
2 -
6 51
6 E
xplo
rer
- S
um
mer
Fu
n I
V
5 4
8 -
11
3 pm
/10
am
$280
$3
10A
ug
2 -
6 51
7 E
xplo
rer
- Aqu
atic
Bla
st I
I 5
4 8
- 1
1 3
pm/1
0 am
$3
05
$335
Jun
e 7
- 11
51
8 D
isco
very
- S
um
mer
Fu
n I
5
4 11
- 1
5 3
pm/1
0 am
$2
80
$310
Jun
e 10
- 1
3 51
9 D
isco
very
- O
utp
ost
Cam
p I
4 3
11 -
15
3 pm
/10
am
$205
$2
25Ju
ne
14 -
19
520
Dis
cove
ry -
Bol
dly
Bou
nd
6 5
11 -
15
3 pm
/10
am
$360
$3
95Ju
ne
15 -
19
521
Dis
cove
ry -
Cre
ativ
ity
Cam
p 5
4 11
- 1
5 3
pm/1
0 am
$2
85
$315
Jun
e 28
- J
uly
1
522
Dis
cove
ry -
Su
mm
er F
un
Min
i II
4 3
11 -
15
3 pm
/10
am
$205
$2
25Ju
ne
28 -
Ju
ly 3
52
3 D
isco
very
- S
um
mer
Fu
n I
I 6
5 11
- 1
5 3
pm/1
0 am
$3
50
$385
Jun
e 28
- J
uly
2
524
Dis
cove
ry -
Ext
rem
e R
obot
ics/
GP
S/G
IS
5 4
11 -
15
3 pm
/10
am
$310
$3
40Ju
ly 5
- 8
52
5 D
isco
very
- A
quat
ic B
last
Min
i I
4 3
11 -
15
3 pm
/10
am
$220
$2
40Ju
ly 5
- 1
1 52
6 D
isco
very
- A
quat
ic B
last
I
7 6
11 -
15
3 pm
/10
am
$455
$5
00Ju
ly 8
- 1
1 52
7 D
isco
very
- A
quat
ic B
last
Min
i II
4 3
11 -
15
3 pm
/10
am
$220
$2
40Ju
ly 1
2 -
17
528
Dis
cove
ry -
Sky
’s t
he
Lim
it I
I 6
5 11
- 1
5 3
pm/1
0 am
$3
65
$400
July
12
- 17
52
9 D
isco
very
- O
utd
oor
Ski
lls
6 5
11 -
15
3 pm
/10
am
$355
$3
90Ju
ly 2
6 -
29
530
Dis
cove
ry -
Su
mm
er F
un
Min
i III
-A
4 3
11 -
15
3 pm
/10
am
$205
$2
25Ju
ly 2
6 - A
ug
1 53
1 D
isco
very
- S
um
mer
Fu
n I
II
7 6
11 -
15
3 pm
/10
am
$420
$4
60Ju
ly 2
9 - A
ug
1 53
2 D
isco
very
- S
um
mer
Fu
n M
ini I
II-B
4
3 11
- 1
5 3
pm/1
0 am
$2
05
$225
July
29
- Au
g 1
533
Dis
cove
ry -
Ou
tpos
t C
amp
II
4 3
11 -
15
3 pm
/10
am
$205
$2
25A
ug
2 -
6 53
4 D
isco
very
- S
um
mer
Fu
n I
V
5 4
11 -
15
3 pm
/10
am
$280
$3
10A
ug
2 -
6 53
5 D
isco
very
- A
quat
ic B
last
II
5 4
11 -
15
3 pm
/10
am
$305
$3
35
2015
Des
tin
atio
n N
ebra
ska
4-H
Cam
ps
Da
tes
# C
am
p S
essi
on T
itle
D
ays
N
igh
ts
Age
s A
rriv
e/D
epa
rt
Ea
rly
Bir
d*
Sta
nd
ard
Jun
e 2-
4
601
Exp
lore
r -
Su
mm
er F
un
***
3 2
8 -
11
10 a
m/1
0 am
$1
80
$200
July
6 -
9
602
Dis
cove
ry -
Sh
ooti
ng
Ski
lls*
**
4 3
11 -
15
10 a
m/1
0 am
$2
30
$250
* E
arly
Bir
d -
10
perc
ent
dis
cou
nt
if c
amp
fees
pai
d b
y A
pril
15,
201
5.**
Day
cam
p fe
es i
ncl
ud
e lu
nch
for
one
chap
eron
e. C
hap
eron
es a
re e
nco
ura
ged
, bu
t n
ot r
equ
ired
.**
* C
amps
wil
l be
hos
ted
at
Cam
p C
omec
a n
ear
Coz
ad, N
ebra
ska.
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.)
Th
e N
ebra
ska
4-H
Cam
ps a
nd
Cen
ters
are
ow
ned
an
d op
erat
ed t
hro
ugh
a p
artn
ersh
ip o
f th
e N
ebra
ska
Ext
ensi
on 4
-H P
rogr
am a
nd
the
Neb
rask
a 4-
H F
oun
dati
on.
All
th
ree
cam
ps a
re a
ccre
dite
d by
th
e A
mer
ican
C
amp
Ass
ocia
tion
. Th
is o
rgan
izat
ion
set
s st
anda
rds
for
safe
ty, m
ain
ten
ance
, pro
gram
s,
hu
man
rel
atio
ns,
tra
nsp
orta
tion
, an
d ot
her
are
as
of c
amp
man
agem
ent.
Ou
r ca
mps
com
ply
wit
h
mor
e th
an 3
00 in
divi
dual
sta
nda
rds
to e
nsu
re t
hat
yo
ur
visi
t is
a p
osit
ive
one.
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.
NONP
ROFI
T OR
GUS
POS
TAGE
PAID
UNL