AGES 12+
Spring 2017
Dryden O.U.R.S. offers free afterschool-programming for residents of Hanshaw, Beaconview, & Congers! Program space is limited; families that participate long-term have priority. Please contact the Dryden O.U.R.S. Program Manager with questions: Lexi Hartley, 540-209-1400
“I TEACH ON TUESDAYS”: AGES 12+ 11 Tuesdays– February 14– May 9 (No program 2/21, 2/28, 4/4)
Consider what you already love to do, Find out what your mentor really loves to do, And then actually do those things together! Van Schedule: Van pick-up @ 4:00pm – 4:45pm Returning Home @ 6:45pm – 7:15pm
Thursdays for Mentors-In-Training : AGES 12+ 12 Thursdays this Fall: February 16- May 11 (NO PROGRAM April 6)
THE MURAL PROJECT Meet professional and student artists from Ithaca, Make them feel welcome to our 4H Community, We will join forces to EXPRESS, SCHEME, CONSTRUCT, CREATE, FORTIFY, AND RULE YOUR WORLD! Van Schedule: Van pick-up @ 4:30pm – 5:15pm Returning Home @ 6:45—7:15
Spring 2017———- O.U.R.S. PROGRAMS FOR YOUTH AGED 12+ YEARS: YOUTH NAME : _____________________________________________________________________ PLEASE CHECK THE BOXES OF THE PROGRAMS THAT YOU ARE SIGNING UP FOR:
YOU CAN SIGN UP FOR BOTH!
“I TEACH ON TUESDAYS”: AGES 12+ 11 Tuesdays this spring: February 14– May 9 (NO PROGRAM 2/21, 2/28, 4/4)
Thursdays for Mentors-In-Training—THE MURAL PROJECT: AGES 12+ 12 Thursdays this Fall: February 16- May 11 (NO PROGRAM April 6)
Name:__________________________ Age: _______ Grade:_______ Date of Birth: _____/_____/_____ Street Address: _______________________________________________________ City: ________________________________Zip: ______________ Guardian Name: ________________________________
Email: _________________________________
Home Phone: __________________________ Cell Phone:_____________________________________ Emergency Contact Person : ______________________________ Phone: ___________________________ Does your youth have medical conditions, food allergies/dietary needs, or any special needs? ____ NO ____YES (If Yes, please explain below) _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ I GIVE PERMISSION FOR THE FOLLOWING CHECK-MARKED ITEMS: ____ My youth to attend the marked programs. ____ Cooperative Extension staff & Emergency Medical Personnel to give my young person medical care. ____ My youth to be transported by Cooperative Extension staff in the CCE Van for OURS Programs. ____ My youth’s photo to be taken for documentation of OURS programs and publicity. ____ My youth to participate in anonymous program evaluation activities. ____ School faculty & staff to exchange information regarding my youth, including grades & attendance.
Parent Signature:
Date:
___________________________________________
______/______/17
Dryden O.U.R.S. offers free afterschool-programming for residents of Hanshaw, Beaconview, & Congers! Program space is limited; families that participate long-term have priority. Please contact the Dryden O.U.R.S. Program Manager with questions: Lexi Hartley, 540-209-1400
“I TEACH ON TUESDAYS”: AGES 12+ 11 Tuesdays– February 14– May 9 (No program 2/21, 2/28, 4/4)
Consider what you already love to do, Find out what your mentor really loves to do, And then actually do those things together! Van Schedule: Van pick-up @ 4:00pm – 4:45pm Returning Home @ 6:45pm – 7:15pm
Thursdays for Mentors-In-Training : AGES 12+ 12 Thursdays this Fall: February 16- May 11 (NO PROGRAM April 6)
THE MURAL PROJECT Meet professional and student artists from Ithaca, Make them feel welcome to our 4H Community, We will join forces to EXPRESS, SCHEME, CONSTRUCT, CREATE, FORTIFY, AND RULE YOUR WORLD! Van Schedule: Van pick-up @ 4:30pm – 5:15pm Returning Home @ 6:45—7:15
Spring 2017———- O.U.R.S. PROGRAMS FOR YOUTH AGED 12+ YEARS: YOUTH NAME : _____________________________________________________________________ PLEASE CHECK THE BOXES OF THE PROGRAMS THAT YOU ARE SIGNING UP FOR:
YOU CAN SIGN UP FOR BOTH!
“I TEACH ON TUESDAYS”: AGES 12+ 11 Tuesdays this spring: February 14– May 9 (NO PROGRAM 2/21, 2/28, 4/4)
Thursdays for Mentors-In-Training—THE MURAL PROJECT: AGES 12+ 12 Thursdays this Fall: February 16- May 11 (NO PROGRAM April 6)
Name:__________________________ Age: _______ Grade:_______ Date of Birth: _____/_____/_____ Street Address: _______________________________________________________ City: ________________________________Zip: ______________ Guardian Name: ________________________________
Email: _________________________________
Home Phone: __________________________ Cell Phone:_____________________________________ Emergency Contact Person : ______________________________ Phone: ___________________________ Does your youth have medical conditions, food allergies/dietary needs, or any special needs? ____ NO ____YES (If Yes, please explain below) _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ I GIVE PERMISSION FOR THE FOLLOWING CHECK-MARKED ITEMS: ____ My youth to attend the marked programs. ____ Cooperative Extension staff & Emergency Medical Personnel to give my young person medical care. ____ My youth to be transported by Cooperative Extension staff in the CCE Van for OURS Programs. ____ My youth’s photo to be taken for documentation of OURS programs and publicity. ____ My youth to participate in anonymous program evaluation activities. ____ School faculty & staff to exchange information regarding my youth, including grades & attendance.
Parent Signature:
Date:
___________________________________________
______/______/17
