Dryden Town Programs
Project Lead 2017 Programs Registration Form Pre-registration is REQUIRED! Space is limited, please fill out this form and return it ASAP You will be contacted by June 15 with confirmation of your registration
1. Fill out a separate form for each youth. Please remember to make a copy of your form for your own records. Be sure to check the box next to the programs that your child is signing up for. 2. Please sent registration form to Cornell Cooperative Extension c / o Rural Youth Services, 615 Willow Ave, Ithaca NY 14850 If you attend Dryden Central Schools, you can also drop off at Dryden Middle School in the mailbox labeled Dryden Youth (before school is out). Questions? Contact Lexi at [email protected] or 540-209-1400 To register online, check out www.drydenprojectlead.org
2017
Youth Information (Please Print) Youth Name: Grade:
Birth date:
M/F:
School:
Address:
_______
Parent/Guardian Name: Phone:(Home) Emergency Contact Information
_______ (Work)
Dryden Town Programs
______(e-mail)_________
Open and free to Dryden Residents (including the
Name: Phone:(Home)
Villages of Ellis Hollow, Etna, Varna, Freeville and Mclean)
(Work)
Medical Conditions/Restrictions, Allergies or special needs? _____________________ _____________________________________________________________________________________________
_____ Yes, I give permission for my child to fully participate in Dryden Youth Summer 2017 programs and to ride in Cooperative Extension program van if necessary to get to and from activities, field trips and to transport youth home if necessary. _____ Yes, I give permission for program staff and/or other emergency care personnel to administer first aid or medical treatment in the event of an emergency involving my child. _____ Yes, I give permission for my child to use a knife for carving and cooking purposes after they have had instruction on safe use and handling. _____ Yes, I give permission for my child to participate in program evaluation activities for the purpose identifying the program’s value and ways to strengthen and improve it in the future. Activities may include: skills checklists, informal discussion, surveys, observation, or group activities. Any feedback or information gathered will remain anonymous. ______Yes, I give permission for my child’s photo to be taken during the activity and for any photo to be use for documentation and publicity purposes. ______If my child is unable to attend a scheduled event, I will alert the program manager at 540-209 -1400 or 607-272-2292 ext. 231 ______ Yes, I understand that my child should bring their own snack, lunch and water for the day. I also understand that they should dress appropriately for the programs that they are attending. ______I fully understand and acknowledge that there are inherent risks and dangers in my child’s participation in the above activities and my child’s participation in such activities and use of any equipment related to such activities may result in injury, illness, or death, and damage to personal property. I understand other participants, accidents, forces of nature, or other incidents may cause these risks and dangers and I hereby accept these risks and dangers. Parent/Guardian Signature:
Date:_______
Games, Community Service, and the Skills You Need to Succeed At Your First Job! Ages 13-14 + Programs managed by Lexi Hartley Drydenprojectlead.org This program is supported by Tompkins County, New York State and your local municipality.
Dryden Youth Services Cornell Cooperative Extension 615 Willow Ave., Ithaca, NY 14850 607)272-2292 ext. 231, (540)-209-1400)
*All participants must be 13 years old or have completed 7th grade. All
Camp Earth Connection Renovations—June 26-29 Please meet at Ellis Hollow Community Center, 111 Genung Rd, Ithaca. We will help build a firepit and other renovations at Camp Earth Connection. Participants can look forward to learning fun outdoor games and camping skills! Community Art Connections— July 10-14 Please meet at Varna Community Center, 943 Dryden Road, Ithaca Work with a local artist to explore the idea of community art and complete a mural at Camp Earth Connection. Be prepared to play outdoor games and develop both your sense of art and your sense of adventure! Rail Trail Renewal - July 17-20 Please meet at Etna Fire Department, 26 Wood Rd, Etna. Have you ever wondered how hiking trails are built? Now is your chance to find out! We’ll work with local naturalists and members of the Dryden Rails to Trails Task Force to identify species, clear the trail, and create signs for the brand-new trail! Community Garden Jam—July 24-27- Please meet at Dryden Town Hall, 93 E Main St, Dryden Do you have a green thumb? Are you passionate about painting? Help the volunteers of the Dryden Community Gardens lay down new flower beds, paint a trellis, and create a road sign! We’ll also hear from small business owners and enjoy visits from some tasty local vendors! Playground Cleanups—July 31- August 4 Please meet at the Varna Community Center, 943 Dryden Rd, Ithaca. Remember your childhood playgrounds… places of fun, adventure and magic? Relive those experiences and give back to your community by assisting with playground and recreation facilities projects at the Varna Community Center and 4H Acres (418 Little Creek Rd). Bring your best ideas from your childhood games! Farm to Table at TC3- August 7-11 and August 14-17 (chose one)Have you ever wondered where your food comes from? Now is a chance to find out! Explore the Farm to Table program farm and facilities at TC3 while honing your gardening skills. We’ll also learn more about opportunities at TC3, including meeting with an admissions officer!
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Project Lead Summer 2017 Programs
Project Lead Registration Form
-----------------------------------
programs meet Monday-Thursday, 9:30 AM - 4:00 PM unless noted. Participants will be transported from meeting to site to project site by CCETC staff*
Dryden Youth Services
Summer 2017
Please number your top three choices. Detach and return completed form to Lexi Hartley at Cornell Cooperative Extension, 615 Willow Ave. Ithaca, NY 14850 ASAP. Questions? Contact Lexi at 540-209-1400 or [email protected] You will receive a confirmation of your program choices by June 15
__ June
26-29: Camp Earth Connection Renovations (Meet
at Ellis Hollow Community Center) __ July 10-14– Camp Earth Connection Mural ( Meet at Varna Community Center) __ July 17-21– Rails to Trail Conservation (Meet at Etna Fire Department) __ July 24-28– Dryden Community Gardens (Meet at Dryden Town Hall) __ July 31– August 4– Playground Cleanups (Meet at Varna Community Center) __ August 7-11 - Farm to Table at TC3 (Meet at Dryden Middle / High School) __ August 14-17- - Farm to Table at TC3 (Meet at Dryden Middle / High School)
Cornell Cooperative Extension of Tompkins County is an employer and educator recognized for valuing AA/EEO, Protected Veterans, and Individuals with Disabilities and provides equal program and employment opportunities.
1. Fill out a separate form for each youth. Please remember to make a copy of your form for your own records. Be sure to check the box next to the programs that your child is signing up for. 2. Please sent registration form to Cornell Cooperative Extension c / o Rural Youth Services, 615 Willow Ave, Ithaca NY 14850 If you attend Dryden Central Schools, you can also drop off at Dryden Middle School in the mailbox labeled Dryden Youth (before school is out). Questions? Contact Lexi at [email protected] or 540-209-1400 To register online, check out www.drydenprojectlead.org
2017
Youth Information (Please Print) Youth Name: Grade:
Birth date:
M/F:
School:
Address:
_______
Parent/Guardian Name: Phone:(Home) Emergency Contact Information
_______ (Work)
Dryden Town Programs
______(e-mail)_________
Open and free to Dryden Residents (including the
Name: Phone:(Home)
Villages of Ellis Hollow, Etna, Varna, Freeville and Mclean)
(Work)
Medical Conditions/Restrictions, Allergies or special needs? _____________________ _____________________________________________________________________________________________
_____ Yes, I give permission for my child to fully participate in Dryden Youth Summer 2017 programs and to ride in Cooperative Extension program van if necessary to get to and from activities, field trips and to transport youth home if necessary. _____ Yes, I give permission for program staff and/or other emergency care personnel to administer first aid or medical treatment in the event of an emergency involving my child. _____ Yes, I give permission for my child to use a knife for carving and cooking purposes after they have had instruction on safe use and handling. _____ Yes, I give permission for my child to participate in program evaluation activities for the purpose identifying the program’s value and ways to strengthen and improve it in the future. Activities may include: skills checklists, informal discussion, surveys, observation, or group activities. Any feedback or information gathered will remain anonymous. ______Yes, I give permission for my child’s photo to be taken during the activity and for any photo to be use for documentation and publicity purposes. ______If my child is unable to attend a scheduled event, I will alert the program manager at 540-209 -1400 or 607-272-2292 ext. 231 ______ Yes, I understand that my child should bring their own snack, lunch and water for the day. I also understand that they should dress appropriately for the programs that they are attending. ______I fully understand and acknowledge that there are inherent risks and dangers in my child’s participation in the above activities and my child’s participation in such activities and use of any equipment related to such activities may result in injury, illness, or death, and damage to personal property. I understand other participants, accidents, forces of nature, or other incidents may cause these risks and dangers and I hereby accept these risks and dangers. Parent/Guardian Signature:
Date:_______
Games, Community Service, and the Skills You Need to Succeed At Your First Job! Ages 13-14 + Programs managed by Lexi Hartley Drydenprojectlead.org This program is supported by Tompkins County, New York State and your local municipality.
Dryden Youth Services Cornell Cooperative Extension 615 Willow Ave., Ithaca, NY 14850 607)272-2292 ext. 231, (540)-209-1400)
*All participants must be 13 years old or have completed 7th grade. All
Camp Earth Connection Renovations—June 26-29 Please meet at Ellis Hollow Community Center, 111 Genung Rd, Ithaca. We will help build a firepit and other renovations at Camp Earth Connection. Participants can look forward to learning fun outdoor games and camping skills! Community Art Connections— July 10-14 Please meet at Varna Community Center, 943 Dryden Road, Ithaca Work with a local artist to explore the idea of community art and complete a mural at Camp Earth Connection. Be prepared to play outdoor games and develop both your sense of art and your sense of adventure! Rail Trail Renewal - July 17-20 Please meet at Etna Fire Department, 26 Wood Rd, Etna. Have you ever wondered how hiking trails are built? Now is your chance to find out! We’ll work with local naturalists and members of the Dryden Rails to Trails Task Force to identify species, clear the trail, and create signs for the brand-new trail! Community Garden Jam—July 24-27- Please meet at Dryden Town Hall, 93 E Main St, Dryden Do you have a green thumb? Are you passionate about painting? Help the volunteers of the Dryden Community Gardens lay down new flower beds, paint a trellis, and create a road sign! We’ll also hear from small business owners and enjoy visits from some tasty local vendors! Playground Cleanups—July 31- August 4 Please meet at the Varna Community Center, 943 Dryden Rd, Ithaca. Remember your childhood playgrounds… places of fun, adventure and magic? Relive those experiences and give back to your community by assisting with playground and recreation facilities projects at the Varna Community Center and 4H Acres (418 Little Creek Rd). Bring your best ideas from your childhood games! Farm to Table at TC3- August 7-11 and August 14-17 (chose one)Have you ever wondered where your food comes from? Now is a chance to find out! Explore the Farm to Table program farm and facilities at TC3 while honing your gardening skills. We’ll also learn more about opportunities at TC3, including meeting with an admissions officer!
- - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Project Lead Summer 2017 Programs
Project Lead Registration Form
-----------------------------------
programs meet Monday-Thursday, 9:30 AM - 4:00 PM unless noted. Participants will be transported from meeting to site to project site by CCETC staff*
Dryden Youth Services
Summer 2017
Please number your top three choices. Detach and return completed form to Lexi Hartley at Cornell Cooperative Extension, 615 Willow Ave. Ithaca, NY 14850 ASAP. Questions? Contact Lexi at 540-209-1400 or [email protected] You will receive a confirmation of your program choices by June 15
__ June
26-29: Camp Earth Connection Renovations (Meet
at Ellis Hollow Community Center) __ July 10-14– Camp Earth Connection Mural ( Meet at Varna Community Center) __ July 17-21– Rails to Trail Conservation (Meet at Etna Fire Department) __ July 24-28– Dryden Community Gardens (Meet at Dryden Town Hall) __ July 31– August 4– Playground Cleanups (Meet at Varna Community Center) __ August 7-11 - Farm to Table at TC3 (Meet at Dryden Middle / High School) __ August 14-17- - Farm to Table at TC3 (Meet at Dryden Middle / High School)
Cornell Cooperative Extension of Tompkins County is an employer and educator recognized for valuing AA/EEO, Protected Veterans, and Individuals with Disabilities and provides equal program and employment opportunities.
