JYC DeWitt Spring Brochure
JYC Youth Programs Spring 2017 Registration Form
Dewitt Middle School Programs– Spring 2017
Name of Participant: __________________________________________ Address:____________________________________________________ Date of Birth: ________________ Grade: ______ Parent/Guardian Name____________________________________________ Home Phone: ___________________ Work Phone: _____________________ E-mail Address: ______________________________________________ Emergency Contact (other than parent/guardian): Name: ________________________________Phone: ____________________ Relation: ____________________ Any allergies, special needs, or medical conditions of which we should be aware?
Please Check All That Apply _____ Yes, I give permission for my child to participate in selected Joint Youth Commission’s Youth Programs in Spring 2017. _____ Yes, I give permission for the Program Manager to transport my child if necessary. _____ Yes, I give permission for my child to participate in program evaluations in order to assess the program’s value. Any information gathered will remain anonymous. _____ 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’s photo to be taken during activities and for these photos to be used for documentation and publicity purposes (including on social media like Facebook & Instagram) _____ Yes, I understand that I must pick up my child at the end of each program and that supervision of my child is not provided beyond program time, unless otherwise arranged.
Parent Signature: ____________________________________________
Date: __________
Please direct any and all questions to: Beth Bannister JYC Youth Program Manager Phone: (607) 272 2292 ext. 229 Email: [email protected]
http://ccetompkins.org/ Facebook: www.facebook.com/JYCYouthPrograms
JYC Spring Program Registration Space is limited– sign up now! Programs at Dewitt Middle School: Dungeons and Dragons, Magic the Gathering , Board Games Tuesdays 3/14-6/13
3:20—6PM
Join us at Dewitt for a D & D, Magic and other games program. You do not need any experience, and we have what you need to play! Not only can you learn the basics, but if you want you will get instruction on deck-building, draft tournament play (including practice with a cube). We will have other games as well, including Apples to Apples, King of Tokyo, Forbidden Island and more. Meet at 3:20PM in the Dewitt Art Room Pick up at 6:00PM at Dewitt Middle School (students can take the 4:30PM bus)
Art and Soul Thursdays
4/27-6/15
3:20—5:30PM
Join us for creating, building and crafting. Projects will be student led, with options such as jewelry making, birdhouse construction, clothing design and upcycling. Possible field trips to Serviente Glass or pottery studio. Meet at 3:20 PM in the DeWitt Art Room Pick up at 5:30 PM in front of Dewitt Middle School (students can take the 4:30PM bus when not traveling for field trips)
Geocaching and Pokemon Go Mondays 6/5-6/19
3:20-6PM
Travel afterschool to area geocaches and Pokemon Go hot spots. GPS units will be provided for geocachers. Plan to be outdoors in any weather! Meet at 3:20 in front of the Dewitt Main Office Pick up at 6PM in front of Dewitt Middle School
Lunch Bunch
Thursdays 3/16-6/15
Your Lunch Period
Join other students for an alternative to the everyday lunchroom experience. We will eat lunch together (with a fun food addition occasionally) as well as have occasional teambuilding games, activities, crafts and special guests. Meet in the cafeteria during your lunch!
($10-20 donation appreciated for each program. No one will be turned away due to inability to pay.) Make checks payable to Cornell Cooperative Extension.
Priority is given to youth living in the Town of Caroline and Ithaca and the Villages of Lansing and Cayuga Heights. Please keep the other side of this form for your information— You will be notified only if the program is full. Please check the program(s) you would like to attend: ___Art and Soul
4/27-6/15, 2017
___D&D and Magic Club ___Lunch Bunch
3/14-6/13, 2017
3/16-6/15, 2017
___Geocaching/ Pokemon Go
6/5-6/19, 2017
Youth must be picked up by a parent or guardian at the program site at the conclusion of each program, unless arranged otherwise. Please let us know if your student will be using the late bus. ___________________________________________________ Detach and return to Penny Boynton’s Office in Dewitt Middle School, or mail completed form to Beth Bannister at Cornell Cooperative Extension of Tompkins County, 615 Willow Avenue, Ithaca, NY 14850.
Dewitt Middle School Programs– Spring 2017
Name of Participant: __________________________________________ Address:____________________________________________________ Date of Birth: ________________ Grade: ______ Parent/Guardian Name____________________________________________ Home Phone: ___________________ Work Phone: _____________________ E-mail Address: ______________________________________________ Emergency Contact (other than parent/guardian): Name: ________________________________Phone: ____________________ Relation: ____________________ Any allergies, special needs, or medical conditions of which we should be aware?
Please Check All That Apply _____ Yes, I give permission for my child to participate in selected Joint Youth Commission’s Youth Programs in Spring 2017. _____ Yes, I give permission for the Program Manager to transport my child if necessary. _____ Yes, I give permission for my child to participate in program evaluations in order to assess the program’s value. Any information gathered will remain anonymous. _____ 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’s photo to be taken during activities and for these photos to be used for documentation and publicity purposes (including on social media like Facebook & Instagram) _____ Yes, I understand that I must pick up my child at the end of each program and that supervision of my child is not provided beyond program time, unless otherwise arranged.
Parent Signature: ____________________________________________
Date: __________
Please direct any and all questions to: Beth Bannister JYC Youth Program Manager Phone: (607) 272 2292 ext. 229 Email: [email protected]
http://ccetompkins.org/ Facebook: www.facebook.com/JYCYouthPrograms
JYC Spring Program Registration Space is limited– sign up now! Programs at Dewitt Middle School: Dungeons and Dragons, Magic the Gathering , Board Games Tuesdays 3/14-6/13
3:20—6PM
Join us at Dewitt for a D & D, Magic and other games program. You do not need any experience, and we have what you need to play! Not only can you learn the basics, but if you want you will get instruction on deck-building, draft tournament play (including practice with a cube). We will have other games as well, including Apples to Apples, King of Tokyo, Forbidden Island and more. Meet at 3:20PM in the Dewitt Art Room Pick up at 6:00PM at Dewitt Middle School (students can take the 4:30PM bus)
Art and Soul Thursdays
4/27-6/15
3:20—5:30PM
Join us for creating, building and crafting. Projects will be student led, with options such as jewelry making, birdhouse construction, clothing design and upcycling. Possible field trips to Serviente Glass or pottery studio. Meet at 3:20 PM in the DeWitt Art Room Pick up at 5:30 PM in front of Dewitt Middle School (students can take the 4:30PM bus when not traveling for field trips)
Geocaching and Pokemon Go Mondays 6/5-6/19
3:20-6PM
Travel afterschool to area geocaches and Pokemon Go hot spots. GPS units will be provided for geocachers. Plan to be outdoors in any weather! Meet at 3:20 in front of the Dewitt Main Office Pick up at 6PM in front of Dewitt Middle School
Lunch Bunch
Thursdays 3/16-6/15
Your Lunch Period
Join other students for an alternative to the everyday lunchroom experience. We will eat lunch together (with a fun food addition occasionally) as well as have occasional teambuilding games, activities, crafts and special guests. Meet in the cafeteria during your lunch!
($10-20 donation appreciated for each program. No one will be turned away due to inability to pay.) Make checks payable to Cornell Cooperative Extension.
Priority is given to youth living in the Town of Caroline and Ithaca and the Villages of Lansing and Cayuga Heights. Please keep the other side of this form for your information— You will be notified only if the program is full. Please check the program(s) you would like to attend: ___Art and Soul
4/27-6/15, 2017
___D&D and Magic Club ___Lunch Bunch
3/14-6/13, 2017
3/16-6/15, 2017
___Geocaching/ Pokemon Go
6/5-6/19, 2017
Youth must be picked up by a parent or guardian at the program site at the conclusion of each program, unless arranged otherwise. Please let us know if your student will be using the late bus. ___________________________________________________ Detach and return to Penny Boynton’s Office in Dewitt Middle School, or mail completed form to Beth Bannister at Cornell Cooperative Extension of Tompkins County, 615 Willow Avenue, Ithaca, NY 14850.
