Summer Flier 2018
Summer 2018
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.
Yes, I give permission for my child to fully participate in 4-H Rural Youth Services 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.
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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.
DANBY
C
Yes, I understand that my child should dress appropriately for the programs that they are attending.
Y
If my child is unable to attend a scheduled event, I will alert the program manager at @ (585) 236-6304 or 272-2292 ext. 221.
IT
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.
N LY . FU FIE L D TRIP S .
Yes, I give permission for my child to participate in program evaluation activities for the purpose of 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.
. F AM I
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.
O KING . G A ME
Yes, my child requires prescription or over the counter medication during the trip. A PRN order must be obtained by child’s physician, the child must be able to self-administer the medication, which should come in the original container with only the specific dosages necessary for the duration of the trip. Parents must sign the PRN.
RS . CO
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.
M
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S IN S.O R G/ RY
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_____ Yes, I understand that my child must bring a bagged lunch to program every day. _____ Yes, my child will be dressed appropriately for the weather and will be equiped with their own water bottle and sunblock. Parent/Guardian Signature:
Date:
Contact: melis schildkraut, (585) 236-6304, [email protected]
Summer 2018 schedule Outdoor Adventures at Hammond Hill Monday – Tuesday, 6/25 - 26 9 AM – 3:30 PM, drop-off and pick-up @ the Danby Community Church Join primitive pursuits instructor and Dryden program manager, Dave Hall, at Hammond Hill where we’ll explore nature and learn outdoor skills. Floating Classroom Wednesday, 6/27 10AM - 2PM, drop-off and pick-up @ the Ithaca Farmer’s Market Spend the day cruising along Cayuga Lake with other youth from Lansing, Dryden, and Ithaca. Special focus on all things science. Choose Your Own Adventure! Monday – Wednesday, 7/9 – 11 9 AM – 4:00 PM @ CCETC Join myself and Beth Bannister of the Joint Youth Commission for an open-ended program. We will meet downtown, where we will have access to many adventures including: the Science Center, the CCETC kitchen, and the Ithaca farmers market! Community Herbalism Monday – Thursday, 7/16 – 19 10 AM – 4:00 PM @ Danby State Forest Hike and learn while collecting medicinal plants to transform into naturally healing body products. At the end of the week, we will share our products with the Danby community at a TBA location. Art & Soul Monday - Thursday, 7/23 – 26 9 AM – 3:00 PM @ Dewitt Middle School Throw yourself into a week of artistic exploration as we join Beth Bannister and JYC youth to complete various arts and crafts. Fishing & Canoeing Tuesday & Wednesday, 8/7 - 8 9 AM - 3 PM @ Jennings Pond Fish, swim, and canoe on Danby’s own pond! Lifegaurds will be on duty for swimming time in the afternoon.
Danby Youth Programs Summer 2018 Registration Form Space is limited, please fill out this form and return it ASAP. 1. Fill out a separate form for each youth. Please remember to make a copy of your form for your own records. 2. A donation of $10/day is requested. However, no youth will be turned away due to inability to pay. All money goes towards funding future Danby youth programs. 3. Please send registration form to 615 Willow Avenue (CCETC) or return electronically to Melis at [email protected].
Please check the programs that your youth would like to attend. If choosing more than three, please rank your top choices. ___ Outdoor Adventures @ Hammond Hill ___ Floating Classroom ___ Choose Your Own Adventure ___ Community Herbalism ___ Art & Soul
___ Baking & Breadmaking ___ Book-making ___ Finger Lakes National Forest Overnight
Since each program is only able to accomodate a maximum of 10 youth, attendance may be limited to 3 programs per individual to ensure that a wide variety of Danby youth will be able to participate.
YOUTH INFORMATION Youth Name: Birth date: School: Address:
M/F:
Grade:
Baking & Breadmaking Thursday & Friday, 8/9 - 10 9 AM - 3 PM, location TBA Learn how to bake bread, pizza, and sweet things, too! On Friday we will take a fieldtrip to a local bakery.
Ethnicity: Hispanic/Non-Hispanic Race: Black or African American/American Indian or Alaska Native /Native Hawaiian or Pacific Islander/ Asian/White/Prefer Not to State Residence: Farm/Rural or Town less than 10,000/Town or City: 10,000-50,000
Outdoor Cooking Tuesday & Wednesday, 8/14 - 15 9AM - 3PM, @ Danby State Forest Hike in the Danby State forest while learning to feed yourself in the great outdoors.
Medical Conditions/Restrictions, or special needs? Y/N
Book-Making Thursday & Friday, 8/16 - 17 9AM - 3PM, location TBA Learn a variety of book-binding techniques while creating plain notebooks or stories of your own. Finger Lakes National Forest Overnight Monday - Wednesday, 8/20 -22 8AM drop-off at CCETC, 2PM pick-up at CCETC Join youth from around Tompkins County on a 2-day overnight trek.
Allergies? Y/N Parent/Guardian Name: Phone: Emergency Contact Name: Phone:
Email:
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.
Yes, I give permission for my child to fully participate in 4-H Rural Youth Services 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.
T
O
O
M
M
. FR . CR AFTS
IE
ND
S
.O
U
D
CO S.
U
N
LE
AR
NIN G
YOUTH PROGRAMS
Y
E
TO
B
C
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.
DANBY
C
Yes, I understand that my child should dress appropriately for the programs that they are attending.
Y
If my child is unable to attend a scheduled event, I will alert the program manager at @ (585) 236-6304 or 272-2292 ext. 221.
IT
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.
N LY . FU FIE L D TRIP S .
Yes, I give permission for my child to participate in program evaluation activities for the purpose of 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.
. F AM I
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.
O KING . G A ME
Yes, my child requires prescription or over the counter medication during the trip. A PRN order must be obtained by child’s physician, the child must be able to self-administer the medication, which should come in the original container with only the specific dosages necessary for the duration of the trip. Parents must sign the PRN.
RS . CO
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.
M
PK
S IN S.O R G/ RY
DA
N
_____ Yes, I understand that my child must bring a bagged lunch to program every day. _____ Yes, my child will be dressed appropriately for the weather and will be equiped with their own water bottle and sunblock. Parent/Guardian Signature:
Date:
Contact: melis schildkraut, (585) 236-6304, [email protected]
Summer 2018 schedule Outdoor Adventures at Hammond Hill Monday – Tuesday, 6/25 - 26 9 AM – 3:30 PM, drop-off and pick-up @ the Danby Community Church Join primitive pursuits instructor and Dryden program manager, Dave Hall, at Hammond Hill where we’ll explore nature and learn outdoor skills. Floating Classroom Wednesday, 6/27 10AM - 2PM, drop-off and pick-up @ the Ithaca Farmer’s Market Spend the day cruising along Cayuga Lake with other youth from Lansing, Dryden, and Ithaca. Special focus on all things science. Choose Your Own Adventure! Monday – Wednesday, 7/9 – 11 9 AM – 4:00 PM @ CCETC Join myself and Beth Bannister of the Joint Youth Commission for an open-ended program. We will meet downtown, where we will have access to many adventures including: the Science Center, the CCETC kitchen, and the Ithaca farmers market! Community Herbalism Monday – Thursday, 7/16 – 19 10 AM – 4:00 PM @ Danby State Forest Hike and learn while collecting medicinal plants to transform into naturally healing body products. At the end of the week, we will share our products with the Danby community at a TBA location. Art & Soul Monday - Thursday, 7/23 – 26 9 AM – 3:00 PM @ Dewitt Middle School Throw yourself into a week of artistic exploration as we join Beth Bannister and JYC youth to complete various arts and crafts. Fishing & Canoeing Tuesday & Wednesday, 8/7 - 8 9 AM - 3 PM @ Jennings Pond Fish, swim, and canoe on Danby’s own pond! Lifegaurds will be on duty for swimming time in the afternoon.
Danby Youth Programs Summer 2018 Registration Form Space is limited, please fill out this form and return it ASAP. 1. Fill out a separate form for each youth. Please remember to make a copy of your form for your own records. 2. A donation of $10/day is requested. However, no youth will be turned away due to inability to pay. All money goes towards funding future Danby youth programs. 3. Please send registration form to 615 Willow Avenue (CCETC) or return electronically to Melis at [email protected].
Please check the programs that your youth would like to attend. If choosing more than three, please rank your top choices. ___ Outdoor Adventures @ Hammond Hill ___ Floating Classroom ___ Choose Your Own Adventure ___ Community Herbalism ___ Art & Soul
___ Baking & Breadmaking ___ Book-making ___ Finger Lakes National Forest Overnight
Since each program is only able to accomodate a maximum of 10 youth, attendance may be limited to 3 programs per individual to ensure that a wide variety of Danby youth will be able to participate.
YOUTH INFORMATION Youth Name: Birth date: School: Address:
M/F:
Grade:
Baking & Breadmaking Thursday & Friday, 8/9 - 10 9 AM - 3 PM, location TBA Learn how to bake bread, pizza, and sweet things, too! On Friday we will take a fieldtrip to a local bakery.
Ethnicity: Hispanic/Non-Hispanic Race: Black or African American/American Indian or Alaska Native /Native Hawaiian or Pacific Islander/ Asian/White/Prefer Not to State Residence: Farm/Rural or Town less than 10,000/Town or City: 10,000-50,000
Outdoor Cooking Tuesday & Wednesday, 8/14 - 15 9AM - 3PM, @ Danby State Forest Hike in the Danby State forest while learning to feed yourself in the great outdoors.
Medical Conditions/Restrictions, or special needs? Y/N
Book-Making Thursday & Friday, 8/16 - 17 9AM - 3PM, location TBA Learn a variety of book-binding techniques while creating plain notebooks or stories of your own. Finger Lakes National Forest Overnight Monday - Wednesday, 8/20 -22 8AM drop-off at CCETC, 2PM pick-up at CCETC Join youth from around Tompkins County on a 2-day overnight trek.
Allergies? Y/N Parent/Guardian Name: Phone: Emergency Contact Name: Phone:
Email:
