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Schools Out! Day Camps
Join us for fun hands-on explorations on a variety of topics!
All camps will be from 9 am - 3 pm at Springbrook State Park's Visitor Center (House)
Snacks and supplies will be provided - please bring a sack lunch

Questions can be directed to Mollie Clark at clarkm@iastate.edu

First and Last Name *
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Email *
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Grade *
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What days will you attend? *
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Dietary restrictions *
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List any physical or medical conditions staff should be aware of. *
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Parent/Guardian Name *
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In case of emergency, notify (other than parent listed) *
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Phone *
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MEDICAL EMERGENCY PARENTAL PERMISSION The health history for my child is correct and complete to my knowledge. If an injury or other medical condition occurs or arises, I hereby give permission to the ISU Extension staff or volunteer to provide routine first aid and seek emergency treatment including x-rays or routine tests. I agree to the release of any record necessary for treatment, referral, billing or insurance purposes. I understand that I am financially responsible for charges to the attending physicians or health care unit (other than those covered by an ISU Extension accident insurance plan). In the event of an emergency where I cannot decide for my child, I give permission to the physician/hospital selected by the ISU Extension staff or volunteer to secure and administer treatment for my child, including hospitalization. (*If you cannot sign this section of the form for any reason, contact the County Extension Director regarding a legal waiver in order to attend and participate.) *
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PUBLICITY/IMAGE/VOICE PERMISSION The Iowa State University Extension 4-H Program normally takes photographs, video, and/or tape recording of our programs. During activities, a photograph or video/audio recording may be taken of you or your child. Unless you request otherwise, your initial below will be considered permission for Iowa State University and the 4-H Program to photograph, film, audio/video tape, record and/or televise your image and/or voice or the image and/or voice of your child for use in any publications or promotional materials, in any medium now known or developed in the future without any restrictions. If you object to ISU using you or your child’s image or voice in this manner, please notify the 4-H program leader. *
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I understand that I will need to provide my child a sack lunch for each day of camp. Snacks and drinks will be provided. *
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I understand that I will have to pay $5 per camp upon arrival *
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