rina “yoli” larosa - broward county, florida · pdf filecounselors will be...

Broward 4-H Youth Development Program Broward Parks and Recreation Division / Extension Education/ Tree Tops Satellite Administrative Building 3900 SW 100 Avenue• Davie, Florida 33328 • 954.357.5270 • FAX 954.357.5271

The Institute of Food and Agricultural Sciences (IFAS) is an Equal Opportunity Institution authorized to provide research, educational information, and other services only to individuals and institutions that function without discrimination with respect to race, creed, color, religion, age, disability, sex, sexual orientation, marital status, national origin, political opinions or affiliations, genetic information and veteran status as protected under the Vietnam Era Veterans' Readjustment Assistance Act. U.S. Department of Agriculture, Cooperative Extension Service, University of Florida, IFAS, Florida A&M University Cooperative Extension Program, and Boards of County Commissioners Cooperating.

May 3, 2013

Dear Broward County 4-H Members, Parents and Volunteers,

Summer is but couple months away, and that means that another fun filled week of educational fun at our annual residential camp at 4-H Camp Cloverleaf in Lake Placid, FL is soon approaching. This year’s camp dates are Monday August 5 through Friday August 9, 2013. We have several fun filled activities planned for our 4-H members such as canoeing, fishing, swimming, natural sciences and much more. We will also be camping alongside Miami, Palm Beach, and other counties during the “Gator Adventures Camp”. This is an opportunity for youth to make new friends. Campers need to be between the ages of 8-11 by September of 2012. Youth who would like to apply for a Camp Counselor position must be ages 12-18 as of September 2012 to be eligible. Counselors will be selected according to a training and application process.

Important Dates: Camp registration deadline July 22, 2013 Camp late registration ($25 late fee) July 26, 2013

This deadline includes camper/counselor applications, Florida Participation Form, and fees. Remember to make fees payable to the Broward County 4-H Association. Only personal checks, money order and cashier checks will be accepted. No cash please!

The camp fee will be $230 for members and $255 for non-members. This fee includes transportation, meals, lodging, and t-shirt. For those participating in the free-and-reduced lunch program, the camp fee will be $180 and for counselors the camp fee will be $180. If you have questions please feel free to contact the Broward County 4-H office at 954-357-5270.

Adults who are interested in chaperoning much be over 18 and must be fingerprinted and a registered 4-H volunteer. Adult volunteers will be selected on an as-needed basis.

Attentively,

Rina “Yoli” LaRosa Broward 4-H Youth Development Agent



4-H Camp Cloverleaf Camper Application: Ages 8 to 11 Camper’s Name: ______________________________________ Gender: _________________________ Ethnicity:_____________________________ Age (as of 9/1/12): ___ Birthdate: ___________________ Address: _________________________________________ City: _________________ Zip: _________ Home Phone: _______________________ Cell: _______________________ 4-H Club Name: _______________________ 4-H Leader’s Name: _______________________ Camp T-shirt Size: S M L XL XXL Parent/Guardian’s Contact Info: Parent/Guardian’s Name: _______________________ _______________________ Work Number: _____________________ Cell:_____________________ Financial Aid Free/Reduce Lunch: $180 *Food stamp recipients, AFDC, Free or Reduced Cost Lunch Program, you must complete and turn in required paperwork. Total Camp Fee (amount paying to attend camp): $ 230 4-H members/ $255 non 4-H members Registration fees must be personal check, money order or cashier’s check, no cash please! No refunds will be given for cancellation after the registration deadline has past. Please make your check or money order payable to: Broward County 4-H Association. Due no later than July 22, 2013. This form and others listed below should be completed and returned no later than July 22, 2013, at 4:30 pm. Please return to: Rina LaRosa

Broward County Extension/Tree Tops Satellite Office Administrative Building

3900 SW 100 Ave. Davie, FL 33328 Fax: 954.357.5271 E-mail: [email protected]

Registration Deadline is July 22, 2013!

Camp Forms Camper Fee Free/Reduced Lunch Program form

Florida 4-H Participation Form (does not need to be notarized) please fill out completely



4-H Camp Cloverleaf Cabin Assignment Request 4-Her’s Name: ________________________________ _________________ ________ Cabin Assignment: Please indicate the name of a friend going to camp that you would like to be in the cabin with (1 person of the same sex). We will do our best to accommodate your request. Name of friend going to Camp: _ _____________________________ County:___________________________________

Also have your friend put your name on his/her form



4-H Camp Cloverleaf Cell Phone Policy Agreement Form In this technological age, it is difficult for youth to not be in contact via cell phone. Camp is a unique environment. We are trying to help youth develop life skills at camp, including independence and self-reliance. Oftentimes, homesickness (which is a normal part of a week at camp) can be worsened by talking to family or friends. We respect and appreciate the wonderful relationships youth and families have, but if our campers are to fully enjoy camp, they must to able to develop this independence. Instead, you are encouraged to write to your child at camp. Address your letter to: Camper’s Name, Broward County 4-H Camp Cloverleaf 126 Cloverleaf Road Lake Placid, FL 33852 If there is an emergency or we are concerned about the youth’s well-being, campers will be allowed to call home. As such, campers are not allowed to bring cell phones or any other electronic devices to camp, including but not limited to the following:

• iPads, iPods and other MP3 devices • Walkie-talkies • CD players • Radios • Laptops • Portable game consoles

If a cell phone or other electronic device is brought with a camper, it will be held by the Broward County 4-H Agent for the duration of camp and returned upon arrival at the Broward County Extension Education office. Please do not call your child at camp or instruct her/him to call you. Campers are not allowed to use the phone unless there is an emergency. If an emergency arises, you may reach the Broward County Extension agent at the numbers provided:

• Camp Office Telephone: EMERGENCY ONLY! 863.465.4884 • Parents may also reach 4-H Extension Agent Rina LaRosa at 954.856.5531 for emergencies or

return times. Please keep in mind this number is not for casual calls or to check up on your child.



I/We ____________________________________________________ (Printed Name(s) of Parent or Legal Guardian(s)) have read the above cell phone policy and agree to the guidelines stated, including that the cell phone will be taken to be returned at the conclusion of Camp Cloverleaf if the policy is violated. I understand that if there is an emergency, I may contact Camp Cloverleaf. I, _______________________________ (Printed Name(s) of Youth Participant), understand that I am not to bring a cell phone or other electronic device to camp. (Signature of Parent or Legal Guardian) (Date DD/MM/YY) (Signature of Second Parent or Legal Guardian) (Date DD/MM/YY) (Signature of Participant) (Date DD/MM/YY)



4-H Camp Cloverleaf Information Sheet

Camp Address: Camp Cloverleaf, 126 Road Lake Placid 33852 Camp Office Telephone: EMERGENCY ONLY! 863.465.4884

• If you need to leave a message for your child, please call the 4‐H Office at 954‐357‐5270. • Campers are not allowed to use the phone.

Suggested Items to bring to camp (make sure to label all items you bring to camp):

Bedding (pillow, twin size sheets, AND light blanket or sleeping bag) Comb / Brush Soap Shampoo/Conditioner Deodorant Toothbrush / Toothpaste Toothpaste Two towels and wash cloths Drinking Cup or Water Bottle / Canteen Insect Repellent

Shower Shoes Sun block (waterproof is suggested) Sneakers or other closed‐toe, outdoor shoes Pajamas Bathing Suit (one‐piece or T‐shirt over a two‐piece) Clothes for 5 days Cap/Hat/Visor Sunglasses Flashlight Pencil/Pen Lunch for the drive over to camp!

Your name should be plainly marked on all clothing, bedding, and suitcases. All possessions should be clearly identified. Items you MAY want to bring (not required):

Disposable camera Stationary / Stamps (if you plan to write home)

Some items NOT to bring to camp: Cell phones, Two Way Radios ,MP3/ IPods Money, Expensive jewelry Weapons of any kind Alcohol ,Drugs ,Tobacco ,Lighters Non-prescribed/prescription drug Medication at Camp:

• If a camper requires special medicine, he or she should bring it to camp and turn it over to the camp nurse(s) upon arrival.

• No camper will be allowed to personally keep medication of any type (aspirin, antacids, etc.) • Parents should advise 4‐H staff of any special needs or problems that involve campers health, in addition to filling out

the medication form

Broward 4-H Youth Development Program Broward Parks and Recreation Division / Extension Education 3245 College Avenue • Davie, Florida 33314 • 954.357.5270 • FAX 954.357.5271


4-H Camp Cloverleaf Parental and Camper Responsibility Form

As a parent, you can expect your child to have a safe and happy camp experience. To facilitate this kind of positive camping environment, it is also important to us that campers, junior counselors, and counselors, behave appropriately at all times. This form is designed to address disciplinary action for inappropriate behavior, as well as the types of inappropriate behavior that may warrant such consequences. We encourage you to discuss the terms of this form with your child before he/she signs it, so that he/she understands appropriate camping behavior, as well as the consequences of inappropriate camping behavior. Please retain a copy of all forms for your records. Behavioral Standards for Out-of -County Events

• Participants are expected to participate in ALL components of the planned program. • Participants are expected to be responsive to the reasonable requests of the event leader/agent. • Participants will be respectful of their need for personal safety and the safety of others. • The possession or use of alcoholic beverages, non-prescription drugs, narcotics, firearms and/or other weapons,

tobacco and tobacco products, is strictly prohibited at all times. • The malicious destruction or theft of personal, state, county, or 4-H property is unacceptable behavior. • Gambling for money is not permitted. • Participants will remain at the premises of the program/event at all times unless they have been granted permission to

leave by the adults in charge. • Visitation by non-registered persons is discouraged. The event leader/agent should be notified if guests are expected. • Participants will leave the premises in as good or better condition than it was upon arrival.

Consequences and Disciplinary Actions 4-H'ers accused of any of the following will be required to appear before a review board:

• Possession or use of illegal drugs or alcoholic beverages; • Theft, misuse, or abuse of public or personal property; • Sexual misconduct; • Possession of weapons or fireworks; • Unauthorized absence from the premises of the event; • Physical assault.

If the accused 4-H’er is found in violation of the above, his/her parents will be notified; and the 4-H'er will be sent home immediately at the parent's expense and be suspended from participation in district, state, national and international 4-H activities for a period of up to 12 months. If the 4-H’er is found with illegal substances or participates in other illegal activity, he/she will be subject to legal discipline. 4-H'ers accused of any of the following may be required to appear before the review board:



• Breaking curfew or disturbing the peace. • Unexcused absence from the activities of the event. • Unauthorized use of vehicles during the event. • Use of abusive language.

If the accused 4-H'er is found in violation of these offenses listed above and receives discipline issued by the review board, his/her parents will be notified, and the 4-H'er may be sent home immediately at the parent's expense and may be suspended from participating in district, state, national, and international 4-H activities for up to six (6) months. In Broward County, such misbehavior may also result in ineligibility for camping with the county the following year. Realizing these guidelines are not "all inclusive" the Extension Service reserves the right to make adjustments to these policies. A policy for dealing with disciplinary violations should provide a clear opportunity for accused individuals to exercise rights of due process. The procedure shown here was developed by Len Davis, a university attorney for the University of Georgia, for use in that state and has been adapted only slightly for use in Florida. Notification Procedures If a 4-H'er is found in violation of the Code and is to be sent home, the person in charge of the event will notify the appropriate County Extension Director/agent responsible. Review Board The person in charge of the event will appoint a review board at the beginning of the event. The review board shall consist of the following: at least one Extension worker, up to two volunteer leaders, and three 4-H members (when appropriate). The person in charge of the event, or designee, shall serve as chairperson. The review board may be convened by the person in charge of the event. Appeal Procedures If a 4-H'er wishes to appeal the decision of the review board, he/she must appeal in writing through his/her County Extension Office. Appeals must be filed within 30 days following notification of punishment. As necessary, the Assistant Dean of 4-H shall appoint an appeal board to meet no sooner than 30 days following the date of the 4-H'er's request. The appeal board shall consist of:

1. A County Extension Agent 2. A Volunteer Leader 3. Three 4-H members (when appropriate) 4. Assistant Dean, 4-H (or designate) chairperson



I/We ____________________________________________________ (Printed Name(s) of Parent or Legal Guardian(s)) have read the above information and understand that I/we am/are ultimately responsible for my/our child _________________________________________________________ (Printed Name of Youth Participant) while he/she is at Camp Cloverleaf, in terms of behavior. Further, I have read, understand, and agree to the following: BROWARD COUNTY 4-H HAS A ZERO-TOLERANCE POLICY, REGARDING VIOLENCE, FIREWORKS, FIREARMS, KNIVES, OR WEAPONS OF ANY KIND, AS WELL AS ALCOHOL, TOBACCO, AND ILLEGAL SUBSTANCES, INCLUDING ILLICIT AND NON-PRESCRIBED, PRESCRIPTION DRUGS. Campers are not allowed to defame or deface ANY camp property. If, for any reason, my child damages and/or destroys real or personal property while attending camp, including but not limited to defaming or defacing property, damaging cabins or other areas of the camping facility, creating graffiti (words or images that are written, scratched, painted, or sprayed on walls or surfaces) etc., I understand I will be subject to any costs associated with cleanup, replacement, and/or repairs. Further, I understand if my child is involved in a group incident that results in damage and/or destruction to real or personal property, I, along with the parents of the other parties deemed responsible, will share the cost of cleanup, replacement, and/or repairs. In the case of group incidents, a child will be deemed responsible through admission of guilt or the intentional omission of information, subject to verification by 4-H and/or camp staff. If a group incident occurs, my child is encouraged to notify 4-H and/or camp staff of the parties at fault, regardless of involvement. In addition, he/she may do so confidentially. Information will be subject to verification by 4-H and/or camp staff. If my child is violent, is found to possess contraband, is in breach of any of the zero-tolerance policies, or is conducting himself/herself in a manner deemed inappropriate by 4-H and/or camp staff, I will be notified immediately and must pick up my child at any time during the week of camp. If the 4-H’er is found with illegal substances or participates in other illegal activity, he/she will be subject to legal discipline. Campers, junior counselors, and counselors are required to remain in their assigned cabins from lights out until the morning wake-up, in the case of an emergency, or if a child must be escorted to the restroom. Participants are also expected to maintain a high standard with regard to members of the opposite sex. Cabins will be off limits to members of the opposite sex. Rules will be distributed in written form and presented orally at assembly during the beginning of each camp week. When misbehavior is observed, it will be reported to the Agent-in-charge. The Agent-in-charge or his/her designee and a witness will counsel the youth. If an Agent or Volunteer Leader from the camper’s county is in attendance, they will be consulted prior to the conference with the youth.



A written record of the misbehavior, of all meetings held, and action taken will be kept by the Agent-in-charge. If disciplinary action is contemplated after counseling the youth, a meeting of the Camp Disciplinary Committee should be called. The youth should be given and opportunity to reply to the accusation and present an explanation and, if available, have another youth or adult give testimony on his/her behalf. If appropriate, the committee may choose to take the following corrective actions depending on the severity of the misbehavior: 1. Restitution: The discipline administered should relate to the misbehavior as closely as possible. Examples: If a child damaged a building or piece of equipment, he/she would assist with repair or pay for repair. When a camper throws food in the cafeteria, appropriate disciplinary action may be for the camper to mop that area. Whatever the action, the safety and health of the camper will be of the utmost importance. Under no circumstances will the camper be subjected to corporal punishment or ordered to participate in an activity that would be detrimental to his/her health (i.e. duck walk),nor will food or canteen privileges be denied. 2. In-Camp Suspension: This form of discipline would result in the camper being denied the opportunity to participate in the camping program for a limited time. Supervision will be provided at all times. 3. Expulsion: If it is deemed necessary to remove the camper from the camp site, the County Camp Coordinator will contact the camper’s 4-H Agent or CED. It is the responsibility of the county extension personnel to notify the camper’s parents that the child will be returning home. Responsibility for safe transportation rests with the parent. The camper will be isolated from the group until such transportation arrives. Every effort throughout the process will be made to involve volunteer leaders and Agents in conferences and counseling sessions, to establish positive correctional efforts before resorting to the extreme remedy of expulsion from the camp program. There will be no fee refund granted to participants who are expelled. If, after camp, it is reported and determined that my child has been involved in an incident, has possessed contraband, or has behaved inappropriately while at camp, he/she will NOT be allowed to camp with 4-H the following year. (Signature of Parent or Legal Guardian) (Date DD/MM/YY) (Signature of Second Parent or Legal Guardian) (Date DD/MM/YY) (Signature of Participant) (Date DD/MM/YY)



4-H Camp Cloverleaf Release Form This authorization form must be completed in full for someone other than the signing parent to pick up a child from camp in the case of an emergency. Full time participation is strongly encouraged. Participants who leave before camp is complete will NOT be refunded. I ______________________________ as parent/guardian of ______________________________ authorize the persons listed below to pick up my child in the case of an unexpected emergency. Names of person(s) who are authorized to pick up my child (include all parents/guardians names also). Persons leaving camp will be required to check out and show their driver license or other official picture ID as proof of identification. * If married, or divorced but having joint custody of the youth, both parents must sign. If divorced and having sole custody of the youth, only that parent with sole custody needs to sign. ____________________________________ _____________________________________ (Signature of Parent or Legal Guardian) (Date DD/MM/YY) _____________________________________ _____________________________________ (Signature of Second Parent or Legal Guardian) (Date DD/MM/YY) _____________________________________ _____________________________ (Signature of Participant) (Date DD/MM/YY)



Florida 4-H Medication Form

Parent or Guardian: Please complete this form for any medication your child will be taking while attending any 4-H event, including non-prescription drugs, lotions, inhalers or any other items. This form must accompany your child’s medication for camp. Write your child’s name on a zip lock bag and place this form along with the medication inside the bag. Please list aspirin or acetaminophen as authorized over the counter drugs if you give permission for camp nurse or health aide to administer in the case of a fever, pain, headache or any related medical condition. Thanks!

4-Hers name:

Parent/Guardian name:

Address:

Phone (day): Phone (evening):

County/City: Gender:

The following will need to be completed for each medication your child will be taking while at any 4-H event, including non-prescription medications such as allergy medicine.

Medication name: Dosage: Time of day for administration: Special instructions or warnings:





For Free and Reduced Form Click Here: For Summer Participation Form Click Here:

rina “yoli” larosa - broward county, florida · pdf filecounselors will be...

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