Saturday, April 26, 2008
12:30-4:00 PM
Build a robot with a team
Make it move
Complete an obstacle course
Who: 4th-5th grade youth
Check made out to: ISU Extension
Schedule: 12:30 Registration
12:30-3:30 Robotics Camp
3:30-4pm Presentation of Certificates
Where:
824 Flindt (Next door to Dairy Queen)
Contact:
Register: First 30 campers registered & paid by Monday, April 21
Presented by: ISU Extension NW 4-H Tech Team and ISU Women in Science and Engineering.
Registration Form
Youth’s Name:___________________________________________________________________________
Parent’s Name & Emergency Contact:_________________________________________________________
Name of adult responsible for picking up camper:_______________________________________________
Street Address:______________________________________City/State/Zip:_________________________
Home Phone Number:____________________________Cell Phone Number:_________________________
q I am a 4-H member( $5 Fee) q I am not a 4-H member ($20 Fee)
Attach Payment: $5 4-H Members and $20 non-4-H’ers (Make Checks to ISU Extension)
BEHAVIOR EXPECTATIONS of the Participant
It is important to follow the directions of the 4-H Club leader(s) at all times. I understand that as a participant I have the responsibility to help make the activity a safe experience for everyone through my behavior and conduct. I also understand the danger of not following rules and directions and agree to follow them.
PUBLICITY/IMAGE/VOICE PERMISSION
4-H CLUB ASSUMPTION OF RISK AND RELEASE OF LIABILITY (Please read carefully.)







