2008 Robotics Camp

Robotics Camp for Kids!

Saturday, April 26, 2008

12:30-4:00 PM

Build a robot with a team

Make it move

Complete an obstacle course

Who: 4^th-5^th grade youth

Camp Fee: $20 * ($5 for 4-H Club Members)

Check made out to: ISU Extension

Schedule: 12:30 Registration

12:30-3:30 Robotics Camp

3:30-4pm Presentation of Certificates

Where: Storm Lake - Area Agency Education Building

824 Flindt (Next door to Dairy Queen)

Contact: ISU Buena Vista County Extension Office, 712-732-5056 ph. /712-732-5006 fax

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

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.

4-H CLUB ASSUMPTION OF RISK AND RELEASE OF LIABILITY (Please read carefully.)

I give permission for my child to participate in the 4-H program. I understand that 4-H club project activities/events may involve certain risks of physical activity and possible injury and that Iowa State University and its 4-H program will provide each participant with reasonable care, but that ISU cannot guarantee that my child will remain free of injury.

Parent or Guardian Signature Date

Mail to registration form & payment to: Buena Vista County Extension,

824 Flindt Drive, Storm Lake, IA 50588