Henry County 4-H’ers -

2019 will be Henry County 4-H camp’s award winning year as the counselor staff presents ‘A Blockbuster Hit!’ Blockbuster, by definiioon, refers to a thing of great power or size…..with great success! We are excited for you to be part of the success! From Horton, to campers’ favorite Marvel characters, travel in a Mystery Machine, a Shrek adventure, 4-H campers are sure to experience their own blockbuster hit.

Held at 4-H Camp Palmer, a 146 acre camp located just outside of Fayette, Ohio, Henry County’s 4-H camp is offered to our 4-H’ers 8 or 9 years of age and in the 3rd grade through 8th grade. Camp features a balance of large and small group acioviioes, physical and cogniiove ac-ioviioes, as well as those that promote self-growth and independence….a harvest of skills development beyond compare! Cost is $170 for

4-H’ers and $180. 00 for non-4-H’ers. Camp fees goes up $10.00 after the June 18th deadline. Don’t delay, get your registraioon in today!

4-H’ers registering for camp may request one friend to stay with at camp. Please be sure to complete the appropriate blank on the registra-ioon form. Be sure this friend is going to camp! Even though the capacity at 4-H Camp Palmer is quite large, it is LIMITED. Campers live in cabins near the central area of camp. Boys and girls bunk in separate cabins which are separated by a stream. Our first year (and someiomes second year) girl campers are lodged in one of the dorm areas in the Woodland Lodge and first year boys lodge in another part of the dorm areas. If you have asked a non-4-H’er to attend, they will stay in your cabin — just be sure to write in their name. Home-style meals are served in the large, comfortable dining hall. Three family-style meals and an evening snack are the tradiioon at camp and the food is deli-cious! A salad bar is offered at both the noon and evening meals. If a camper has special dietary needs, please provide details on your regis-traioon form. This style of dining provides our young people an opportunity to learn and pracioce eioquette, working together in doing chores and trying perhaps, new food items. You will get to know the outdoors because it is where you spend most of your iome. You will learn to get along with others and compete in various acioviioes with team members of your assigned group. Swimming will be offered at various iomes during the day along with plenty of other fun and exciiong acioviioes for you to enjoy. All camp acioviioes are held in various faciliioes including the Craft pavilion, Nature center, mulio-purpose Recreaioon hall, Adirondack Shelter and Dining Hall. Recreaioonal acioviioes take place on the sports field, volleyball court, basketball court, miniature golf course, archery range, swimming pool and Harrison Lake (canoeing). We have a human foos ball game, Ga-Ga Pit, and Square in the Air for all to enjoy.

Travel groups are named by the counselors and each camper is assigned to a group. We do not accommodate any requests by campers, unless you have invited a non-4-H’er, to be in specific travel groups together. Part of the camp experience is to meet new friends and get to know others from all areas of the county.

CHECK-IN: Check-in iome will begin at 3:00 p.m. on June 25 at the Recreaioon Hall at 4-H Camp Palmer for campers. PLEASE DO NOT AR-RIVE ANY SOONER THAN 3:00 P.M. Lines will be formed by boys/girls. From this line you will need to go through the nurse’s line and/or the bank line. Each camper receives a printed schedule of the weeks acioviioes. Their cabin number and group name will be printed on their name tags. Name tags are given as campers check-in and should be worn throughout camp. At 4:45 p.m. campers will be assembling for their first aciovity. We ask that parents and others vacate camp by 4:30 p.m.

CHECK-OUT: Check out on June 29 ends with clean-up acioviioes and our closing comments around the flag pole. Campers bring all their luggage from the cabins to the volleyball court (or Rec Hall if it is raining). Each cabin is assigned an area to clean-up before our closing. Please arrive to pick up your child/ren at approximately 10:00 a.m. We will have our closing at 9:50 a.m. with official dismissal from camp at 10:00 a.m. if all cleaning is complete. Please wait at the covered bridge until you hear camp is dismissed. We will be gathering all camp-ers who have a dismissal restricioon or designee other than a parent/grandparent picking them up (circle of chairs by the flag pole). If your child/ren are NOT to leave camp on Saturday morning or at any other iome with anyone other than you, please indicate this on the health form. A counselor will check off each camper as the person who is responsible for the camper arrives. This is a precauioonary measure in case any situaioons arise before I leave camp myself.

Check out all the details inside this all-inclusive 4-H camp informaioon packet! If you have any quesioons please give me call - hope to see you at Camp!

Sincerely,

Henry County 4-H Camp Palmer June 25 - 29, 2019 “A Blockbuster Hit!”

Typical Schedule at Camp 7:15 a.m. Rise & Shine

8:00 a.m. Breakfast

8:30 a.m. Flag Raising

8:45 a.m. Cabin Clean Up

9:30 a.m. Sessions

10:30 a.m. Sessions

11:30 a.m. Free Time

12:00 p.m. Lunch

1:00 –3 p.m. Sessions

3:15 p.m. Afternoon Large Group Activity

4:15 p.m. Swim/Open Recreation

5:00 p.m. Supper

5:45 p.m. Flag Lowering

6:15 p.m. Open Recreation

7:00 p.m. Prepare for Evening Programs with groups

8:00 p.m. Evening Activity

10:30 p.m. Snack

11:00 p.m. Lights Out *This is an approximate time schedule… each day is a little different from each of the others!

To get into the spirit of the daily themes, campers are encouraged to bring costumes or apparel

that fits the daily themes….

Tuesday— Horton Hears A Camper! Wednesday— Camp is Marvel-ous Thursday— Intermission

Friday— Fandango Friday Saturday—Curtain Call

Cabins

Groups

Themes

CABINS

Group Names

The Krusty Krabs

The Avengers

The Addams Family

The Incredibles

Andy's Toys

A Million Minions

The Mystery Machine

The Paw Patrol

The Camera Crew

Cabin 1- Barden Bellas

Cabin 10-Magnificent 10

Cabin 11- The Fast & The Furious

Cabin 12- Supermen

Cabin 2- Residents of the Wallaby Way

Cabin 3- Lilo's Ladies

Cabin 4- The Little Merladies

Cabin 5- F.R.I.E.N.D.S

Cabin 6- This Is Our Swamp

Cabin 7- The Lorax

Cabin 8- Princess Palace

Cabin 9- Pirates of Camp Palmer

Lodge Boys- Andy's Toy Box

Lodge Girls-The Princesses of Motunui

Rob's Cabin- The Incredibles

Henry County 4-H Camp Guidelines

1. Campers are not permitted to leave camp at any time without the consent of the Henry County 4-H Camp Director, parent or legal guardian or camp

nurse. If leaving with a parent upon request, please check out and upon returning check-in with the Camp Nurse or Camp Director.

2. The bell is to be used to signal group changes and the P.A. for emergency purposes. The Adult Staff and counselors have authorization to use these

devices only.

3.The following areas and equipment are to be used only with staff supervision or during assigned times:

a. Pool b. Wetlands, streams and lake c. Canoes d. Nature Center

e. Shooting Sports range f. High ropes g. zip-line h. Climbing Wall

4.Dining Hall etiquette:

*Campers will wash or sanitize their hands before each meal. Campers select a table to sit at for the duration of camp for all meals. Campers

may be excused from the meal table by a counselor, camp director or nurse.

*Shirts and shoes are to be worn at all meals. Hats need to be taken off upon entering the dining hall. Campers wearing swimsuits to meals should wear shorts and a shirt over them. Theme dress is encouraged for meals and activities.

5. Cabin etiquette:

*Campers are expected to respect individual’s property. This includes not being in anyone’s belongings without permission.

*Girl campers are to be in girl’s cabins and area; boys in boy’s cabins and area.

*Cabin inspection will be anytime from 9:00-11:45 a.m. daily. Campers are responsible for cleaning areas around the cabins, buildings and

trash receptacles. Clean cabins will be selected each day for boys and girls. Dirty cabins will also be selected each day.

*When it is time for lights out- lights are to be off, flashlights off and campers in their bunks.

6. Campers should refrain from bringing personal sports equipment with them to camp. Lost or stole items will not be replaced.

7. Other Expectations:

A. Campers should always be with their assigned groups during group activities (unless with the camp nurse or director). B. All injuries or illnesses need to be reported to the camp nurse. The camp nurse will be the only person to dispense medicine to campers. C. NO drugs, alcohol, fireworks or cell phones are allowed at camp. Cell phones confiscated will be kept by the camp director until the end of camp. D. NO profanity. E. Shoes must be worn at all times. F. NO vehicles permitted on the camp. G. NO visitors are permitted without permission of the Camp Director. Visitations should be arranged ahead of time. H. NO cell phones—Ohio 4-H Policy 8. All campers, counselors and county staff are expected to assist in camp clean up daily and the final day of camp. Lastly, any individual found doing damage to any area of the camp facilities, especially recreational equipment and within the cabins, will be disciplined

by the Camp Director. The camper/s will be charged the cost of replacement or repairs. Parents will be notified immediately of such activity.

2019 Henry County 4-H Camp Registration Please register by June 18th, 2019

Camper Name: ________________________________________________________________________ Phone # ______________________________________ My 4-H Age ___________ I completed ________ grade in school this year Gender ___________ This is my 1st year at 4-H Camp yes no I am a member of the __________________________________________________________4-H Club. I have invited the following non 4-H individual: _____________________________________________ Cabin Mate Request: Please note that we cannot guarantee any request, and requests are based on first come, first served. Requests are limited to one child and must be of similar age and same gender. Request must be mutual. Large groups that all request each other will not be honored. Cabin Mate Name: __________________________

Two Hour Sessions

____ $30 High Ropes (Wednesday)

____ $10 Hi-Flying Drones (Thursday)

____ $10 Shooting Sports (Wednesday)

“Choose Your Own” Activities (please mark your first three choices {1-2-3} from the ENTIRE list.)

____Lamp to Camp ($12) _____Tye Dye Art (bring an item to dye) ____Archery _____Friendship Bracelets ____Flying Squirrel _____Rope Making ____Canoeing _____Swimming ____Line & Square Dancing _____Outdoor Cooking ____Atl Atl _____Board & Card Games ____Spa Hour (hair & make up) _____Name That Tune ____Volleyball _____Pallet Painting ____Tumbling _____STEM - LED Art ($2) ____WEDO Kits ($10) _____Echo Drumming ____Cake Decorating _____Acrylic Paint Boards ____Slip n Slide Kickball

Campers will have the opportunity to spend a night out in the Adirondack shelter during the week if they wish. As part of OUT POSTING camp-ers will listen to folklore, cook over an open fire, stargaze and sleep overnight in the shelter. Campers out posting will not miss any regular camp programming. For groups that choose to do so, breakfast in the morning consists of pancakes and sausage cooked over an open fire. Space is limited each night of this activity the two nights we offer this activity (Wednesday and Thursday evenings). Out Posting: ___ Wednesday ___ Thursday

The HIGH ROPES course is a series of aerial log, rope and cable obstacles 20 feet off of the ground. Campers participating on the high elements are at all times “on belay”, a safety tie-in system utilizing ropes and cables. Under the supervision of properly trained instructors, this system pro-vides safe and challenging experience for each camper. Because of the design of the high ropes course, participation in this activity must be limited to campers 4’ 10” and taller; at least 12 years of age or older and need to be able to reach the cables, which are approximately 6’ 2”.

Campers who are eligible must pre-register for the experience. Cost is $30.00 and is payable at the time you send in your camp registration The high ropes fee will only be refunded if the Extension Office is notified of cancellation prior to the first day of 4-H camp.

Camper Commitment I understand that I _____________________________________ (name of youth) will be expected to participate in all of the Henry County 4-H Camp Palmer activities and to follow the planned program. I agree that I am not to have or use any tobacco, alcoholic beverages, or other drugs, or firecrackers while at camp. I agree that I will not leave the camp grounds without the permission of the Camp Director. I will conduct myself with respect for others at all times and will cooperate with the camp staff. I understand that areas are restricted to boys in the boys cabin area and girls in the girls cabin area. I will not deface or destroy any camp property. Further, I have read the camp rules. If I break any part of

the agreement or camp rules, I understand I will be sent home without refund of my camp fees and at my own expense.

Signed…. Camper________________________________ Parent_______________________________________________

Payment for Camp

_____ $170.00 for camp as a 4-H member

_____ $180.00 for camp as a Non-4-H member

_____ $30.00 for High Ropes

_____ $10.00 for Shooting Sports

_____ $10.00 for STEM WEDO Kit

_____ $12.00 for Lamp to Camp

_____ $2.00 STEM - LED Art

_____ $10.00 for each Cloverbud Experience participant

Total: _____ Make checks payable to: OSU Extension - Henry County Return registration form with picture, emergency medical form and payment to:

OSU Extension - Henry County Attn: 4-H Camp 104 East Washington St. Suite 302 Napoleon OH 43545

Alternate Dietary Request Form

In order to accommodate individual guest needs, requests must be submitted at least two weeks prior to your arrival. This will

enable the food services team to plan appropriate meals and order needed foods. It is helpful for you to list foods that you regu-

larly eat at home on this form, especially if your dietary needs are restrictive. If we are unable to fulfill your request(s) due to

cost or availability, our food services team will contact you to ask you to bring specific food items to supplement what is availa-

ble at camp.

Please check if applicable:

___ Lactose Intolerant (No Dairy)

___ Gluten Intolerant (No Gluten)

___ Diabetic (Extra Protein)

Food Allergies: These are the 8 most common food allergies.

Please check any that are applicable:

___ Milk ___ Eggs ___ Peanut ___ Tree Nut ___ Fish ___ Shellfish ___Soy ___ Wheat ___ Corn ___ Yeast

Please be aware that these foods are used in our kitchen and served at our camp. If your allergy is so severe that this may be a

problem, please make note of it here:

___________________________________________________________________________________________________________

___________________________________________________________________________________________________

Other Food Allergy ____________________ (You will be contacted if this cannot be accommodated.)

Staff… Laura Rohlf, Camp Director Emily Cordes, Office Associate Lindsay Ferguson, Summer Assistant

Camp Nurses: Madison Giesige Madelyn Giesige

4-H Camp Palmer 26450 County Rd. MN

Fayette OH 43521 Phone: 419-237-2247

Fax: 419-237-2455

Administrative Staff Bill Goodson, Camp Director Kristy Helberg, Program Manager

Jo Brown, Kitchen Supervisor

WHAT TO BRING: (PLEASE MARK ALL OF YOUR ITEMS) _____Bedding (sheets and blankets OR a sleeping bag AND pillow) *You may want to bring a sheet to cover the mattress if you bring a sleeping bag. _____2 Towels _____1-2 Washcloths _____1 Beach Towel _____Flashlight (with batteries) _____Comfortable clothes (not new) _____Sweatshirt or jacket _____Rain poncho or rain coat _____Clothing or costumes to fit the themes _____Personal hygiene items (soap, shampoo, toothbrush/paste, deodorant, etc.) _____Bathing Suit _____Two Pairs of shoes (not new) _____Flip-flops for the shower and pool area _____ Bug Spray _____ Sunscreen _____Opioonal spending money for camp store Opioonal Items to consider: __Camera (PLEASE MARK WITH CAMPER NAME) __Rug/mat for cabin floor by bunk __Snacks must be in sealed container PLEASE HAVE ANY MEDICATIONS READY TO TURN IN TO THE NURSE AS YOU CHECK-IN AT REGISTRATION.

Campers are highly encouraged to deposit money brought to camp in our camp bank at check-in.

4-H CAMP PALMER INFORMATION www.camppalmer.org

A special THANK YOU to 4-H Advisory Council for their donation toward camp expenses.

Attention Last Year Cloverbuds!!!

Next year you will be old enough to attend Henry County 4-H Camp

at 4-H Camp Palmer! The 4-H camp counselors would like to ex-

tend an invitation to you to spend an afternoon at 4-H Camp Palmer

in 2019 so that you can experience a little bit of “camp life” before

2020.

Save the date: Thursday, June 27th, 2019

Details at henry.osu.edu/program-areas/4-h-youth-development/camp

Emergency Contact Information:

Parent/Guardian Name: Parent/Guardian Cell Phone:

Other Contact/Relationship: Other Cell Phone:

Other Contact/Relationship: Other Cell Phone:

Physician: Physician Phone:

Dentist: Dentist Phone:

Participant/Member Information:

Name: ______________________________________________________________________

(Last) (First) (Middle)

Address: ______________________________________________________________________

(Street) (City) (State) (Zip)

Home Phone: County:

Date of Birth: Male/ Female Age (today):

Ohio 4-H Health Statement ALL SIDES of this form MUST be completed for each participant. Minors must have the

form completed and signed by a parent/guardian. This information will be kept confidential

and used only for the welfare of the participant. PRINT neatly using blue or black ink.

REQUIRED!

Attach

Picture

(for I.D.

purposes only)

CFAES provides research and related educational pro-grams to clientele on a nondiscriminatory basis. For more information: go.osu.edu/cfaesdiversity. For an accessible

format of this publication, visit cfaes.osu.edu/accessibility.

ohio4h.org

Medical Instructions: Medications/Allergies, Current/Past Medical Conditions: Current Medications (Prescribed and Over-The-Counter, Current or Past Medical Treatment): (please list additional medications or needs on a separate sheet)

Name of Medication: Dosage: Frequency/Instructions:

Health History:

Communicable Diseases:

Provide the date (approximate is acceptable) at which participant has had or was exposed to:

Immunization/Vaccine Record:

To the best of knowledge, the participant is up-to-date on all immunizations which may include, but is not limited to: Diphtheria/Pertussis (Whooping Cough-TDAP), Polio, Measles/Rubella/Mumps (MMR), Haemophilus Influenza (HIB), Varicella (Chickenpox) that are required for school.

The participant has received a Tetanus Booster. Date of last booster: ____________

If the participant is not current or up-to-date with immunizations, please complete the Ohio 4-H Immunization

Exemption Form.

Chicken Pox _______ Measles _______ Whooping Cough _______

Tuberculosis _______ Mumps _______ Other Communicable Diseases ______________

OHIO STATE UNIVERSITY EXTENSION

Acetaminophen

( ex: Tylenol)

Antibiotic Ointment

(ex: Neosporin)

Dramamine Poison Ivy Medicine

(ex: Calamine Lotion)

Aloe Lotion Cough Syrup/Drops Ibuprofen

(ex: Advil, Motrin)

Sore Throat Medicine

Antacids (ex: Maalox, Tums) Decongestant (ex: Sudafed) Insect Repellent Sun Screen

Antihistamine

(ex: Benadryl, Claritin)

Diarrhea Medication

(ex: Imodium)

Laxative

(ex: Milk of Magnesia)

Swimmer’s Ear Medicine

Antiseptics

Description of any past or current physical, mental, or psychological conditions requiring medication, treatment,

or special restrictions or considerations while at camp: ____________________________________________

Description of any camp activities from which my child should be exempted for health reasons: ____________

________________________________________________________________________________________

Check below if the participant is subject to any of the following conditions:

Asthma

Controlled? yes/no

Bronchitis Cramps Fainting Heart Trouble Seizures Sore

Throat

Athlete’s Foot Constipation Diarrhea Frequent Colds Home Sickness Sinusitis Other?

____________ Bed Wetting Convulsions Ear Infections Headaches Kidney Trouble Sleep Walking

Allergies: If none, please write NONE here: __________________________________________________________ Food allergies: ________________________________________________________________________ Medication allergies: ____________________________________________________________________ Serious Ivy, Oak or Sumac Poisoning: What is the prescribed treatment? __________________________ Serious bee or insect sting reactions: What is the prescribed treatment? ___________________________

NOTE: If participant’s allergy may require use of an “EPI-PEN”, then the participant must provide the “Epi-Pen(s)” and discuss possible administration with health care professional upon arrival to camp.

Accommodations for Camp: Please tell us about the accommodations your child may need at 4-H camp:

I will be bringing medications to camp (please describe whether they require refrigeration or special storage below).

I have dietary restrictions (describe below). I have limited mobility (e.g. crutches, cane, etc.). I have ADHD or a related attention deficit disorder; a visual, hearing, cognitive processing, reading, or a

speech impairment. (describe any needs you anticipate at camp and the accommodations you typically receive at school and home below).

I require the use of medical equipment that needs electricity (describe below). I require other accommodations not listed above (describe below). I do NOT require any special accommodations (none of the above apply to me). ______________________________________________________________________________________________________________________________________________________________

Instructions for Medications:

All prescription drugs must be carried in the container in which they were issued (with medical orders and physician’s name intact) and given to the nurse/health director. Other prescription drugs will not be accepted. Only bring the amount needed for your stay at camp.

If you need regular over-the-counter medications, they must be in the original container. Like prescription medications, these medications must be given to the nurse/health director.

All medications will be given as directed on the original package/container. If there are any dosage adjustments, you must bring signed documentation from your physician.

Check medication(s) that participant may receive if deemed necessary and administered by a health professional. Examples of brand names are given in parentheses. Generic or other name brands may be provided:

Last Name________________ First____________

CFAES provides research and related educational programs to clientele on a nondiscriminatory basis. For more information: http://go.osu.edu/cfaes.diversity.

{00255577-2} Bloir, K., Epley, H.K. Updated 8/2016

Last Name________________ First____________

Emergency Medical and Informed Consent/Camp/Program Release I understand that my child, ____________________ will be a participant in the Ohio 4-H program and I grant permission for him/her to participate in this program and associated activities with the exception of any restricted activities that I have listed below. I understand that my child is not required to participate in this program, but grant my permission for him/her to do so, despite the potential risks. I recognize that by participating in this program, as with any physical activity, my child may risk personal injury, paralysis and/or death. I understand program participants will be supervised and acknowledge that the 4-H staff and volunteers, OSUE, The Ohio State University, and the 4-H Camp Site are not responsible for any potential injury or illness resulting from my child’s participation. I hereby attest and verify that I have been advised of the potential risks, that I have full knowledge of the risks involved and that I assume any expense that may be incurred in the event of an accident, illness, or other incapacity, regardless of whether I have authorized such expenses. I understand that most program activities are conducted outdoors and that wearing proper dress (e.g., rain gear, warm clothing) is an essential part of the camp safety rules and procedures. I am aware of and have discussed with my child the established safety rules and procedures. In the case of serious illness or injury of my child, I understand that I will be notified. If I cannot be contacted,

unless otherwise specified below, I grant permission to the attending medical professional to secure proper treatment, hospitalize, and/or take any other action deemed necessary for the immediate care of my child. In consideration of the opportunity for my child to participate in this program, I, acting for my child, myself and our respective heirs, executors, administrators and assigns, agree to assume any and all risks associated with this activity and do hereby release, indemnify and hold harmless The Ohio State University, its Board of Trustees, OSUE, the Ohio 4-H program, the 4-H camping facility, and their respective officers, agents, and employees from any and all liability, damage, and/or claim of any nature resulting from or arising out of my child’s participation in this program and its activities. Restricted activities and/or special notification instructions: ________________________________________ _____________________________________________________________________________________________________________________________________________________________________________.

Photo and Video Release I give permission to The Ohio State University, OSUE, the Ohio 4-H program, and the 4-H camping facility to record and edit into video and/or photographs the likeness, voice, image and video images of my child, __________________________, and to use all or parts of the video or photographs in print or electronic materials for The Ohio State University, OSUE, the Ohio 4-H program, and 4-H camping facility to promote any and all public awareness for the program(s) in which my child is involved.

__________________________ _________________________ _________________

Parent/Guardian Printed Name Parent/Guardian Signature Date