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NIOBRARA COUNCIL
2009 River Camps
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280 North Main Street
P.O. Box 206
Valentine, Nebraska 69201
(402) 376-2793 voice, (402) 376-1331 fax
2009 Fall Day Camp
“Colors of the Niobrara”
The Niobrara Council is pleased to sponsor its first fall day camp. This free day camp directed toward children who are enrolled in the 4th or 5th grade. Its aim is to get kids outdoors and excited about the Niobrara river and other natural resources that we treasure in this area. Activities will allow for the kids to experience nature and the Niobrara River up close and personal.
¨ A total of 12 campers can be accommodated with registration based on a first come first serve basis with a preference given to those that were on the waiting list for the summer day camps.
¨ This camp will be held on one day, Saturday October 10.
Oct 10 Smith Falls 9:00 am-4:00 pm
Parents drop off/pick up @ Valentine Rural High School Parking Lot
Canoe from Cornell Bridge to Smith Falls
Crafts
Photography
The Valentine Rural High School will be used as the drop off and pick up point for the day. Supplies and drinks/snacks and lunch will be provided at no charge to the students. ________________________________________________________________________________________________
Parents—If you would like your child to attend this camp, do the following:
¨ Fill out both sides of the attached registration form/liability waiver (both parents' signatures required if
applicable).
¨ Submit the completed application form/waiver to the Niobrara Council office by Monday, September 28th. Registration is based on a first come, first serve basis, with a preference given to those that were on the waiting list for the summer day camps.
¨ You will be notified, Wednesday, September 30th with confirmation of registration. Please do not register your child if he/she will be unable to attend.
¨ If your child could not be registered, you will be notified Wednesday, September 30, and your child will be placed on the waiting list (if you desire).
For more information contact Kayla Kelly at (402) 376-2793 or kelly@niobraracouncil.org.
Registration materials may be mailed to:
Niobrara Council * P.O. Box 206 * Valentine, NE * 69201
or dropped off at the Council office:
280 North Main Street, weekdays 9:00am-noon or 1:00pm-5:00pm.
Phone registrations will not be accepted.
Registration for 2009 Fall Day Camp
October 3 or 10, 2009
My child is enrolled in 2nd or 3rd grade– Camp date October 3
My child is enrolled in 4th or 5th grade– Camp date October 10
1) Please fill out a separate form for each child.
Child's Name:_____________________________________ Date of Birth:_____________
Parents' Names:___________________________________________________________
Mailing Address:___________________________________________________________
Home Phone:___________________Cell Phone(s):_______________________________
Work Phone(s):________________________ Email:______________________________
Conditions or Allergies
Food allergies:____________________________________________________________
Insect allergies:____________________________________________________________
Other allergies:____________________________________________________________
Conditions: (Asthma, diabetes, etc.)____________________________________________
Emergency Contacts: (If parent/guardian cannot be reached)
Name:______________________________ Relationship to Child:___________________
Home Phone:_____________Cell Phone:______________ Work Phone:____________
Name: _____________________________ Relationship to Child:____________________
Home Phone:_____________Cell Phone:______________ Work Phone:____________
Complete and sign the liability waiver on the reverse side of this application.
3) Registration will be based on a first come first serve basis, with a preference given to those that were on the waiting list for the summer day camps.
4) Return this form (with both sides completed) to the Niobrara Council office by Monday, September 28. Office address is 280 North Main Street in Valentine. Mailing address is P.O. Box 206, Valentine, NE 69201. Enrollees will be notified Wednesday, September 30.
Questions? Contact Kayla Kelly at (402) 376-2793 or kelly@niobraracouncil.org.
No phone registrations will be accepted.
2009 Fall Day Camp
“Leaves of Change”
The Niobrara Council is pleased to sponsor its first fall day camp. This free day camp directed toward children who are enrolled in the 2nd or 3rd grade. Its aim is to get kids outdoors and excited about the Niobrara river and other natural resources that we treasure in this area. Activities will allow for the kids to experience nature and the Niobrara River up close and personal.
¨ A total of 12 campers can be accommodated with registration based on a first come first serve basis with a preference given to those that were on the waiting list for the summer day camps.
¨ This camp will be held on one day, Saturday October 3.
Oct 3 Smith Falls 9:00 am-4:00 pm
Parents drop off/pick up @ Valentine Rural High School Parking Lot
Canoe from Cornell Bridge to Smith Falls
Crafts
Photography
The Valentine Rural High School will be used as the drop off and pick up point for the day. Supplies and drinks/snacks and lunch will be provided at no charge to the students. ________________________________________________________________________________________________
Parents—If you would like your child to attend this camp, do the following:
¨ Fill out both sides of the attached registration form/liability waiver (both parents' signatures required if applicable).
¨ Submit the completed application form/waiver to the Niobrara Council office by Monday, September 28th. Registration is based on a first come, first serve basis, with a preference given to those that were on the waiting list for the summer day camps.
¨ You will be notified, Wednesday, September 30th with confirmation of registration. Please do not register your child if he/she will be unable to attend.
¨ If your child could not be registered, you will be notified Wednesday, September 30, and your child will be placed on the waiting list (if you desire).
For more information contact Kayla Kelly at (402) 376-2793 or kelly@niobraracouncil.org.
Registration materials may be mailed to:
Niobrara Council * P.O. Box 206 * Valentine, NE * 69201
or dropped off at the Council office:
280 North Main Street, weekdays 9:00am-noon or 1:00pm-5:00pm.
Phone registrations will not be accepted.
PERMISSION TO PARTICIPATE IN SUMMER DAY CAMP ACTIVITIES
SPONSORED BY NIOBRARA COUNCIL
AND
AGREEMENT FOR RELEASE OF LIABILITY
TO: NIOBRARA COUNCIL, Valentine, Nebraska
RE: Release of Liability and Permission to Participate in Summer Day Camp Activities
DATE:_________________
THE UNDERSIGNED, in consideration of opportunity and license to participate in summer day camp sponsored by and provided by Niobrara Council, Valentine, Nebraska, do hereby grant to my child____________________, permission to participate in the activities designed for the summer day camp through the Niobrara Council. I furthermore acknowledge, understand and agree that I am familiar with the possible risks associated with the Niobrara River and unfamiliar lands, together with the activities of the Niobrara Council within the Scenic River Corridor; and in traveling to and from the same, and I do hereby release Niobrara Council, its staff,
employees, agents and assigns from any liability whatsoever, including costs of defense, and expenses and attorneys' fees incurred, for any injuries that my child or myself may suffer during or as a result of participation in, attendance at and travel to and from Niobrara Council day camp activities. I further certify that I have made my own independent evaluation of the dangers and hazards associated with such activities and am familiar with the consequences of this release.
IN WITNESS WHEREOF, I HAVE HEREUNTO SET MY HAND THIS______DAY OF_____________, 2009.
________________________________ ______________________________
Parent Parent
_____ I give permission to use my child's name/photograph in publications, advertisements, Niobrara Council webpage or news articles pertaining to Niobrara Council camp activities.
_____ I do NOT give permission to use my child's name/photograph in publications, advertisements, Niobrara Council webpage or news articles pertaining to Niobrara Council camp activities.
NOTE: Both parents must sign. Alternatively, custodial parent or legal guardian as provided by Court of competent jurisdiction must sign.