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Parent Permission
I hereby give permission for my child to attend this Clover Kids program sponsored by Clayton County Extension. Extension staff/volunteers will supervise the event and provide necessary emergency care. If a serious illness or injury develops and medical and/or hospital care is necessary, I give permission for emergency treatment or surgery as recommended by the attending physician.
Extension staff may photograph my child.
Parent’s Signature:
__________________________________
In case I can not be reached during the course of the program, please contact:
__________________________________
Phone: _____________________________
Relationship:_________________________
Please check appropriate response:
_____ I will pick my child up at the end of the program.
_____ I give permission for my child to walk home after this program.
_____ My child will be picked up by
________________________
Why Clover Kids?
▪ Participate in activities uniquely
suited for their developmental age
▪ Grow and learn in a non-
competitive environment
▪ Participate in hands on learning
▪ Cooperative learning environment
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To participate in this Clover Kids program:
• Detach and complete both sides of the registration form.
• Enclose the registration fee. (Checks payable to Clayton County Extension)
• Return to Clayton County Extension Office by February 17th
. . . and justice for all
The U.S. Department of Agriculture (USDA) prohibits discrimination in all its programs and activities on the basis of race, color, national origin, gender, religion, age, disability, political beliefs, sexual orientation, and marital or family status. (Not all prohibited bases apply to all programs.) Many materials can be made available in alternative formats for ADA clients. To file a complaint of discrimination, write USDA, Office of Civil Rights, Room 326-W, Whitten Building, 14th and Independence Avenue, SW, Washington, DC 20250-9410 or call 202-720-5964. Issued in furtherance of Cooperative Extension work, Acts of May 8 and June 30, 1914, in cooperation with the U.S. Department of Agriculture. Cooperative Extension Service, Iowa State University of Science and Technology, and United State Department of Agriculture cooperating.
9/9/05
CLOVER KIDS
Retreat
For Grades K-3
Winter Beach Party Fun
Saturday, February 25
Johnson’s Reception Hall, Elkader
12:30 -3:00 pm
SPONSORED BY:
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Clayton County Extension
Clayton County Circle of Friends
Clayton County Clover Kids 4-H Clubs
For Kindergarten -3rd grade students
Where children experience the
joy of learning by being in a supportive, creative, challenging
and fun environment.
Come join the fun on Saturday, February 25th at Johnson’s Reception Hall in Elkader
from 12:30 – 3:00 pm
Scheduled sessions include
o Music
o Games
o Volcanoes
o Sand Art
o Lei necklaces
o Storybook time
o Fish Mobile Craft
o Ice Cream Sundaes
Winter Party Fun
Who: Kindergarten - 3rd graders
Date: Saturday, February 25
Time: 12:30- 3:00 pm
Location: Johnson’s Reception Hall
916 High Street, Elkader
Cost: $2.00 per student
(Includes snacks and materials)
$5.00 maximum cost per family
Students will do hands on activities, crafts, play games and have a snack.
We will also have the new Clayton County Clover Kids t-shirts available at the Winter Beach Party. Price is $6.00
SPECIAL: $2 off the normal price if you attend the Winter Beach Party program on February 25th.
For more information contact the
Clayton County Extension Service
120 South Main Street
Elkader, IA 52043
563-245-1451
Clover Kids Winter Party
Name________________________
Grade________________________
Parents’ Names_________________
Address______________________
Town________________________
Phone________________________
Cell Phone_____________________
Return to
Clayton County Extension Office,
120 S Main Street, PO Box 357, Elkader, IA 52043 by February 17th
Registration Fee: $2.00 per child,
$5 maximum per family
Make check payable to
Clayton County Extension Service
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