In Emporium-Cameron County
Mission to Mars!

Open to students in 4th and 5th grade
Date: Monday, January 20, 2025
Location: Cameron County Rec Center
Time: 10:00am-2:00pm
Discover Day Description:
Blast off with the CEC and Cameron County Chief Science Officers on this No School Day in Space! Create solar system models, budget a mission to Mars, and team up to communicate with a rover in the thrilling Rover Races. Get ready for these out-of-this-world activities!
Cost: Free
Campers will need to bring their own bagged lunches. Snacks and drinks will be provided. Pick up and drop off is at the Cameron County Rec Center.
Questions, contact:
Courtney Rieger - courtney@communityedcenter.com or call 814-781-3437

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* 1. Child's Name

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* 2. Child's Age

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* 3. Child's Grade

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* 4. Parent/Guardian's Name

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* 6. Parent/Guardian's Phone Number

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* 7. Address

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* 8. Emergency Contact One: Name

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* 9. Emergency Contact One: Phone Number

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* 10. Emergency Contact One: Relation to Child

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* 11. Emergency Contact Two: Name

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* 12. Emergency Contact Two: Phone Number

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* 13. Emergency Contact Two: Relation to Child

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* 14. Please list any medical problems, including any requiring maintenance medication (i.e. Diabetic, Asthma, Seizures).

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* 15. Is your child presently being treated for an injury or sickness, or taking any form of medication for any reason?

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* 16. Is your child allergic to any type of food, medication or environmental?

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* 17. Photo Release Consent

I hereby give permission for my child to be photographed during the Summer Camp. I understand the photos will be used to keep a journal of activities, to share during power point presentations and/or reports and for promotional purposes including flyers, brochures, newspaper and on the internet. I understand that although my child’s photograph may be used for advertising, his or her identity will not be disclosed, I do not expect compensation and that all photos are the property of the Community Education Center for Elk and Cameron Counties and Elk County PSU Extension 4H

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* 18. Participation Consent

I, the parent/guardian, herby release discharge, indemnify, hold harmless and defend The Community Education Center for Elk and Cameron Counties and co-organizers, officers, employees and servants from any and all liability (claims, demands, losses, causes of action, suits, judgements) of any kind that I or my family may have against The Community Education Center for Elk and Cameron Counties due to death, personal injury or illness, loss or damage to property, or future causes that occur during the 2023 Summer Camp Program. In the event of any medical emergency, I authorize and consent for The Community Education Center for Elk and Cameron Counties and co-organizers to act on my behalf for medical care deemed necessary for the participant.

I understand The Community Education Center for Elk and Cameron Counties is not responsible for lost or damaged personal property, all scheduled events are subject to change and children's photos and quotes may be used for publicity purposes.

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* 19. Rules and Regulations

  • Campers must be at camp from designated time unless the program managers are instructed by the parent.
  • Campers are expected to be respectful and courteous to all campers, staff, speakers and guests.
  • Absolutely no physical or verbal altercations with fellow campers or staff. Fighting, the use of offensive language or any other inappropriate behavior will not be tolerated, and the camper’s parent will be notified immediately.
  • Bullying of any kind will not be tolerated. This includes any intentional written, verbal, or physical act intended to harm another camper.
  • Shorts must be an appropriate length, and shirts or tank tops must be modest. Activities will be held outdoors. It is recommended that your child dress appropriately.
  • All apparel may not have inappropriate language or graphics on them.
  • All campers must sign in and out with a counselor before leaving.
  • Cell phones, I-Pods, I-Pads, or other electronic devices are not allowed during camp hours, but may be used during breaks, lunch and bus rides. The Community Education Center for Elk and Cameron Counties are not responsible for lost or stolen electronics.
  • The Community Education Center for Elk and Cameron Counties is not responsible for any lost or stolen items.
Consequences:

A zero tolerance policy is enforced in regard to bullying as well as other acts of aggression. Fighting, hitting, or physical altercations of any kind will result in the camper/campers being separated and removed from the camp group until a parent or guardian can pick them up, a refund will not be given.

I realize that the staff in charge will exercise precaution for the safety of youth involved in these events, and I agree to assume full responsibility for any unforeseen accident which might occur during travel or while participating in this program. I further assure that my son/daughter has been instructed to comply with the regulations of the camp and/or chaperones who are in charge of the activity.

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