August 4—8, 2014; 9am—3pm

Texas A&M AgriLife Extension Service 1402 Band Road, Suite 100, Rosenberg, TX 77471

Educational Activities Prairies! Wildlife, ranch living, insects-pollinators, native plants, the great migra-tion, crafts and more!

Open to all youth entering

3rd grade—5th grade.

Space limited to first 25

paid participants.

Payment ensures

your spot!

Registration includes

all materials, snacks,

& T-shirt!

RREGISTRATIONEGISTRATION

FFEEEE::

$50.00! $50.00! $50.00!

Educational programs of the Texas A&M AgriLife Extension Service are open to all people without regard to race, color, religion, sex, national origin, age, disability, genetic information or veteran status. Persons with disabilities who plan to attend this meeting and who may need auxiliary aids or services are required to contact Texas AgriLife Extension Service at 281.342.3034 five working days prior to the meeting so appropriate arrangements can be made. The Texas A&M University System, U.S. Department of Agriculture, and the County Com-missioners Courts of Texas cooperating.

For Information, contact

Margo “Mac” McDowell,

Program Coordinator/Master Gardeners

281-633-7033

Download & print

Registration form

at www.fbmg.com.

Registration

deadline is:

July 28th!

2014 Earth-Kind® Kids’ Kamp

Fort Bend County Master Gardeners announce their Junior Master Gardener Earth-Kind®

Kids’ Kamp (“EK3”) to be held August 4-8, 2014, from 9 am to 3 pm at the Fort Bend County Agriculture Center in Rosenberg, Texas. The Kamp is open to children ages 8-10 and entering grades three through five for the 2014-2015 school year. We have space for 25 children. Master Gardener volunteers will mentor each group and lead daily activities, and we have several guest speakers during the week.

“Our Coastal Prairie” is our selected theme. At one time, Texas had 6.5 million acres of coastal prairie—what was it like before farmers plowed the fertile soil, houses and roads built and millions of people settled here? Where did it go and what happened to the people and wildlife who once called it home? Kampers will not only learn about the people, the plants and wildlife; they will be immersed in Texas history throughout the week. The kids will make themed crafts to take home. To earn a Junior Master Gardener Plant medal, children must attend Kamp every day. The fee for Kamp is $50, includes activities, a t-shirt, snacks, and drinks. Kampers should dress for gardening and outside activities, including closed-toed shoes, and bring a sack lunch each day (no microwavable food). Registration closes July 28th, or when all spaces are filled. We do recommend applications be sent early, because space is limited and registration is on a first-come, first-serve basis. No phone registrations will be accepted; registration with payment (cash or check only) accepted only by mail or in person. No refunds after July 28thh. The Registration form is available on our website: www.fbmg.com or may be picked-up from the Texas A&M AgriLife Extension Service – Fort Bend County, 1402 Band Rd., Ste 100, Rosenberg, TX 77471. Please come to the Extension Annex next to the Main office; Mon-Fri 8am – 5pm. For more information, contact Margo “Mac” McDowell at 281-633-7033 or email: mmcdowell@ag.tamu.edu. Mail – completed forms and a check (payable to FBMG) to Texas A&M AgriLife Extension Service, 1402 Band Road, Suite 100, Rosenberg, TX 77471, attention Margo “Mac” McDowell. In Person – bring completed registration forms and cash or a check (payable to FBMG) to the Texas AgriLife Extension –Fort Bend County, Extension Annex Building, 1402 Band Rd., Ste 100, Rosenberg, TX 77471 (quarter mile west of HWY 36); Mon-Fri 8am – 5pm. Parking is convenient. Educational programs of the Texas A&M AgriLife Extension Service are open to all people without regard to race, color, religion, sex, national origin, age, disability, genetic information or veteran status. Persons with disabilities who plan to attend this meeting and who may need auxiliary aids or services are required to contact Texas A&M AgriLife Extension Service at 281.342.3034 five working days prior to the meeting so appropriate arrangements can be made. The Texas A&M University System, the U.S. Department of Agriculture and the County Commissioners’ Court of Texas cooperating.

Registration Form Kamper’s Name (please print) _______________________________________________________________ _____ Male _____ Female Age _____ Birth Date _____/_____/_____ Upcoming school grade (2014-2015 school year – must be entering 3rd-5th grade only) _____ 3rd _____ 4th _____5th School ___________________________________________ Home Address: Street _____________________________________ City: ____________________ Zip: ________________ Parent(s) or Guardian(s) Names: ___________________________/_________________________________ Home Phone: __________________________ Daytime Phone: ___________________________________ Cell Phone & Name: ___________________________ Cell Phone & Name:__________________________ Parent or Guardian’s E-mail Address: _________________________________________________________ Emergency Contact (other than parent or guardian): Name: _____________________________________ Phone: ______________________________________ If someone else is dropping-off or picking-up Kamper: Name: __________________________________________________________________________________ Kamper’s T-shirt size: _______ Youth-M ________ Youth-L ________ Adult-S Cost: $50.00 per child; Cash or Checks only. Please make checks payable to FBMG, with reference to EK3. Applications and payments can be dropped off at the office or mailed to:

Margo “Mac” McDowell Program Coordinator, Master Gardeners/Master Naturalist

Texas A&M AgriLife Extension Service 1402 Band Road, Suite 100

Rosenberg, TX 77471

2014 Earth-Kind® Kids’ Kamp August 4 – 8, 2014

Time: 9:00 a.m. – 3:00 p.m.

Educational programs of the Texas A&M AgriLife Extension Service are open to all people without regard to race, color, religion, sex, national origin, age, disability, genetic information or veteran status. Persons with disabilities who plan to attend this meeting and who may need auxiliary aids or services are required to contact Texas AgriLife Extension Service at 281.342.3034 five working days prior to the meeting so appropriate arrangements can be made. The Texas A&M University System, U.S. Department of Agriculture, and the County Commissioners Courts of Texas cooperating.

Participation Agreement My child, ward, or person (the “Kamper”) for whom I am legal guardian seeks participation in the Fort Bend County Master Gardeners’ Junior Master Gardener (“JMG”) Earth-Kind® Kids’ Kamp (“EK3”). Please read, sign and date where indicated: In consideration for my child or ward’s participation, I/we agree, as follows: ______ 1. I/we agree that I or another parent or guardian will be available at all times by telephone while my child or ward

is participating in the EK3.

_______ 2. I/we understand that my child or ward may be temporarily or permanently suspended from EK3 if they engage in improper conduct, including, but not limited to:

• Disruptive, harassing, or reckless behavior; • Defacing, disfiguring, damaging, or destroying public or private property during the EK3; • The threat or commission of physical violence against any person on Texas A&M AgriLife Extension

Service property or during the EK3. ______ 3. I/we agree that I or ________________________________________, will be responsible for transporting my

child or ward to and from the assigned location, according to the scheduled EK3 beginning and ending times. ______ 4. I/we agree that I or ___________________________________ will accompany my child or ward and remain

with them if they arrive more than 15 minutes prior to the scheduled EK3 beginning time. ______5. I/we agree that I or _____________________________________ will pick-up my child or ward within 15

minutes of the scheduled EK3 ending time. Parental/Guardian Consent and Waiver _______ I/We do hereby consent and agree that it is satisfactory for my/our minor son/daughter or ward

___________________________________________________________ (“Kamper”) to participate in JMG activities during the week of August 4 - 8, 2014 at the Earth-Kind® Kids’ Kamp.

In case of sudden illness or accident to the above named Kamper requiring immediate treatment or surgery during this activity; while there as a participant, and/or while enroute from or returning to an event, I/we authorize the Fort Bend County Master Gardeners, Inc. or the Texas A&M AgriLife Extension - Fort Bend County personnel serving as chaperone(s) to take such actions as deemed reasonably necessary and appropriate to protect the health and physical well-being of the participant. This authority extends to any physician or surgeon selected by the chaperone(s) to perform medical or surgical procedures necessary to preserve the life or well-being of the above named participant. The following information is provided as an aid to the chaperone(s) in dealing with the well-being of the above named Kamper. My/our signature(s) below indicates that I/we give permission for the above named Kamper to participate in a field trip. I/we also give permission for photos or videotapes of this named Kamper to be produced for promotional or educational purposes. Medical history information Kamp staff should know to insure the safety of the child during all Kamp activities. (Please print)

_________________________________________________________________________________________________

_________________________________________________________________________________________________

_________________________________________________________________________________________________

2014 Earth-Kind® Kids’ Kamp August 4 – 8, 2014

Participation Agreement and Parental/Guardian Consent and Waiver Form

Educational programs of the Texas A&M AgriLife Extension Service are open to all people without regard to race, color, religion, sex, national origin, age, disability, genetic information or veteran status. Persons with disabilities who plan to attend this meeting and who may need auxiliary aids or services are required to contact Texas AgriLife Extension Service at 281.342.3034 five working days prior to the meeting so appropriate arrangements can be made. The Texas A&M University System, U.S. Department of Agriculture, and the County Commissioners Courts of Texas cooperating.

My child has a prescription and/or non-prescription medication s/he will need to take during Kamp. Please list medication; dosage; dispensing instructions; and special storage instructions, if any. (Please print) ________________________________________________________________________________________________

________________________________________________________________________________________________.

________________________________________________________________________________________________

________________________________________________________________________________________________.

We will be serving snacks throughout the week. Please list any food allergies your child may have, if any. (Please print)

_________________________________________________________________________________________________

_________________________________________________________________________________________________

_________________________________________________________________________________________________

Accommodations: If your child needs an accommodation due to some disability or condition to safely enjoy camp, please contact:

Margo “Mac” McDowell Program Coordinator, Master Gardeners/Master Naturalist

Texas A&M AgriLife Extension Service 1402 Band Road, Suite 100

Rosenberg, TX 77471 Phone: 281-633-7033

Email: mmcdowell@ag.tamu.edu Signature of parent(s) or guardian(s): __________________________________________ _________________________________________ Date: _____/_____/_____ Date: _____/_____/_____ __________________________________________ _________________________________________ Printed name Printed Name Participation Agreement and Consent and Waiver Form Earth-Kind Kids Kamp August 4 – 8, 2014

Educational programs of the Texas A&M AgriLife Extension Service are open to all people without regard to race, color, religion, sex, national origin, age, disability, genetic information or veteran status. Persons with disabilities who plan to attend this meeting and who may need auxiliary aids or services are required to contact Texas AgriLife Extension Service at 281.342.3034 five working days prior to the meeting so appropriate arrangements can be made. The Texas A&M University System, U.S. Department of Agriculture, and the County Commissioners Courts of Texas cooperating.

PARTICIPANT WAIVER, INDEMNIFICATION, AND MEDICAL AUTHORIZATION

THE TEXAS A&M UNIVERSITY SYSTEM

I, ____________________________________, parent/legal guardian of __________________________,

participant, a minor, understand that the Earth-Kind® Kids Kamp (EK3 ), August 4-8, 2014, involves certain risks and that regardless of the precautions taken by the Earth-Kind® Kids Kamp (EK3 ), Master Gardener Volunteers and Agents, some bodily injuries may occur. Specific risks/hazards involved in the Earth-Kind® Kids Kamp (EK3 ), include but are not limited to the following: (1) dehydration; (2) physical injury sustained while participating in the Earth-Kind® Kids Kamp (EK3 ), and (3) medical problems such as illness, allergies, etc. 1. In consideration for receiving permission to participate in the Earth-Kind® Kids Kamp (EK3 ), which is sponsored by Texas A&M AgriLife Extension Service, a component member of The Texas A&M System, I hereby release, waive, discharge, and covenant not to sue, and agree to hold harmless for any and all purposes, Earth-Kind® Kids Kamp (EK3 ), Fort Bend County Master Gardeners and Instructors, Texas A&M AgriLife Extension Service, The Texas A&M University System and its Board of Regents, and their officers, servants, agents, volunteers, or employees (herein referred to as RELEASEES) from ANY AND ALL LIABILITIES, CLAIMS, DEMANDS, OR INJURY, INCLUDING DEATH, that may be sustained by me or by participant, while participating in such activity, or while on the premises that is owned, leased, or controlled by RELEASEES, including travel to and from the Earth-Kind® Kids Kamp (EK3 ), activities, including injuries sustained as a result of the negligence of RELEASEES. I understand this waiver does not apply to injuries caused by intentional or grossly negligent conduct. I understand Fort Bend County, Fort Bend County Master Gardeners, Inc., and Texas A&M AgriLife Extension Service are separate legal entities. 2. I, as parent/legal guardian, am fully aware that there are inherent risks involved with the Earth-Kind® Kids Kamp (EK3 ), and I, and participant, choose to voluntarily participate in said activity with full knowledge that said activity may be hazardous to participant, and our property. I acknowledge there may be physically strenuous activities. I know of no medical reason why participant should not participate. I voluntarily assume full responsibility for any risks of loss, property damage, or personal injury, including death, which may be sustained by participant, as a result of participating in said activity including injuries sustained as a result of the negligence of RELEASEES. I and participant further agree to indemnify and hold harmless the RELEASEES for any loss, liability, damage or costs, including court costs and attorney’s fees that may occur as a result of my participation in said activity including injuries sustained as a result of the negligence of RELEASEES. I and participant understand this agreement to indemnify and hold harmless does not apply to injuries caused by intentional or grossly negligent conduct. 3. I, as parent/legal guardian, understand that RELEASEES may not maintain any insurance policy covering any circumstance arising from participant’s participation on in this activity or any event related to that participation. As such, I am aware that I should review my personal insurance coverage. 4. It is my express intent that this Waiver shall bind the members of my family and spouse if I am alive, and my heirs, assigns, and personal representatives if I am deceased, and shall be governed by the laws of the State of Texas.

5. I, as parent/legal guardian, understand RELEASEES cannot be expected to control all of the risks articulated in this form but RELEASEES may need to respond to accidents and potential emergency situations. Therefore, I, as parent/legal guardian, hereby give my consent for any medical treatment that may be required during my participation with the understanding that the cost of any such treatment will be my responsibility. I, as parent/legal guardian, agree

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to indemnify and hold harmless RELEASEES for any costs incurred to treat me, even if a RELEASEE has signed hospital documentation promising to pay for the treatment due to my inability to sign the documentation. 6. In signing this Waiver, I, as parent/legal guardian, acknowledge and represent that I have read it, understand it, and sign it voluntarily as my own free act and deed; no oral representations, statements, or inducements, apart from the foregoing agreement that has been reduced to writing have been made. I, as parent/legal guardian, execute this document for full, adequate, and complete consideration fully intending to be bound by the same, now and in the future. I represent that I am eighteen (18) years of age or older and am otherwise competent to execute this agreement. If the participant is younger than 18 then his/her parent or legal guardian must sign where indicated on page 2 below. I consent to the information on this form being shared with Fort Bend County 4-H and County Agents. Parent or Legal Guardian SIGNATURE ________________________________________ DATE __________________ PRINT NAME ___________________________________________________________________________________ Participant’s Date of Birth _____________________________ Parent or Legal Guardian DRIVERS LICENSE # __________________STATE OF ISSUE ____________ LOCAL ADDRESS __________________________________________ LOCAL PHONE___________________________ PERMANENT ADDRESS _______________________________ PERMANENT PHONE __________________________ I am the parent or legal guardian of ___________________________________participant indicated above, who is under the age of 18. I agree on behalf of my child or ward to all the terms contained in this Waiver. PARENT OR LEGAL GUARDIAN SIGNATURE (if participant is younger than 18) ____________________________________________________________ PRINT PARENT OR LEGAL GUARDIAN NAME ___________________________________________________________

State law may require you to be informed of the following:

(1) you are entitled to request to be informed about the information about yourself collected by use of this form (with a few exceptions as provided

by law); (2) you are entitled to receive and review that information; and (3) you are entitled to have the information corrected at no charge to you.

TAMUS-OGC Approved 05/13/2005

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