January 3 rd, 2017 TO: Prospective 4-H Lego Robotics Club Members FROM: Ryan Farley, County Extension Agent for 4-H Youth Development RE: 4-H Lego Robotics Club 2017 Thanks for your interest in the 2017 4-H Lego Robotics Club! This packet has all of the necessary information and forms to apply for participation this year. The 4-H Lego Robotics Club is available for 4 th 8 th grade Woodford County 4-H members and space is limited. Because of interest this year the club will feature four teams of four participants, with two teams designated for 4th/5 th grade participants and two teams for middle school participants. Team spots will be filled on a first-come/first-served basis and submission of all paperwork plus payment is due for the spot to be held. If either age group doesn t fill their spots by January 30 th, any additional participants on the waiting list will be allowed to fill those spots. Please keep in mind though that any team with middle school members on it will be designated as a middle school team for the sake of lessons and competition. Practices will be held primarily on Thursday nights from 6:00pm to 7:30pm at the Woodford County Extension Office. Practice begins on Thursday, February 2 nd and will continue on until May when the District 4 4-H Lego Robotics Competition takes place on Saturday, May 6th at West Irvine Intermediate School in Estill County. Team members are expected to attend all practices and the competition. If a scheduling conflict takes place, participants will be expected to notify the Extension Office prior to the meeting. Woodford County 4-H was also fortunate enough to receive a STEM Grant from the Kentucky 4-H Foundation, which went to the purchasing of two new laptops to be used by the Lego Robotics Club. As part of this grant, club members will also be expected to participate at the Kentucky State Fair STEM Day Robotics Competition, usually held during the 2 nd week of the fair. More information on that date will follow. Cost for participation in the 4-H Lego Robotics Club is $15 which includes a 2017 club t-shirt (different from the 2016 shirt) and covers the registration fee for each participant for the competition. Checks can be made out to Woodford County 4-H Council. To sign-up please complete the attached expectations form and submit it, with payment. Once we receive those your spot will be reserved. Also attached is a 4-H enrollment form for those that have not filled one out since September. For any questions, please call the Woodford County Extension Office at 859-873-4601 or email Ryan at ryan.farley@uky.edu. Thanks! Ryan Farley Woodford County Extension Agent for 4-H Youth Development Reply to: Woodford County Cooperative Extension Service Woodford County 184 Beasley Drive Versailles, KY 40383-8992 Telephone: (859) 873-4601 Fax: (859) 873-8936 http://woodford.ca.uky.edu/ Email: dl_ces_woodford@email.uky.edu
4-H Robotics Club Member Expectations 2017 All youth interested in the 4-H Robotics Club must have all forms completed and fees paid and turned into the Woodford County Extension Office in order for their spot in the club to be held. This includes a 4-H enrollment form and a signed club members expectations form. Applications and forms are available on Thursday, January 12 th and are due no later than January 30 th. Youth and adults understand that the 4-H Robotics Club is a time commitment comprised of 10 spring practices (With 2 optional practices during WCPS Spring Break) and participation in the District 4 Robotics Competition in Estill County on May 6 th, 2017. The first practice is February 2 nd at 6:00pm. Youth participants will also be asked to participate at the Kentucky State Fair 4-H Robotics competition in August with more details to follow. Youth may not miss more than 2 club practices throughout the program year. If the youth miss more than 2 club practices without discussing it with the 4-H Agent or Volunteer leader prior to missing, their membership may be in question. Youth are required to practice respect for others and for equipment at all times. If coaches feel members are disrespectful they may ask the youth to sit out of practice, if the problem continues youth s membership may be in question. Youth and adults understand that the equipment used for the Robotics Club is property of the Woodford County 4-H Program and any loss or damage of the equipment may result in an added fee to participate in the club or requirement of replacement of lost or damaged equipment. Youth and adults understand that the purpose of the Woodford County 4-H Robotics Club is to facilitate growth and learning while participating in friendly competition in a safe and nurturing environment. Any members failing to live by these standards may be asked to sit out or leave. By signing the 4-H Robotics Club Member Expectation I understand my responsibility as a participant of the 4-H Robotics Club and Woodford County 4-H Program. Both the youth and parent/guardian must understand the expectations and sign the form. Parent/Guardian (print & sign) Youth (print & sign)
Kentucky 4-H Enrollment System Woodford County 4-H - Member Form Personal Info First Name: Last Name: Street: City: State: KY Zip: Gender (Circle One): Male Female Birth Date (MM/DD/YYYY) / / Primary Phone ( ) - Email Address Parent /Guardian Info Name: Primary Phone ( ) - Name: Primary Phone ( ) - Relation: Relation: Demographic Info Ethnicity (circle one): 1. Hispanic 2. Not Hispanic Race (circle all that apply): 1. Asian 2. White 3. Black 4. American Indian 5. Hawaiian/Pacific Islander Residence (circle one): 1. Farm 2. Town <10K 3. Town 10K-50K 4. Suburbs >50K 5. Cities >50K Do you require an accommodation for a disability to participate in this program? Please list any health considerations: Military Family? If yes, please indicate your branch: School: Grade Over
Authorization of Use I, (print full name) (*) herby grant permission to the University of Kentucky and its affiliates and subsidiaries, including but not limited to the College of Agriculture Cooperative Extension and Agricultural Alumni Association, to interview, photograph and/or videotape me, or my minor child, and/or to supervise any others who may do the interview, photography, and/or videotaping and/or to use and/or permit others to use information from the aforementioned interview and/or the aforementioned images in educational and promotional activities for the following without compensation: University Educational Publications/Videos University Electronics Publishing (e.g. World Wide Web) University Promotion/Advertising Local/regional/national news media (w/permission of the University of Kentucky) Signature of Parent or Guardian: Date: Relationship: Educational programs of the Kentucky Cooperative Extension Service serve all people regardless of race, color, age, sex, religion, disability, or national origin. Ares of Interest (Check all the apply) Bicycle Rodeo Cake Decorating Country Ham Project Dog Club Entomology Entrepreneurship Foods Forestry Other Child Pick-Up Form Name of child/youth: Horse & Pony Club Horticulture Issues Conference for Teens Land Judging Livestock Club (Beef, Sheep, Goat, Poultry) Electricity, Robotics Needlecraft (Knitting, Crochet, Quilting) Photography Sewing Shooting Sports (Rifle, Shotgun, Archery) Teen Conference (High School Students) Teen Summit (Middle School Conference) Tractor School Youth Expo Woodworking 4-H Camp The youth named above has my permission to be picked up by person or persons listed below. I understand my child cannot be picked up from the designated camp or 4-H program by anyone except his/her guardians unless they are on this list. Individuals other than legal guardian /parent(s) authorized to pick up my child from the University of Kentucky Cooperative Extension Service are: Name: Address: Phone Number: Name: Address: Phone Number: By signing this, I acknowledge that I have read all the above information related to picking up my child when he/she returns from the 4-H activity, and I have instructed my child that they are to leave with no one unless listed above. He/she also has been told to report immediately to the agent if the designated person(s) are not present at the time the central drop off is reached. Signature Relationship to Child Date Return this form to: Woodford County Cooperative Extension Service 184 Beasley Road Versailles, KY 40383 Office: (859) 873-4601 Fax: (859) 873-8936