National Park Service

National Capital Parks-East

Junior Ranger Program Application

2009

Park Requested: Greenbelt Park, NCP East

Session requested:

Session I July 6 –July 10 ______Application deadline for Session I is JUNE 30

Session II July 13- July 17 ______Application deadline for Session II is JUNE 30

This program is for 8-12 year old children.

Child’s Name______Male______Female______Age______

Date of Birth______Home Phone Number______

Please remember this program is for 8-12 year old children.

Home Address______

State______Zip Code______

Parent(s) /Guardian(s) Name(s) and Daytime Phone Number:

Name______Number______

Name______Number______

Each Parent or guardian must attend the Orientation session on Monday morning 9:00 -9:40.

Emergency Contact Person(s)

Name______Number______

Name______Number______

Does your child have any allergies, illnesses, physical conditions or disabilities we should know about? Yes______No______

If so, please list them.

Is your child required to take any medications(s)? If so, please list them and indicate how often it is required. Please be advised that we will not be responsible for administering any medication.

FIELD TRIPS

We are planning several field trips. Please have your child bring a bag lunch and drink, wear bug and tick repellant and /or suntan lotion.

______is/is not allowed to participate in field trips planned for the Jr. Ranger Program.

Parent/Guardian’s Signature______Date______


Please allow your child to fill in this section and write a short essay.

Last School Attended:______Grade level_____

Teacher:______

What are your hobbies:

If you have a special interest in any of the following subjects, please check:

Small Mammals _____ Birds_____ Insects_____ Reptiles_____ Trees_____

Amphibians_____ Weather_____ Rocks_____ Spiders_____ Plants_____ History_____

Arts & Crafts_____ Gardening_____ Computers_____

Other special interests:

Do you have any volunteer experience, i.e. Jr. Ranger, Boy/Girl Scouts, Candy Striper, Volunteer in Parks (VIP), etc.? Yes_____ No_____

What were your duties and responsibilities?

If yes, please list where a give contact name and number.

Applicants, please answer the following questions in a brief essay.
(no longer than one (1) page). Why do you want to be a Jr. Ranger?
What do your expect to learn and again from this program? What can you add to this program? Why should your application be accepted?

Applications and essays should be hand delivered to:

Greenbelt Park Attn: Greenbelt Park 2009 Junior Ranger Program

6565 Greenbelt Road Greenbelt, Maryland 20770

Thank you for your interest in the Greenbelt Park, NCP-East Ranger Program

National Park Service Division of Interpretation and Education
U. S. Department of the Interior 1849 C Street, NW
Washington, DC 20240
202.513.7139 Phone
202.371.6662 Fax
Junior Ranger Photo and Film Release /

I hearby give the National Park Service and their legal representatives and assigns the right and permission to publish without change my image, in print, on the web or through video media for educational purposes.

On (Month/Day/Year): __Summer 2009______

At (Location or Event): __Greenbelt Park 2009 Junior Ranger program______

These photographs may be used in publications, including electronic publications, or in audio-visual presentations or in similar ways. The National Park Service will not sell these images, nor will they give the images to for-profit organizations.

Please check below any cases for which you do NOT wish to grant permission:

___ Print publication

___ Web publication

___ Audio-visual presentations in the parks

___ Broadcasts or distance learning programs outside the parks

Please check one:

___ I hereby certify that I an over 18 years of ages and am competent to contract in my own name.

___ I hereby certify that I am the legal guardian of the minor in the photographs and can legally grant permission for the use of this image.

Print Name: ______

Signature: ______Date: ______

Address: ______

City: ______State: ______Zip Code: ______

Name of Photographer: ______

The above information is held in confidence and is never released or sold.