printable registration form

The Child Protection Center of Ross County
Presents
2015
Saturday, March 28, 2015
Held this year at
Allen Elementary School,
located at 174 Plyleys Lane.
The Child Protection Center is a child advocacy center. We provide free services for abused children,
a supervised visitation program, parent education, and Body Safety classes. A professional staff
provides these services in a child-friendly atmosphere. The Child Protection Center is a non-profit
organization. For more information about the center, please visit our website at
www.thechildprotectioncenter.org. All donations are appreciated and are tax-deductible. Thank you
for supporting our mission.
Parents
Cafe
While your children are in classes, stop by the Parents Café between 9:30 and 11:30.
Enjoy light refreshments while you learn about the joys and challenges of parenting
your children. Stephanie Winegardner of Winegardner Chiropractic at 10:00 & Julie
Oates of The Child Protection Center at 10:30 will discuss parenting choices and
disorders in children. Dr. Stephanie Winegardner will discuss topics which will include
family nutrition, fitness, health and wellness and positive discipline.
And don’t forget about our great raffle packages!
9:30 – 10:20 a.m.
AKJU TEAM AMERICA KARATE. Buck Schwartz and Steve Nichols from AKJU Team America Karate. Instructing the registered
participants on the uses and benefits of Karate (Kara/te). The students will be given a demonstration on basic techniques, kata, and
traditional weapons of the martial art. All Ages. Limit 16 Students.
BASEBALL. Cody Smith from Menards & Michelle Smith from Integrated Services. Fundamentals of throwing and hitting a baseball. All
Ages. Limit 16 students.
BASIC CPR & FIRST AID. Suzie Dalton of the American Red Cross. Learn basic first aid and participate in a hands only CPR
demonstration along with disaster preparedness. All Ages. Limit 16 Students
BASIC PHOTOGRAPHY. Frank Robertson of the Chillicothe Gazette. So you like to take photos? How about making photos? In this
class, you’ll learn hands-on how to go from simply taking a photo to making more interesting photos, whether they’re of your friends,
family, or family pets. We will supply you with a one-time use disposable camera or you can bring your own. Ages 9 & UP. Limit 10
Students.
BUG JAR-MAKE YOUR OWN. Tamara Hodge from Headstart. Spring it’s on its way. Be ready to capture all the little critters in your
own backyard with your very own bug jar you made yourself. Ages 3-5. Limit 12 Students.
CARTOONING. Charles Doyle. Methods of drawing basic cartoon images. Ages 5 & UP. Limit 16 Students.
CUPCAKE DECORATING. Elizabeth Radcliff from University of Phoenix. Using basic techniques, students can choose from a variety of
goodies, to decorate 2 of their own favorite cupcakes to enjoy. Ages 6 and Up. Limit 12 Students.
DOLL SLEEPING BAG. Kelli Gothard and Ashley Smith from the Walnut Street Children’s School. Make a fleece sleeping bag for your
18 inch doll. Students must be able to tie a double knot. Ages 5-12. Limit 16 Students.
DUCTIVITIES. Tabitha Muse and Sarah Singer from Integrated Services. Use your favorite Duct Tape color or print to make
something special to take home and enjoy. Ages 7 & UP. Limit 16 Students.
FLOWER POT CREATIONS. Kayla Lemaster Volunteer. Use Sharpies to decorate your very own clay flower pot, add dirt, your favorite
seeds, a little bit of water and watch it grow. All ages. Limit 12 students.
FUN WITH PETS BY PETLAND. Gabbi Detty from Petland. Where do guinea pigs come from? Why are hamsters nocturnal? Learn fun
facts about the environment, eating habits, and care of your favorite pets! This hands on class includes interaction with puppies, small
animals, and other ideal family pets. Ages 3-7. Limit 16 Students.
EDIBLE ART. Brandy McCord from the Ross County Juvenile Court. Come play with your food and learn how to use every day foods to
create your own edible art projects. (Please note any food allergies on your registration form). Ages 7-9. Limit 16 students.
GALAXY SLIME. Ashlee Tackett Volunteer. Slime experiment! Mix a little of this and a little of that to get slimy. Take home your own
slime! Age Limit 4-12. Limit 16 Students.
LINE DANCING. Nicole Pickerrell from The Child Protection Center. Learn how to Line Dance. Age Limit 5-7. Limit 16 Students.
NO SEW FLEECE PILLOWS. Annette O’Bryant. Use fun fleece to make a pillow that you will finish in class and take home. You must
know how to tie a knot. Ages 6 & UP. Limit 10 Students.
PEEP PEEP! Sarah Winans from Ohio University. Make your very own gingerbread Peep house. Ages 5-7. Limit 12 students.
RC: FLIGHT. Christopher Parsons from Ohio State University. Basics and fundamentals of RC Flight. All Ages. Limit 16 Students.
SOLAR OVEN COOKING. Shelley McCoy from Union Scioto Local Schools. Make your own solar oven and learn to cook in it. Age 5-7.
Limit 8 Students.
THEATER ACTING WORKSHOP. Alan Christy of Allen Elementary School. Explore the world of theater and creative drama in a nopressure workshop for students! Great for Drama Kings, Drama Queens, and great for students who are new to performing with others,
to have fun working together expressing themselves, and ending with a showcase of their talents and abilities. Ages 5-6.
Limit 12 Students.
TISSUE PAPER FLOWERS. Lisa Bair Volunteer. Paper blossoms are super-fun and easy to make! Ages 8-12. Limit 16 Students.
WHAT DO I SEE? Julie Oates from the Child Protection Center. Take a journey and see what is all around. Will explore outdoor
areas, looking at bugs, worms and other treasures that are outside. Ages 5-12. Limit 12 Students.
10:30-11:20 a.m.
AKJU TEAM AMERICA KARATE. Buck Schwartz & Steve Nichols from AKJU Team America Karate. Instructing the registered
participants on the uses and benefits of Karate (Kara/te). The students will be given a demonstration on basic techniques, kata, and
traditional weapons of the martial art. All Ages. Limit 16 Students.
BASEBALL. Cody Smith from Menards & Michelle Smith from Integrated Services. Fundamentals of throwing and hitting a baseball. All
Ages. Limit 16 Students.
BASIC CPR & FIRST AID. Suzie Dalton of the American Red Cross. Learn basic first aid and participate in a hands only CPR
demonstration along with disaster preparedness. All Ages. Limit 16 Students
BASIC PHOTOGRAPHY. Frank Robertson of the Chillicothe Gazette. So you like to take photos? How about making photos? In this
class, you’ll learn hands-on how to go from simply taking a photo to making more interesting photos, whether they’re of your friends,
family, or family pets. We will supply you with a one-time use disposable camera or you can bring your own. Ages 9 & UP. Limit 10
Students.
BOUNCING OFF THE WALLS. Stephanie Winegardner from Winegardner Chiropractic. Join us as we teach you teamwork, balance, and
agility. Ages 6-12. Limit 16 Students.
BUG JAR-MAKE YOUR OWN. Tamara Hodge from Headstart. Spring it’s on its way. Be ready to capture all the little critters in your
own backyard with your very own bug jar you made yourself. Ages 5-7. Limit 12 Students.
CARTOONING. Charles Doyle. Methods of drawing basic cartoon images. Ages 5 & UP. Limit 16 Students.
CUPCAKE DECORATING. Elizabeth Radcliff from University of Phoenix. Using basic techniques, students can choose from a variety of
goodies, to decorate 2 of their own favorite cupcakes to enjoy. Ages 6 and Up. Limit 12 Students.
DOLL ACCESSORIES. Kelli Gothard & Ashley Smith from Walnut Street Children’s School. Get your doll ready for a party. In this
class, we will make doll-sized party cakes and fancy drinks. Ages 5-12. Limit 16 Students.
DUCTIVITIES. Tabitha Muse of ISAO/ROSS CO.CASA. Use your favorite Duct Tape color or print to make something special to take
home and enjoy. Ages 7 & UP. Limit 16 Students.
EDIBLE ART. Brandy McCord from the Ross County Juvenile Court. Come play with your food and learn how to use every day foods to
create your own edible art projects. (Please note any food allergies on your registration form). Ages 7-9. Limit 16 Students.
FLOWER POT CREATIONS. Kayla Lemaster Volunteer. Use Sharpies to decorate your very own clay flower pot, add dirt, your favorite
seeds, a little bit of water and watch it grow. All ages. Limit 12 Students.
FUN WITH PETS BY PETLAND. Gabbi Detty of Petland. Where do guinea pigs come from? Why are hamsters nocturnal? Learn fun
facts about the environment, eating habits, and care of your favorite pets! This hands on class includes interaction with puppies, small
animals, and other ideal family pets. Ages 3-7. Limit 16 Students.
LINE DANCING. Nicole Pickerrell from The Child Protection Center. Learn how to Line Dance. Ages 9-12. Limit 16 Students.
NO SEW FLEECE PILLOWS. Annette O’Bryant. Use fun fleece to make a pillow that you will finish in class and take home. You must
know how to tie a knot. Ages 6 & UP. Limit 10 Students.
RC: FLIGHT. Christopher Parsons from Ohio State University. Basics and fundamentals of RC Flight. All Ages. Limit 16 Students.
SOLAR OVEN COOKING. Shelley McCoy from Union Scioto Local Schools. Make your own solar oven and learn to cook in it. Age 7-10.
Limit 8 students.
PEEP PEEP! Sarah Winans from Ohio University. Make your very own gingerbread Peep house. Ages 9 & UP. Limit 12 students.
THEATER ACTING WORKSHOP. Alan Christy of Allen Elementary School. Explore the world of theater and creative drama in a nopressure workshop for students! Great for Drama Kings, Drama Queens, and great for students who are new to performing with others,
to have fun working together expressing themselves, and ending with a showcase of their talents and abilities. Ages 7-9.
Limit 12 Students.
TISSUE PAPER FLOWERS. Lisa Bair Volunteer. Paper blossoms are super-fun and easy to make! Ages 8-12. Limit 16 students.
11:30 – 12:20 LUNCH
ENTERTAINMENT PROVIDED BY
Child Protection Center
12:30 – 1:20 p.m.
AKJU TEAM AMERICA KARATE. Buck Schwartz and Steve Nichols from AKJU Team America Karate. Instructing the registered
participants on the uses and benefits of Karate (Kara/te). The students will be given a demonstration on basic techniques, kata, and
traditional weapons of the martial art. All Ages. Limit 16 Students.
BASEBALL. Cody Smith from Menards & Michelle Smith from Integrated Services. Fundamentals of throwing and hitting a baseball. All
Ages. Limit 16 students.
BASIC CPR & FIRST AID. Suzie Dalton of the American Red Cross. Learn basic first aid and participate in a hands only CPR
demonstration along with disaster preparedness. All Ages. Limit 16 Students.
BUG JAR-MAKE YOUR OWN. Tamara Hodge from Headstart. Spring it’s on its way. Be ready to capture all the little critters in your
own backyard with your very own bug jar you made yourself. Ages 8-12. Limit 12 Students.
CUPCAKE DECORATING. Elizabeth Radcliff from University of Phoenix. Using basic techniques, students can choose from a variety of
goodies, to decorate 2 of their own favorite cupcakes to enjoy. Ages 6 and Up. Limit 12 Students.
DINO DIGS. Kelli Gothard & Ashley Smith from The Walnut Street Children’s School. Young Paleontologists can dig up their own
dinosaur. Join us and learn about creatures who roamed the Earth millions of years ago. Ages 3-6. Limit 16.
EDIBLE ART. Brandy McCord from the Ross County Juvenile Court. Come play with your food and learn how to use every day foods to
create your own edible art projects. (Please note any food allergies on your registration form). Ages 10-12. Limit 16 students.
FLOWER POT CREATIONS. Kayla LeMaster Volunteer. Use Sharpies to decorate your very own clay flower pot, add dirt, your favorite
seeds, a little bit of water and watch it grow. All ages. Limit 12 students.
FUN WITH PETS BY PETLAND. Gabbi Detty of Petland. Where do guinea pigs come from? Why are hamsters nocturnal? Learn fun
facts about the environment, eating habits, and care of your favorite pets! This hands on class includes interaction with puppies, small
animals, and other ideal family pets. Ages 3-7. Limit 16 students.
LOOM BRACELETS. Tabitha Muse & Sarah Singer from Integrated Services. Join us while we teach ourselves while teaching you, how
to make and use a loom to make wonderful rubber band bracelets, necklaces, and rings. All Ages. Limit 16.
NO SEW FLEECE PILLOWS. Annette O’Bryant. Use fun fleece to make a pillow that you will finish in class and take home. You must
know how to tie a knot. Ages 6 & UP. Limit 10 Students.
PEEP PEEP! Sarah Winans from Ohio University. Make your very own gingerbread Peep house. Ages 5-7. Limit 12 students.
RC: FLIGHT. Christopher Parsons from Ohio State University. Basics and fundamentals of RC Flight. All Ages. Limit 16 Students.
SOLAR OVEN COOKING. Shelley McCoy from Union Scioto Local Schools. Make your own solar oven and learn to cook in it. Age 7-10.
Limit 8 students.
THEATER ACTING WORKSHOP. Alan Christy of Allen Elementary School. Explore the world of theater and creative drama in a nopressure workshop for students! Great for Drama Kings, Drama Queens, and great for students who are new to performing with others,
to have fun working together expressing themselves, and ending with a showcase of their talents and abilities. Ages 10-12.
Limit 16 Students.
TINY TOT DANCE. Jeriah Bowling and Hannah Snodgrass from Chillicothe Dance. Large motor skills, fun routine, get moving! Basic
dance, stretch & conditioning for BOYS & GIRLS!! Ages 4-6. Limit 10 students.
WHAT DO I SEE? Julie Oates of the Child Protection Center. Take a journey and see what is all around. Will explore outdoor
areas, looking at bugs, worms and other treasures that are outside. Ages 5-12. Limit 12 students.
1:30 – 2:30 p.m.
AKJU TEAM AMERICA KARATE. Buck Schwartz and Steve Nichols from AKJU Team America Karate. Instructing the registered
participants on the uses and benefits of Karate (Kara/te). The students will be given a demonstration on basic techniques, kata, and
traditional weapons of the martial art. All Ages. Limit 16 Students.
BASEBALL. Cody Smith from Menards & Michelle Smith from Integrated Services. Fundamentals of throwing and hitting a baseball. All
Ages. Limit 16 Students.
BASIC CPR & FIRST AID. Suzie Dalton of the American Red Cross. Learn basic first aid and participate in a hands only CPR
demonstration along with disaster preparedness. All Ages. Limit 16 Students.
BASIC SOCCER SKILLS. Jeriah Bowling & Lewis Bowling from Chillicothe Dance. Basic Soccer skills & Scrimmage. Ages 5-8. Limit 16
Students.
BUG JAR-MAKE YOUR OWN. Tamara Hodge from Headstart. Spring it’s on its way. Be ready to capture all the little critters in your
own backyard with your very own bug jar you made yourself. All Ages. Limit 12 Students.
CUPCAKE DECORATING. Elizabeth Radcliff from University of Phoenix. Using basic techniques, students can choose from a variety of
goodies, to decorate 2 of their own favorite cupcakes to enjoy. Ages 6 and Up. Limit 12 Students.
DINO DIGS. Kelli Gothard & Ashley Smith from The Walnut Street Children’s School. Young Paleontologists can dig up their own
dinosaur. Join us and learn about creatures who roamed the Earth millions of years ago. Ages 7-12. Limit 16 Students.
EDIBLE ART. Brandy McCord from the Ross County Juvenile Court. Come play with your food and learn how to use every day foods to
create your own edible art projects. (Please note any food allergies on your registration form). Ages 10-12. Limit 16 Students.
FLOWER POT CREATIONS. Kayla LeMaster Volunteer. Use Sharpies to decorate your very own clay flower pot, add dirt, your favorite
seeds, a little bit of water and watch it grow. All ages. Limit 12 Students.
FUN WITH PETS BY PETLAND. Gabbi Detty of Petland. Where do guinea pigs come from? Why are hamsters nocturnal? Learn fun
facts about the environment, eating habits, and care of your favorite pets! This hands on class includes interaction with puppies, small
animals, and other ideal family pets. Ages 3-7. Limit 16 Students.
JEWELRY MAKING. Tabitha Muse and Sarah Singer from Integrated Services. Make your own jewelry! You decide whether you make a
necklace, bracelet, or keychain out of beads. Ages 5 and UP. Limit 16 Students.
NO SEW FLEECE PILLOWS. Annette O’Bryant Use fun fleece to make a pillow that you will finish in class and take home. You must
know how to tie a knot. Ages 6 & UP. Limit 10 Students.
PEEP PEEP! Sarah Winans from Ohio University. Make your very own gingerbread Peep house. Ages 8-10. Limit 12 Students.
RC: FLIGHT. Christopher Parsons from Ohio State University. Basics and fundamentals of RC Flight. All Ages. Limit 16 Students.
SOLAR OVEN COOKING. Shelley McCoy from Union Scioto Local Schools. Make your own solar oven and learn to cook in it. Age 7-10.
Limit 8 Students.
THEATER ACTING WORKSHOP. Alan Christy of Allen Elementary School. Explore the world of theater and creative drama in a nopressure workshop for students! Great for Drama Kings, Drama Queens, and great for students who are new to performing with others,
to have fun working together expressing themselves, and ending with a showcase of their talents and abilities. Ages 10-12.
Limit 16 Students.
WHAT DO I SEE? Julie Oates of the Child Protection Center. Take a journey and see what is all around. Will explore outdoor
areas, looking at bugs, worms and other treasures that are outside. Ages 5-12. Limit 12 Students.
Registrations must be received by March 26th. Some classes are limited in size and the first paid registrants (up to the
class limit) will have secured places in the class. Fill out the registration form and mail or bring it to:
The Child Protection Center
138 Marietta Road, Suite E
Chillicothe, Ohio 45601
www.thechildprotectioncenter.org
You must fill out a form for each child attending classes. Indicate the desired class for the appropriate time. If your
child is not taking a class during a time slot, leave it blank. Children 3 years of age and younger must be accompanied
by an adult.
**You must sign-in and pick up a nametag for your child the morning of Kid’s Day.**
Child’s Name _________________________________________________________ Age ______________
Parent/Guardian Name _____________________________________ Relationship to Child ______________
Email Address ___________________________________________________________________________
Address ________________________________________________ City __________________________
How can we reach you during Kid’s Day? ________________________________________________________
9:30 ______________________________________ 12:30 ______________________________________
10:30 ______________________________________ 1:30 ______________________________________
Cost of each class $5.00
Lunch will be served 11:30 – 12:20
MEAL # 1
2 pieces of Pepperoni
Pizza, 1 fruit cup, 1 bag
of pretzels, & 1 bottle of
water
Quantity
Price
$5.00
Total
Total amount enclosed
for classes & lunch:
$ ________________
Make checks payable to Child Protection Center.
MEAL #2
2 pieces of Cheese Pizza,
1 fruit cup, 1 bag of
pretzels, & 1 bottle of
water
$5.00
Total
My child named above is participating in Kid’s Day. Participation carries with it a certain inherent risk that cannot be eliminated regardless of
the care taken to avoid injuries. I do release and/or waive the Child Protection Center, Chillicothe City Schools, and Kid’s Day class instructors
liable from any claims resulting in personal injury, accidents or illness, and property loss arising from, but not limited to, participation in Kid’s
Day activities.
Please indicate who will pick the child up. When picking up the child, they will have to show an ID.
Other authorized person(s) for pick up __________________________________________________________
Parent signature __________________________________________ Date __________________________