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                                      th
                      14 annual
                  RIC Youth Summit
                   July 25 - 29, 2012
                          in Ames, Iowa
  Rooted in Community (RIC) is a national grassroots network that empowers
          young people to take leadership in their own communities.
                  Please root into the network by joining us!
             https://lists.riseup.net/www/info/ric   www.rootedincommunity.org




                             Rooted in Community Conference                      1
                                       Rooted in Community
                                       2012 National Summit
                                       July 25th - 29th, 2012
                                            Central Iowa

                                     General Information
The Rooted In Community National Network (RIC) is a national grassroots network that empowers
young people to take leadership in their own communities. We are a diverse movement of youth and
adults working together and committed to fostering healthy communities and food justice through
urban and rural agriculture, community gardening, food security, and related environmental justice
work.

RIC has evolved into a network of groups seeking (1) to increase their knowledge and skills for doing
this work; (2) to increase public awareness of this work and (3) most importantly, to foster and
promote leadership in young people working in their own communities.

Over 75 organizations from around the U.S. have participated in the RIC national network since its
founding in 1998. RIC has strengthened the leadership skills of hundreds of youth and adult
community organizers by co-sponsoring intensive national trainings, action days, and networking
opportunities.


This year's conference launches in Iowa. While many only think of Iowa as hogs and corn, the state
also supports a variety of agricultural projects, including small Community Supported Agriculture
businesses, diverse farmers markets, and more tractors than people (well, maybe this only seems
true). While visiting Iowa, you’ll have the opportunity to experience the heart of agriculture, at a
university that is world-renowned for its research and innovations in agriculture.

Look forward to:
      • field trips to vegetable farms where you’ll lend a hand
      • getting a taste of urban agriculture in the heartland at community & school gardens
      • youth-led workshops
      • visiting towns enhanced by recent immigrants
      • staying in dorms at Iowa State University
      • growth, inspiration, and fun!!!

We invite your dedicated youth and a supervisor to contribute their energy to the experience. We
hope your group can offer an empowering workshop to share with our peer network. Feel free to
bring program materials to share too!




                                  Rooted in Community Summit                            2
                                                 Rooted in Community
                                                 2012 National Summit
                                                 July 25th - 29th, 2012
                                                     Central Iowa

                                            Registration Check List
Due online by June 15th for early registration and July 13th for regular registration:

     Registration Form

     Payment of Registration fees

If you want to register after the July 13th deadline, please contact Kate Casale at
kate@rootedincommunity.org

Due July 13th (at the latest!) by email to riciowa2012@gmail.com

        Workshop Proposal Form (all groups encouraged to send one!)
        Signed Code of Conduct (one for each group member including the chaperone)
        Signed Medical and Liability Waiver (signed and completed by each participant/guardian)
        Signed Photo Release Form (signed and completed by each participant/ guardian)
        Travel Information (please send arrival and departure times so that transport can be
     arranged)
        Submit top 3 points from the Youth Food Bill of Rights

If unable to scan and email documents, please fax to:
Rooted In Community
ATTN: Nellie Catzen
510.550.7831

**CONFERENCE FEES AND REGISTRATION PROCESS
Early Registration: May 1 to June 15 Youth: $175 Adult: $225
Regular Registration: June 15 to July 13 Youth: $225 Adult: $275
Late Registration: any submissions after July 13 might not be accepted

Rates include a discount/scholarship for all participants. No additional discounts are available. Fees include housing, food
and conference activities.

Registration fees CANNOT be paid at the conference. Please make checks payable to Earth Island Institute, with “2012
Rooted in Community Summit” in the memo line. You can also pay them on the RIC website - go to the site and click
“Donate to RIC” or follow the link in the checklist above.

        Please send checks and documents (if not emailing) to following address:
        RIC c/o Kate Casale
        2150 Allston Way, Suite 460
        Berkeley, California
        USA 94704-1375




                                         Rooted in Community Summit                                         3
                                          Rooted in Community
                                          2012 National Summit
                                          July 25th - 29th, 2012
                                              Central Iowa

                                         Travel Information
The conference officially begins Wednesday, July 25th at 6:00 pm at Iowa State University and
ends Sunday, July 29th at 12:00PM. Please try to be present for the entire conference.

1.     Travel by car(pool) or van:
Ames, Iowa is 45 minutes north of Des Moines, three hours south of Minneapolis, and six hours west
of Chicago. Parking is available at Iowa State University in several places; instructions for parking will
be made available to you in a registration e-mail.
Directions from I-35:
        Take exit 111B to merge onto U.S. 30 W towards Ames/Iowa State University (3.5
          miles)
            From U.S. 30 W, take exit 146 towards Iowa State University
            Merge onto University Blvd. (stay on University for about 1.5 miles)
            Turn left onto Lincoln Way (Stay on Lincoln Way for about half a mile)
            Arrive at Iowa State University, which will be on your right.
2.   Bus Travel
Jefferson Lines and Greyhound both offer bus stops in Ames. The bus stop is conveniently located in
the center of Iowa State University’s campus, at the Memorial Union.
3.    Air Travel
Please fly into the Des Moines airport (DSM) by 5:00 PM. We will have 3 shuttle buses from the
airport to Iowa State University for arrivals before 5:00PM. If you miss the bus, plan on catching a taxi
to Ames (~$90). Another option is to reserve a seat with Executive Express. You will have a shuttle
back to the airport on Sunday afternoon for departures after 1:30PM. Travel plans made outside of
these shuttles will not be guaranteed shuttle service to/from the airport.
                                        Rooted in Community
                                        2012 National Summit
                                        July 25th - 29th, 2012
                                            Central Iowa

                                       Tentative Schedule

Wednesday, July 25
3:00 - 6:00PM         arrival & registration
6:00 - 6:45           dinner
6:45 - 7:30           opening activity – tone setting, games, get to know everyone!
9:00 - 9:45           chaperone meeting
Thursday, July 26
7:30 - 8:15 AM        breakfast
8:30 AM               depart for field trips
9:00-3:30             farm tours to dig potatoes, taste ice cream, and learn about prairie soils
4:00 - 6:00           free time
6:00 - 7:00           dinner
7:30 - 8:30 PM        evening program – creative arts!
Friday, July 25
7:30 - 8:15 AM        breakfast
8:30 AM               welcome - group activity
9:00-10:15            session 1 youth-led workshops
10:30 - 11:45 AM      session 2 youth-led workshops
12:00-1:00PM          lunch
1:00 - 2:15           session 3 media, creative action, and advocacy workshops
2:30 - 4:30 PM        garden tours
4:30 - 6:00           free time
6:00 - 7:00           community dinner
Saturday, July 28th
7:30 - 8:15 AM        breakfast
8:30 AM               morning workshops – preparation for Day of Action
10:00 AM - 2:30PM     field trip to Marshalltown
3:15 - 4:30PM         large group action – press conference!
4:30 - 6:00 PM        free time
6:00 - 7:00           dinner
8:00 - 10:00 PM       dance party
Sunday, July 29th
7:30 - 8:15 AM        breakfast
9:00 - 11:30AM        closing ceremony
12:00PM               goodbyes! Grab the airport shuttle at 12:15 & 1:30PM




                                  Rooted in Community Summit                                       5
                                                       Rooted in Community
                                                       2012 National Summit
                                                       July 25th - 29th, 2012
                                                           Central Iowa

                                              YOUTH FOOD BILL OF RIGHTS

 In order to select appropriate outside workshops and design an awesome Day of Action that reflects
  the focus of youth and organizations attending, we are asking that you take a minute to review the
  Youth Food Bill of Rights with your youth crew. There is a whole workshop below that we highly
                       recommend you take the time to conduct with your youth.

   After reviewing the Bill, please select the 3 top declarations in the Youth Food Bill of Rights for
                                YOUR ORGANIZATION and YOUR YOUTH.
 Which ones are most relevant and meaningful for your community? Which ones are you working the
                  hardest on or feel the most passionate about? We want to know!

                                    Remember TOP 3, included in your registration.

    --------------------------------------------------------------------------------------------------------------------------------------

                                                          Eat Up. Power Up.

      An introductory workshop about Food Justice and youth leadership, tailored to your
community.

  This workshop has been designed by the Rooted in Community Youth Food Bill of Rights Working
Group, a collective of high school students from around the country who are dedicated to empowering
                our peers with knowledge about our food system and leadership skills.

 Our goal is to reach 100 new communities in the 2012/13 school year and this is where you come in!

We invite you to use this workshop to strengthen your community with three easy steps:

            1. First step is easy -- run the workshop with your own group. Once you are done you will
               have your own Food Bill of Rights, which you can use to advocate for change?

            2. Tailor this workshop to address pertinent issues of food justice in your community. Do
               you live in a community where many people work as farm laborers? Does your
               community have too few grocery stores? Does your community have a lack of locally
               owned restaurants?

            2. Take the show on the road, now you’re the teacher. This means you will follow the writing
               in italics as a guide for leading this workshop. Practice with your friends and co-workers
               until you feel confident (or at least a 6 out of 10 on the confidence scale). Then Identify 3
               places to run this workshop for other teens; maybe for a class in school, a local youth
               group, church group, teen center or at an event.

Length:

Approximately 1 hour and 30 minutes
                                              Rooted in Community Summit                                           6
Supplies

    Butcher Paper                                       Pens for participants

    Markers                                             Copies of Youth Food Bill of Rights for
                                                           participants:
    Sheets of paper for participants                      www.youthfoodbillofrights.com

                                                         Copies of this document for participants
Introduction (5 mintues)

- First step is to introduce yourselves to your audience, who are you? How old are you? Where are you
from? Why are you here?

- Introduce workshop, say something like: “This workshop is designed to make sure you know about
what’s going on with our food system, and to get your voice heard about what matters to you. This
workshop was designed by youth for youth to make sure our communities can access food that is
good for out bodies, good for the people who produce it and good for our planet. The youth that
designed this workshop wrote the first ever ‘Youth Food Bill of Rights’ with the goal of changing the
rules and laws that make our current food system broken.”

- Go over workshop agenda:

          Ice breaker game

          Discussion of rules and policies and how they affect our lives

          A picture of our food system

          Youth Food Bill of Rights

          Make your own Youth Food Bill of Rights

Ice Breaker-- “Biggest Fan” (5 minutes)

This game is basically a tournament of the game Rock Paper Scissors also known as Ro-sham-bo.

Do a demonstration match between two facilitators of best-out-of-three.

Explain: Rock crushes scissors, scissors cut paper, paper covers rock.

If you tie, just try again.

Here is the catch to this game, every time you get a new opponent introduce yourselves. When there is
a person who wins two times out of three games, that person goes on to find another winner, AND THE
LOSER BECOMES A CHEERLEADER, for the winner. At the end there will be just two people battling it
out with a squad of cheerleaders.




                                   Rooted in Community Summit                             7
Discussion of rules and policies (15 minutes)

This is where we introduce the ideas of “policy” so people can have an understanding of “changing
the rules.”

Prepare three pieces of butcher paper or a whiteboard with four columns:

Write “RULE”, “WHO MAKES THIS RULE AND ENFORCES IT” , “WHO DOES THIS RULE EFFECT” and
“HOW DOES THIS EFFECT THOSE PEOPLE”

Say something like “Now we want to talk about the RULES in our lives, why? Because after learning
about our food system, we decided that we needed to change the rules. Lets talk about the rules in our
lives.”

This is a brainstorm so ask for some one to name a rule and than ask the group who makes and
enforces that rule, who it effects, and how it effects those people. Write down the responses as you go
and then ask for another suggestion. Get at least five diverse rules written down.

Examples include: Curfew, School Dress Code, Laws about driving, rules at home, laws about
citizenship, rules about drugs, no eating on the bus, rules about marriage, who gets to vote...

Wrap up discussion:

Explain: These are just some examples of the rules that shape our lives. Do people notice any
patterns? Are the people who make and enforce the rules different or the same than the people they
affect?

Explain: Some of these rules are rules at our houses, some are policies in institutions like schools and
businesses and others are laws enforced by our government. We recognize that some of these rules
have negative consequences right?

Well, believe it or not our food system has many rules, policies and laws that also have negative
consequences on our communities and that is why we are going to talk about the YFBR - a tool to
change those rules, policies or laws.

A Picture of Our Food System (15 minutes)

For this activity you can show video clips about our broken food system (the Meatrix, CIW clips, Future
of Food) or host a quick discussion:

Ask people to think about what they ate for breakfast:

      - Did you even eat?

      - Who grew it? Who packaged it?

      - Where was it purchased?

      - What nutrients were in it? Did it prepare you for a full day?

      - Was it fresh?
                                   Rooted in Community Summit                      8
         - Where did it come from?

         - How did it get here?

When we think about our food system we realize it is complex and there are many places where things
can go wrong? For example how much were the farmers paid for their work? Were the animals treated
well? Did your food come from far away and require a lot of fuel to reach you?

Ask for other examples of our BROKEN FOOD SYSTEM.

         People may say things like: GMO’s, Pollution, School Lunch, Obesity....

Ask: Do we agree the Food System has some flaws?

Youth Food Bill or Rights (10 minutes)

Ask folks to read over the Youth Food Bill of Rights.

Ask for a few people to point out what seemed important to them? Why is it important? What do you
like about this bill? What is missing? What needs more explanation?

Make Your Own Youth Food Bill of Rights (30 minutes)

Let people know that we will be breaking into groups to create or modify a Youth Food Bill of Rights for
their own community. Each group will participate in dialogues just like the ones used to create the
Youth Food Bill of Rights.

            Each group will either pick three of the points on the YFBR and edit them to address a
             specific issue in their community

OR

            Write up three new declarations that address a specific issue in their community

Remind people to dream big, because big change is needed. Remind people to step up and step down,
sharing the mic.

        Break folks into groups of five-seven people each and provide each group with paper and pens.
         Tell them they have 15 minutes to vote/select their points and add the specifics about their
         community or create new ones. Ask each group to take notes.

        At ten minute mark check-in see if people are ready. Ask each group to pick a representative to
         report back.

        Groups share their top 3 and give explanations specific to their community. Write them up on
         the wall.

        Do people have comments or thoughts?



                                     Rooted in Community Summit                             9
Have everyone vote on the top three for the whole group! The best way is to give 3 sticky dots
to each person and they put it next to the ones they are most passionate about.

                       Tally the results and send it to Rooted in Community!!!



Debrief (10 minutes)

In pairs, have youth answer the question:

       - How/where will they use their issue to advocate for change? What are 2 action steps they
could take?

Congratulate Everyone!




Extensions:

      Conduct a power mapping exercise with the top points to learn more about how the rules are
       made and who they affect. This is an important first step for action.

      Take the top items and create an action plan around them for your community.

      Do some research to see if there are any local or state policies that are in process that you
       could become an advocate for – if so, call your representative or talk to your school board. If
       not, enlist some support and see what policy you could create to address the issue.




                                   Rooted in Community Summit                       10
                                             Rooted in Community
                                             2012 National Summit
                                             July 25th - 29th, 2012
                                                 Central Iowa

                                         Workshop Proposal
The RIC Conference focuses on sharing our passion, knowledge and skills. Our goal is to provide
guidance and inspiration to communities working to build local food system self-reliance. Please help
us by doing activities to help bring local fresh, nutritious and affordable food into our neighborhoods.
Keep in mind that the workshops should be YOUTH-LED, ENGAGING, CREATIVE, HANDS-ON,
EMPOWERING, and FUN! Plan your workshop to be 75 minutes in length and try to incorporate
hands-on-aspect or other sensory involvement (i.e. movement, writing). Workshop proposals are due
by e-mail to riciowa2012@gmail.com by July 13th, 2012.
Workshop Title:

Workshop Topic (circle      Nutrition/Health/Healing
best one):                  Community Food Security/ Sustainable Food Systems
                            Food and Culture
                            Gardening Methods
                            Environmental Justice
                            Food Politics/Industrialization
                            Community Organizing
                            Leadership Training
                            Youth Enterprise Projects
                            Inspiring others to action and social change

Description (what will
people learn?)


Presenters: (for about me   name:                                      age:
- tell us about yourself;   about me:
why are you a great
person to put on this
                            name:                                      age:
workshop?)
                            about me:
*feel free to provide
additional information on   name:                                      age:
the back of this form       about me:


Materials needed for        Easel
presentation:               Flipcharts
                            Markers
                            Overhead projector
                            Power Point projector
                            Other_____________________

How much space does         a) small meeting room
this workshop require?      b) large meeting room
                            c) outdoor space
                            d) other: ________________________________

Number of people in the     10   15     20    25   30   other:_____________________
workshop:

                                   Rooted in Community Summit                             11
                                                Rooted in Community
                                                2012 National Summit
                                                July 25th - 29th, 2012

                                       Code of Conduct Procedures
Goal: To create a safe space where participants will be able to participate and share themselves fully
in the hopes of creating lasting positive social change in the food systems movement.

Before Conference
· Organizations will receive this registration packet, which outlines the guidelines everyone is expected to follow during
   RIC. Contracts must be signed and submitted before the beginning of the conference. You may bring these
   documents with you when you arrive, but we encourage you to fill and mail/fax these documents as soon as possible
   – this helps our staff make sure everyone’s paperwork is in order.
· Staff and supervisors representing youth from each organization (at least one) will be required to participate in a
   conference call outlining and explaining the guidelines in full that everyone will be expected to follow during RIC –
   approximately 1 hour. There will also be a half hour allotment of time to ask questions or voice concerns from
   participants for those who wish to do so. If changes are to be made for any of these Conference Policies, the RIC
   planning council will do so after the conference call and follow up with email to update everyone on new changes prior
   to attending RIC. This conference call will be scheduled in early July; you will receive an e-mail once you are
   registered. We will send information about the call-in number as the date approaches.

During Conference
· Please see attached document for the list of the guidelines that everyone is expected to follow during RIC.
· There will be a designated Committee of youth and adults that will ensure that these policies are followed for the
   duration of this conference. In your welcome packet that you will receive when you check in, a list of those on that
   committee will be available for you with phone numbers included in the event that you have questions or need
   support.
· Committee members will introduce themselves during the orientation to RIC and will explain their roles for the
   conference to everyone in attendance.
· Organizations will also have a designated check in time with their own members they have in attendance to give
   refreshers of RIC Policies and to ensure their own during each day.
· Committee members will check in with all organizations during the conference to ensure that support is granted where
   needed and that policies continue to be followed by each organization for the duration of this conference.
        o In the event that an organization violates these agreed upon policies, a representative of that organization will
            meet with Committee members to determine what steps need to be taken to address these concerns for
            present and for future participation in RIC Conferences. Serious violations of these agreed upon policies (as
            determined by Committee members) may jeopardize that organization’s current and future participation in
            RIC.

After Conference
· If it is found out that an organization has violated these agreed upon policies after the conference has been
    completed, representatives of that organizations will be required to participate in a phone conference with Committee
    members to determine what steps need to be taken to address these concerns for future participation in RIC
    conferences.
· RIC is a fairly new conference that will be piloting various policies and structures to create a safe space for all
    participants. In order to make sure that this structure continues to become better for future RIC conferences, we
    require all organizations to submit a positives and deltas form specifically regarding these policies and structures.
    Everyone has valuable input and we believe that having the input from such a diverse group of participants will only
    make RIC stronger and quite possible a lead model for other conferences around the country.




                                         Rooted in Community Summit                               12
                                                Rooted in Community
                                                2012 National Summit
                                                July 25th - 29th, 2012                Name:
                                                    Central Iowa

                                                 Code of Conduct
The following are the policies put in place for participants in the 2012 Rooted in Community National Conference. There
have been some changes made to the code of conduct in response to the suggestions and requests of several groups–
these changes are for a one year trial basis and will be re-evaluated by the Rooted in Community Advisory Committee
following the 2012 conference. Please take a look at the RIC Policy Procedures (Attached) for detailed instruction
regarding the following:
·   The conference is an alcohol-free and drug-free event. Possession or use of alcoholic beverages or illegal drugs is
    prohibited. This includes the grounds and streets surrounding the conference site. In addition, a group with a
    participant exhibiting public intoxication must leave the conference.
·   Possession of sexually explicit materials is prohibited. In addition, public access computers at the conference site may
    not be used to download, create, receive, forward, or transmit inappropriate, offensive, or sexually explicit
    communications.
·   Smoking or using other tobacco products is prohibited in all buildings, meeting rooms, and guest’s rooms. Smoking is
    permitted in designated outdoor areas only.
·   Fireworks are prohibited.
·   Lighting of candles or incense is prohibited in all buildings, meeting rooms, and guest rooms.
·   No pets or animals are allowed, except for trained guide dogs.
·   Shirts and shoes are required inside all buildings at all times.
·   Guests must respect personal public property and follow all additional rules of campus dorms. Repair costs of
    damages incurred to property will be billed to the group responsible for such damages.
·   There will be no “organized” programs or activities after 10:00 p.m. during the conference. Everyone is asked to be in
    their own room by 10:00 pm and to refrain from making noises that will disrupt others. The conference curfew is 11:00
    pm., which means each person needs to be in their own room and on their way to bed.
·   Vending and selling merchandise is prohibited in public areas and to others outside your own group membership.
·   Before or during checkout, each participant or his/her group must pay for all incidental charges.
·   To protect the safety of conference participants, no fraternization is allowed in participant’s lodging rooms. Any
    participant who has a complaint regarding fraternization should contact his or her adult group leader.
·   Each participant must submit an up-to-date medical form and emergency contact information. Adult chaperones are
    responsible for having this information on hand for their designated youth for the duration of the conference.
·   Violent behavior or behavior which threatens violence is absolutely prohibited and not tolerated under any
    circumstances.
·   Adult chaperones are responsible for reporting any incidents involving their youth to Committee members.
Adult chaperones and group leaders are responsible for enforcing the rules as stated. Individuals who violate this code
may be asked to talk with the conference planning committee and their organization may be subject to a strike. If three
strikes are accumulated by any organization they will not be permitted to participate in the conference for at least one
year. With regard to violence or the threat of violence, any conference participant, youth or adult, posing any physical
threat to any other conference participant will be immediately dismissed from the conference. In alignment with many of
the participating organizations' code of conduct, there will be no tolerance for any physical threat that compromises the
safety of conference participants. These rules are not subject to interpretation and each group is expected to follow them
without exception. Our primary consideration is to provide a safe, secure environment for all our conference participants.
I have read and understand the above Code of Conduct and will inform all group participants of its contents.

Signature                                                                                 Date
_____________________________________________________________________                              _______________




                                         Rooted in Community Summit                                        13
                                                  Rooted in Community
                                                  2012 National Summit
                                                  July 25th - 29th, 2012                Name:
                                                      Central Iowa

                                    Liability and Medical Release Form
I hereby give approval for _______________________________________ (Youth Name) to participate in all
activities associated with the RIC National Conference, including a conference in central Iowa July 25 - 29,
2012. I assume all risks and hazards related to participation in the program, including transportation.

In the event, __________________________ (Youth Name), a minor, becomes ill or sustains an injury while in
attendance at the Rooted In Community National Conference; I give my permission to administer first aid to my
child. If I, (the parent or legal guardian), cannot be contacted immediately in the event of an emergency, I
authorize the adult supervisors and RIC staff and volunteers to consent to emergency hospital care for my
child. Should any illness or accident occur to him or her, I will not hold liable the representatives of the Rooted
In Community staff and volunteers, Iowa volunteers, or my child’s sponsoring organization staff and volunteers.
I assume full responsibility for all related medical costs.

Youth’s Name:                                                         Date of Birth:

Social Security Number (Optional-Recommended):

Youth’s Address:

City/Country/Zip:

Parent or Legal Guardian’s Name:

Phone Number: Day                          Eve                        Is this a cell phone? Yes / No

Health Insurance Company:                                             Policy Number:

Any special health concerns, allergies to medication etc.?



Please list any medication the student is currently taking.



In case of an emergency if I cannot be reached, please notify:

Name:                                                         Relationship:

Phone Number: Day                          Eve                        Cell

Name:                                                         Relationship:

Phone Number: Day                          Eve                        Cell


Signature of Parent or Guardian                                                                         Date




                                          Rooted in Community Summit                               14
                                             Rooted in Community
                                             2012 National Summit
                                             July 25th - 29th, 2012             Name:
                                                 Central Iowa

                                            Photo Release Form

During the course of the RIC 2012 National Conference, July 25- 29, 2012, photographic and video images of
participants are often taken by staff, youth and others. These are sometimes then used in non-commercial
materials to tell the story of the program, or to make reports to funders, etc. This form gives you (youth of legal
age) or adult parents or guardians the option to give or deny permission to use those photos for non-
commercial purposes, as outlined below.

____ Yes, I give the Rooted In Community staff and volunteers, Iowa volunteers, and other helpers the right to
copyright and/or publish, reproduce, or otherwise use my child’s name, voice, and likeness and/or written
material, photographs, and audiovisual recordings about or by my child for instruction, art advertising, program
website, publications or brochures, or any other lawful purpose. I hereby agree to relinquish all rights, title and
interest I may have in the finished product and waive all rights to any compensation thereof.

____ No, I would prefer that my/my child’s image not be used.


Youth’s Name:

Youth’s Address:

City/Country/Zip:

Parent or Legal Guardian’s Name:

Phone Number: Day                     Eve                    Is this a cell phone? Yes / No




Signature of Parent/Guardian or Youth Over 18 Years Old



Date




                                      Rooted in Community Summit                                    15
                                            Rooted in Community
                                            2012 National Summit
                                            July 25th - 29th, 2012
                                                Central Iowa

                                                Packing List
The following is a list of recommended items. Keep in mind that Iowa is hot and humid in the summer
(low of 65℉ and high of 90℉). Bring light-colored cotton clothing for when we are working in the field.

Clothing:
   • Shorts: 2 Pairs (1 for outside work and 1 for workshops/less physical stuff)

   • Pants: 2-3 Pairs (1 for working and 1 for evening activities)

   • T-Shirts: 2-3 short sleeve and 2 long-sleeve (1 for sun cover)

   • Shoes: One closed-toe pair for walking and working outside

   • Warm Layers: Jacket or sweatshirt for cool nights

   • Pajamas

   • Socks: 3-4 pairs

   • Underwear

   • Swim Suit (just in case)

   • Hat (for sun protection)

   • Rain Jacket (though we will wish for sunny days, we can’t make any promises)

Personal Items:

   • Toiletries (including shampoo, soap, tooth paste, tooth brush and hair brush)

   • Sun protection (sunscreen, sunglasses,)

   • Medication

Additional Items (optional):

• Journal                                                   • Camera with cord (so we can get copies of the
                                                              photos for our slide show)
• Reading Book

• Workshop Materials
Items to consider leaving at home: Anything Valuable (i.e. electronics, IPOD, jewelry)




                                     Rooted in Community Summit                            16

								
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