Author: CAES

2025 4-H Summer Camp
Registration Form
$440 (Monthly Payments Available)
Please complete this form in its entirety, please print:
4-H’er Name: __________________________________________
Preferred Name: ________________________________________
Gender: 󠄀Male 󠄀Female
Birthdate: ______/_______/_______
Circle T-shirt Size (adult sizes): S M L XL XXL
Mailing Address: ___________________________________
City: ___________________Zip Code: _______________
Parent’s Full Name: _______________________________
Email Address: __________________________________________
Home/Cell Phone Number: (_______) ________-__________
Alternate Phone Number: (_______) ________-__________
Name of School: _____________________
2021 - 2022 Grade: _____
Additional Info—
Has your child been to 4-H camp before? 󠄀Yes 󠄀No
Medical/Dietary Needs: ___________________________________
Allergies: _____________________________________________
Can your camper swim? 󠄀Yes 󠄀No
If no, would you like your child to take swimming lessons INSTEAD of the major interest class (i.e. archery, canoeing, & wildlife)? 󠄀Yes 󠄀No
_________________________________________
Signature of Parent or Guardian