Registration deadline is July 17, 2015 (or until filled).

Note: Each county’s fee is different due to varying county support. Be sure you have your county’s form. This is Boone County’s form.

Camper Fees

Camper Fee $ 180.00*

MinusBooneCounty Support

(Lowery Charitable Foundation provides discount) $ -60.00

Subtotal Boone County Camper Fees $ _ 120.00

(Add to Friday Evening Fees below.)

Friday Evening BBQ Fees

Fees for additional family members for Friday evening.

(Camper fees for the evening are already covered in their registration.)

BBQ and Campfire:

12 years to adults x $6.00 =

Children 5-11 years x $4.00 =

Children 4 years and under (free)

Subtotal Friday Evening BBQ Fees$

Total Amount Enclosed

(Camper Fee + Friday evening BBQ Fee)$

Make check payable to ISU Extension.

Send to:ISU Extension and Outreach, Boone County

603 Story Street

Boone, IA 50036

*Fees for service will be used to off-set direct expenses and to support this extension program.Partial funding for camp expenses is provided by Lowery Charitable Foundation.

.… and justice for all The U.S. Department of Agriculture (USDA) prohibits discrimination in all its programs and activities on the basis of race, color, national origin, age, disability, and where applicable, sex, marital status, familial status, parental status, religion, sexual orientation, genetic information, political beliefs, reprisal, or because all or part of an individual’s income is derived from any public assistance program. (Not all prohibited bases apply to all programs.) Persons with disabilities who require alternative means for communication of program information (Braille, large print, audiotape, etc.) should contact USDA's TARGET Center at 202-720-2600 (voice and TDD). To file a complaint of discrimination, write to USDA, Director, Office of Civil Rights, 1400 Independence Avenue SW, Washington, DC 20250-9410, or call 800-795-3272 (voice) or 202-720-6382 (TDD). USDA is an equal opportunity provider and employer.

B:\4-H Camp\Tri County Camp\Fun in the Sun/2015\Boone Tri Co Jr Camp reg

Tri-CountyJunior 4-H Camp

Boone, Hardin, Marshall, and Story Counties

4th, 5th, & 6th Graders

August 5-7, 2015

Iowa 4-H Camping Center

RACE to Which CAMP!

Campers will have three fun-filled days learning new skills, making new friends, reuniting with other campers, testing their skills during camp activities, and enjoying the great outdoors.

What:

Boone, Hardin, Marshall, Story Tri-county Junior 4-H Camp

When:

Wednesday, August 5, 10:00 a.m. to Friday, August 7, 8:30 p.m.

Where:

Iowa 4-H Camping Center nearMadrid in Boone County

Who:

Junior 4-H members who have completed 4th, 5th, or 6th grades in Boone, Hardin, Marshall and Story Counties

Friday Evening Events for campers’ families:

5:30 p.m.– 6:00 p.m.:

Pick up campers at Elm Village, proceed to BBQ shelter.

6:00 p.m. – 7:00 p.m.:

Barbecue at BBQ Shelter. Cost: $6.00 for 12 years to adults,

$4.00 for 5-11 year olds, 4 years and under are free.

Campers $0 - cost is included with their registration.

7:00 p.m. – 8:30 p.m.:

Campfire at Pinecone Amphitheater. Awards, Songs and S’mores!!!

All campers need to be picked up by 8:30 p.m. Friday, August 7.

Questions? Contact your County Youth Coordinator or

Annette Brown, 4-H Youth Development Specialist

(515) 432-3882 or

Registration deadline is July 17, 2015 (or until filled).

Complete both sides of this registration form and forms listed below.

Forms are available at your county extension office and at

  • Camper Health History Form (include copy of front & back of insurance card)
  • Camper Release Form
  • Iowa 4-H Camp Participant Information Form
  • Parent Confidential Form
  • Medications Form

Send registration, forms, andfee payment to:

ISU Extension and Outreach, Boone County

603 Story Street, Boone, IA 50036

4-H’ers Name:

Parent/Guardian Names:

Address:

City: Zip:

Home Phone: ( ) Parent Cell:( )

E-Mail:

County (circle one):Boone Hardin Marshall Story

Grade just completed (circle one):4th5th6th

T-shirt size (adult sizes) S M L XL

Male: Female:

I give my child permission to participate in the Race to Which Camp!conducted by ISU Extension and Outreach.

I give camp staff permission to include my child in photographs for

ISU Extension and Outreach media use.

Parent/Guardian Name (printed)

Parent/Guardian Signature

(Complete other side for fees)