Special Information for Parents Camp Registration Form Camper’s Name _______________________ 2015 SE District Teen Camp Address _____________________________ City _______________ State ____________ 1. Arrival Time: 7:00 p.m. on Sunday, August 23 Departure Time: 9:30 a.m. on Tuesday, August 25 2. A formal camper code of conduct form, a media release form, and health history form will be sent to parents for completion upon the receipt of this registration form accompanied by the fee. ZIP ______ Birth Date _________ Age ____ Gender: M__ F__ Phone _______________ Email________________________________ Parent/Guardian _____________________________________ Please circle the payment amount you are making. Refer to information in the Camp Fee section: $75 / $90 / $105 / Teen Counselor Checks or money orders should be made payable to: “Jamestown 4-H Educational Center.” A registration form must be completed for each child and received by the registration deadline along with payment. The camp fee is non-refundable after August 15, 2015. Return with payment to: 3751 4-H Club Road Williamsburg, VA 23185 (757) 253-4931 Fax (757) 253-7231 [email protected] If you are a person with a disability and desire any assistive devices, services, or other accommodations to participate in this activity, please contact the Ruben Brown, Jamestown 4-H Center, at 757-2534931/TDD* during the business hours of 8:30 a.m. and 5:00 p.m. to discuss accommodations 5 days prior to the event. *TDD number is (800) 8281120. Jamestown 4-H Center Attn: SE District Teen Camp 3751 4-H Club Road Williamsburg, VA 23185 There will be a charge of $25 for all returned checks due to insufficient funds. The fee plus the original amount of the check will be payable by money order or cashier’s check only. No exceptions will be made. August 23-25, 2015 www.jamestown4hcenter.org Virginia Cooperative Extension programs and employment are open to all, regardless of age, color, disability, gender, gender identity, gender expression, national origin, political affiliation, race, religion, sexual orientation, genetic information, veteran status, or any other basis protected by law. An equal opportunity/affirmative action employer. What will I get to do? Teen Camp C Aftter working hard all summer and be eing role models to t all of the ca ampers that come e to camp, this is the e time for you to be b campers yo ourselves!! Yo ou will be able to choose your cla asses to take: Arc chery, Riflery, Ca anoeing, Kayaking, and many mo ore! Po ool time is always s a plus in the hott sun! You will also be b doing a service e pro oject as well to giive back. It h has been a long time t since all of the e teens of the dis strict have gotten tog gether and had a ton of fun and wa as able to turn ba ack the clock for wh hen you were cam mpers! Didn’t hav ve tha at opportunity, the en you will get to exxperience it! Sign up today and be ab big kid! Schedule S Sunday 7pm – Registra ation 8pm – Introducctions 8:30pm – Get Acquainted A Game es 9pm – Free Tim me 12am – Lights Out Monday 8am – Flag Ra aising 8:15am - Break kfast 9am – Class 1 10am – Class 2 11am – Class 3 11:50am – Line e up for Lunch 12pm – Lunch 1pm – Free Tim me 2pm – Pool Tim me 4pm – Service Project 5:15pm – Flag Lowering 5:30pm – Dinner 6:30pm – Spec cial Program 7:45pm – Snac ck 8:30pm – Cam mpfire 9:30pm – Free e Time 12am – Lights out Tuesday 8am – Flag Ra aising 8:15am – Brea akfast 8:45am – Evaluations/Picture/P Pack-up 9:30am – Closing Slideshow How much does this camp cost? Realizing that ffamilies have differing g abilities to pay, we are offe ering a voluntary 3-tie er pricing program at the 4-H Center. Please take a ons below moment to lookk at the rate descriptio and determine which of the prices yo our family is o pay for your child’s camp able & willing to experience. The first price (($75) is our historicallyy subsidized rate ($90) is a p partially subsidized ra ate ($105) represents the true cost of camp. ose the price), This program iss voluntary (you choo and in no way influences the quality of experience eacch child receives. ncial assistance may b be available Additional finan to ensure all ch hildren have this wond derful opportunity to a attend camp. Registration Inform mation How old is my y camper? Youth 14-19 ye ears of age may attend. Youth must reach their fourteenth birthday by September 30, 2015. olunteering? What about vo Counselor and leadership opportunitties are dult volunteers. Adultss are free. available for Ad camp? Where is the c Jamestown 4-H H Center is located on n the beautiful James River, ju ust one mile from Jam mestown Island and the C Colonial Parkway, and five miles from Colonial W Williamsburg. It is an e easy drive from anywhere in Hampton Roads o or Richmond.
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