Boyle-Lincoln-Powell
4-H Summer Camp
Blast from
the Past!
4-H Camp
July 6-10, 2015
Cost: $225
J.M. Feltner 4-H Camp
London, Kentucky
Includes all lodging, meals,
t-shirt, activities,
and ALL class fees
Open to all youth
ages 9-14
Deadline:
June 22, 2015
but space is limited
and first come/first served!
When & Where: Monday, July 6 – Friday, July 10 at J.M. Feltner 4-H Camp in London, KY. Campers check-in at
Powell County Extension Office before 8:00 a.m. on Monday. We will return Friday afternoon at same location.
Picture ID of adult listed on Pick Up/Release Form required to pick up camper and the pick up person must come
into the Extension Office to sign their camper out before leaving.
Who Can Go: Campers do not have to be currently enrolled in 4-H to attend! Camp for youth ages 9-14 (must
turn 9 before July 6, 2015). Youth ages 15-17 can apply to serve as Junior Counselors (JCs). All 14-year-old
campers will participate in the Outpost Leadership Experience; see enclosed details.
Adult Counselors: Any parent or adult wishing to attend camp should contact the Extension Office for a registration packet immediately. All adults must undergo a background check, reference check, interview, and be
approved by the CP/RM Committee before attending 4-H Camp. There is no charge for adults selected to
attend. Please contact us at 606-663-6405 for more information.
How to Sign Up: All camp forms and $25 deposit are due no later than June 22nd to hold your campers spot.
SPACE IS LIMITED! Please make checks payable to Powell County 4-H Council. ONLY Complete registration
and deposit will hold a spot until June 22nd. If all available beds are full and your application is incomplete, it
will move to the waiting list.
Lodging & Meals: Camp registration is $225 and includes all meals, lodging, transportation, use of equipment at
camp, a camp tee-shirt and ALL class fees. All campers will stay in cabins with 10-20 other youth and at least
one adult and one teen leader (except 14 year olds; see enclosed details).
Scholarships: Scholarships are available upon request. Please complete and return the enclosed form to apply.
All scholarship requests should be received by May 29th at which time scholarships will be awarded and campers will be notified of the amount received. Any remainder fees will then be due by June 22nd.
Health Forms: NEW FOR 2015 We require you provide all health information, including vaccinations and
health exam. Every PERSON attending camp must document or get an up to date tetanus shot. Any physical
exam performed in the last two years may be attached in place of the health exam. Free opportunities for
health exams and tetanus shot will be available at camper orientation.
Medical Insurance Card: Each camper must submit a copy of the Medical Insurance Card that covers him/her. If
the camper has no medical insurance coverage, an agreement to pay for care must be signed by the parent/
guardian. Please contact the Extension Office to obtain a copy.
Head Lice Checks: Camp has a NO NIT policy so we will be conducted head checks at camper orientation. Please
check your campers heads before orientation. Thank you for your cooperation.
Important Info!
What to Bring: You will need shorts, t-shirts, jacket, plenty of socks, and at least two pairs of
shoes (all with closed toes and a back or strap) including at least one pair of tennis shoes; shower shoes; bedding (twin sheet and blanket or sleeping bag) plus pillow; toiletries; washcloths
and towels; swimsuit and beach towel. A complete list will be provided at Camper Orientation.
Campers should bring loose change for Mason Steigerwald Scholarship Fund to win a chance
to pie a AC/JC/Camp Staffer!
Camper Orientation: All campers and at least one parent/guardian MUST attend Camper Orientation on June 30 at 6 p.m. at the Extension Office. Campers will receive class schedules and
cabin assignments at this meeting. Orientation is mandatory for attendance at camp. No exceptions.
Powell County 4-H Camp Refund Schedule
June 22 Completed camp applications due & $225.00 Paid
June 22 First cancellation deadline: If 4-Her notifies Powell Co. 4-H in writing received
by the end of business on June 22 he/she does not want to go to camp, camper will be refunded $200. 4-H Council retains $25.00.
June 29 Second cancellation deadline: If 4-Her notifies Powell Co. 4-H in writing received by the end of business on June 29 he/she does not want to go to camp,
camper will be refunded $125.00. 4-H Council retains $100.00
July 6
Final cancellation deadline/depart for camp: If 4-Her notifies Powell Co. 4-H
in writing received after end of business June 29 and before camper boards
bus on July 6, camper will be refunded $100.00. 4-H Council retains $125.00.
Once 4-H campers have boarded the bus, no portion of fees will be returned.
Please Don’t Forget!
Every camper and parent/guardian must attend mandatory camp orientation on
June 30 at 6 p.m. at the Powell County Extension Office. No exceptions.
Camp Checklist
Please make sure you’ve completed all items below before submitting this
application by June 22, 2014.
Return to Powell Co. Extension, 169 Maple Street, Stanton, KY 40380.
Only complete applications & $25.00 deposit will hold a camper’s spot for
camp. We do expect to be completely full with a waiting list this year.
Does this application include:
_____ A complete Registration/Health Form (3 pages) We do require all health information, include
ing vaccinations and health exam. Any physical exam within the last 2 years may be attached
in place of health exam. ***Exam & tetanus will be available at camper orientation if needed!!
_____ A copy of camper’s medical insurance card?
_____ A completed Pick-Up/Release Form listing all adults with permission to pick up your child on J
uly 10 or from camp?
_____ Completed Camp Class Choices form showing preferences and t-shirt size?
_____ A completed JM Feltner 4-H Camp Activity Release Form?
_____ Payment in full of $225 OR $25.00 deposit to hold spot (checks made payable to Powell
County 4-H Council)
_____ Payment of $25 along with Camp Scholarship Application
4-H Camp Scholarship Application
A limited number of scholarships are available on a limited basis. Scholarships are based on financial need, special circumstances and availability.
Please complete and return the enclosed form to apply. All scholarship applications must be received no later than May 29, 2015! Scholarship winners
will be notified as soon as possible after this date and all remaining camp
fees must be paid by June 22, 2015. A $25.00 deposit is still required to hold
your spot.
Camper Name:
School Attended in 2014-2015:
Grade last completed:
Number of children in family attending 4-H Camp:
Years attended 4-H Camp:
Did you qualify for free/reduced lunch during the 2014-15 school year?
Why do you want to attend 4-H Summer Camp? Must be completed by camper. Attach separate page if needed.
What other 4-H Clubs or Activities have you participated in during 2014-15?
Camper Signature: _______________________
Parent Signature: _______________________________
Ask a Teacher, Guidance Counselor, Family Resource Center Director, or adult from your
church or community organization to complete the following (no relatives):
Why do you believe this young person should receive a 4-H Camp Scholarship?
Signature and Title: ____________________________________________________________________________
Relation to Camper: ________________________________
Contact Address/Number: _____________________
Name:
School Attended in ‘14-’15:
If possible, I would like to be in a cabin with (same gender only):
1. _________________________
2._______________________
Please note: All efforts are made to place campers in cabins with those they request, but only a small number of
cabins are available. All reasonable efforts will be made to accommodate your requests. Also, please note that
we have a strict “no bullying” policy. Parents please notify agents if there are existing issues.
Rockin’ Classes!
Please rank your top 7 choices (total) for your camp classes, with “1” being first and “7” being your last choice.
Classes fill on a first come-first serve basis, so turn in your application early! Note: Only mark “Swimming” if you
want lessons. Everyone will receive “Free Swim.” 14-year-olds do not need to sign up for classes. If you would
like to try to coordinate classes with a friend or two, please list:
1.___________________________ 2.___________________________
___
Advanced Swimming
___ Fishing
___
Archery
___ Nature
___
Arts and Crafts
___ Newscast/Photography
___
Basketball
___ Riflery
___
Beginning Swimming
___ Robots
___
Canoeing
___ Rockets
___
Cooking
___ Ropes
___
Dance/Recreation
___ Soccer
___
Fencing
___ Tie-Dye
___
Fishing
___ Volleyball
___
Field Games
___ Weird Science
Select Tee-Shirt Size:
Youth S
Adult M
Youth M
Adult L
Youth L
Adult XL
Youth XL
Adult 2X
Adult S
Adult 3X
Outpost for
14 year olds!
Outpost is open to all campers 14+
years of age and/or those who have
completed the 8th grade or higher.
All 14 year olds must stay at Outpost.
This training program builds strong
leaders and offers campers a different
4-H camping experience. Participants
will take Counselor-in-Training classes
and assist with the instruction of
other classes.
14 year olds DO NOT need to sign up
for classes.
7/10/15
TBA
Powell Co. Extension Office
Powell County Camp
POWELL
6/22/15
POWELL
169 Maple Street, Stanton, KY 40380
July 6-10, 2015