4-H Winter Camp will run from 7:00 p.m. on Friday, February 27 through 11:00 a.m. on Sunday, March 1 at the Northern Virginia 4-H Education Center in Front Royal, Virginia. **Campers: All boys and girls (9 to 14 years of age as of 9/30/15) are welcome.** **Teen Leaders must have past experience as a CIT or a Teen Counselor at a 4-H camp. We do not accept new CITs at CSR 4-H Winter Camp.** There will be an Emergency Medical Technician on staff during the weekend. Any medicine brought to camp, must be in the original container with directions for dispensing. In case of bad weather, call the Shenandoah Extension Office at 540/459-6140. If the weekend is cancelled, it will NOT be rescheduled, due to unavailability of the 4-H Center, and full refunds may take 30 days. If you have any questions, feel free to contact: Cristy Mosley, 4-H Agent, at 540/727-3435 If you are a person with a disability and desire assistance or accommodation, please notify Cristy Mosley, Culpeper Extension Office at 540/727-3435 during business hours of 8:00 a.m. and 5:00 p.m. by February 10, 2015 www.ext.vt.edu Virginia Cooperative Extension programs and employment are open to all, regardless of race, color, national origin, sex, religion, age, disability, political beliefs, sexual orientation, genetic information, marital, family, or veteran status, or any other basis protected by law. An equal opportunity/affirmative action employer. Issued in furtherance of Cooperative Extension work, Virginia Polytechnic Institute and State University, Virginia State University, and the U.S. Department of Agriculture cooperating. Edwin J. Jones, Director, Virginia Cooperative Extension, Virginia Tech, Blacksburg; Jewel E. Hairston, Administrator, 1890 Extension Program, Virginia State, Petersburg Culpeper-Shenandoah Rappahannock 2015 4-H Winter Camp February 27 - March 1, 2015 4-H Center in Front Royal 2015 CULPEPER-SHENANDOAHRAPPAHANNOCK 4-H WINTER CAMP REGISTRATION Please check: TEEN Choose which activities you would prefer to attend: Please rank your workshop selections from 1—10 With 1 being your top pick. You will be assigned to 3 classes. CAMPER Name ________________________________ Culpeper County ___ Make-up, Nails & Hair __________________________________________________________ ___ Video Production Phone ______________________ ___ Cooking Class ___ Decorating for the Dance E-mail ________________________________ ___ Arts & Crafts Choice of one roommate: ______________________________________ ___ Karaoke Do you prefer to be contacted by email or phone? _________________ ___ Rocketry ___ Scrapbooking ___ Science Fun Address ___________________________________________________ Male ___ Female ___ Date of Birth _____________________ Age _________ Parent/Guardian Name _______________________________________ Are you already enrolled in 4-H for 2014-15? _______ If so, name of club?_________________________________________ If not, you’ll be required to complete enrollment, health history, media release, and code-of conduct forms. Have you been to 4-H Camp before? _____________ If so, when? __________________________________________ REGISTRATION COST: CAMPER: $100 TEEN: $80 Return this form with the payment to: VCE-Culpeper County 101 S. West Street Culpeper, Virginia 22701 Make checks payable to: Treasurer, Virginia Tech– Culpeper Please note there is a returned check fee of $50. Registration Deadline is February 10, 2015 There are a limited number of spaces available, so register early. Workshops will be assigned on a first-come, first-served basis.