Attend Millstone 4-H Camp with Moore County 4-H

Millstone 4-H Camp 2020
Please carefully select the camp session you wish to register your child(ren) in. If the camp is "unavailable," all spaces have been filled at this time.

If you wish to be placed on the waitlist, please select the appropriate waitlist option and continue to complete the following information.
MILLSTONE 4-H CAMP - FEMALE CAMPER (AGES 8-14) JUNE 21-26, 2020
MILLSTONE 4-H CAMP - MALE CAMPER (AGES 8-14) JUNE 21-26, 2020
WAIT-LIST: FEMALE CAMPER (AGES 8-14) JUNE 21-26, 2020
WAIT-LIST: MALE CAMPER (AGES 8-14) JUNE 21-26, 2020
PARTICIPANT INFORMATION
Name*

FirstLast
Birth Date*

MonthDayYear
Gender*
Do you plan to complete a scholarship request for your child(ren) to attend camp?*
We receive private donations and grant funds to help families send their children to camp.
Do you have another child you wish to register*

PARTICIPANT INFORMATION - SECOND CHILD
Name*

FirstLast
Birth Date*

MonthDayYear
Gender*
Do you have another child you wish to register*

PARTICIPANT INFORMATION - THIRD CHILD
Name*

FirstLast
Birth Date*

MonthDayYear
Gender*
Do you have another child you wish to register*

PARTICIPANT INFORMATION - FOURTH CHILD
Name*

FirstLast
Birth Date*

MonthDayYear
Gender*

PARENT/GUARDIAN INFORMATION
Name*

FirstLast
Relationship to Participant*
Phone Number:*

Area CodePhone Number
Email Address:*
example@example.com
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
How did you find out about us?*
BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
- I understand that this camp will be held June 21-26, 2020.
- I acknowledge that my child will be between the ages of 8-14 by June, 2020.
- I understand my child's registration is not complete. I understand that upon receipt of this submission, I still need to provide the $50 non-refundable deposit within five business days in order to retain my child's camp space.
- I understand that my remaining payment and the completed paperwork (provided Spring 2020) are due by May 1, 2020 in order for my child to attend this camp.
- I understand the full cost to send a child to this camp is $270 (if deposit is paid by February 3, 2020) OR $320 (if deposit is paid after February 3, 2020).
Signature*

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