2024 Riverside 4-H Summer Camp Registration Form

Riverside County 4-H Summer Camp

June 24-June 29, 2024

Mount Kare, Wrightwood, CA

Camp is open to all youth ages 7-12 (based on age on 12/31/23)*.

Early Bird (Ends May 13, 2024):

First Camper-$300

Siblings-$250

Out of County-$425

Regular Registration (May 14th through June 10th):

First Camper: $350

Siblings: $300

Out of County: $450

Questions: Email dcbean123@gmail.com

Please follow our Facebook page Riverside County 4-H Summer Camp For updates on camp.

If you are interested in being a chaperone, please email dcbean123@gmail.com with your questions or to complete a sign up survey.

* 7 yr olds may attend with a sibling or parent chaperone

**Non-4-H members are those not currently enrolled and part of a club. They must complete additional registration and pay 4-H enrollment fee in addition to camp fees.

✻ = Required

Parent Information

Name of Parent/Guardian ✻

Parent/Guardian E-mail ✻

Parent/Guardian Phone Number ✻

First Camper Information

Camper Name ✻

Preferred Name

Birthdate (MM/DD/YY) ✻

Name of Primary 4-H Club: ✻

Age (on December 31, 2023) ✻

Gender ✻

Female Male Nonbinary Gender Identity Not Listed Prefer Not to Respond

T-Shirt Size ✻

Youth S Youth M Youth L Youth XL Adult S Adult M Adult L Adult XL

Please indicate any allergies, dietary restrictions or special needs. (including vegetarian)

Additional Camper Information

Camper Name

Preferred Name

Birthdate (MM/DD/YY)

Age (on December 31, 2023)

Gender

Female Male Nonbinary Gender Identity Not Listed Prefer Not to Respond

T-Shirt Size

Youth S Youth M Youth L Youth XL Adult S Adult M Adult L Adult XL

lPlease indicate any allergies, dietary restrictions or special needs.

Additional Camper Information

Camper Name

Preferred Name

Birthdate (MM/DD/YY)

Age (on December 31, 2023)

Gender

Female Male Nonbinary Gender Identity Not Listed Prefer Not to Respond

Youth E-mail

T-Shirt Size

Youth S Youth M Youth L Youth XL Adult S Adult M Adult L Adult XL

Please indicate any allergies, dietary restrictions or special needs.

Additional Camper Information

Camper Name

Preferred Name

Birthdate (MM/DD/YY)

Age (on December 31, 2023)

Gender

Female Male Nonbinary Gender Identity Not Listed Prefer Not to Respond

T-Shirt Size

Youth S Youth M Youth L Youth XL Adult S Adult M Adult L Adult XL

Please indicate any allergies, dietary restrictions or special needs.

I have read, understand, and agree to follow the Parent, Adult, Guardian Code of Conduct and Member Code of Conduct. I agree to prepare my child/children by familiarizing them with the Member Code of Conduct. I will make sure I have my child to camp on time and pick up my child from camp on time. I agree that if my child is not allowed to continue participating in camp due to not abiding by the Code of Conduct, I will not receive a refund of the camp fee. ✻

Yes No

Payment: Choose from the options below to pay by credit card. When you click "Submit Registration", you will be taken to the payment screen. Make sure you click through until you receive a payment confirmation. If you would like to pay by check, make your check payable to Riverside County 4-H and mail. If you would like to use funds from your golf tournament account, please email Leslie Rendon at lrendon@ucanr.edu.

How will you be paying? ✻

Pay the registration for the first camper ($300)

$300.00

Pay the registration for additional camper/s from the same family ($250)

$250.00 Quantity:

Pay for registration for Counselors ($250)

$250.00 Quantity:

Pay for registration for out of county Counselors ($375)

$375.00 Quantity:

Pay for registration for Out of County/non 4-H members ($425)

$425.00 Quantity: