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4-H Summer Camp in Mariposa, Youth Camper and Youth Staff Registration 2024

2024 4-H Summer Camp

Campers will stay in cabins; restrooms and showers are provided;

meals, snacks, activities, and t-shirts are all provided.

Registration Deadline is May 15, 2024

Camp registrations received after camp is full (100 youth)

will be notified and added to the waitlist.

Unpaid registrations are considered to be incomplete.

Be sure to register & submit your payment early.

Financial Assistance:

Contra Costa: Complete the Camp Fee Assistance Form

Alameda, Mariposa and San Joaquin - Contact your local 4-H office

To be considered complete, a camper's 4-H enrollment

MUST be "Active" in the ZSuite enrollment system

and payment made for camp registration.

Incomplete enrollment status registrations will be returned

to you by email as "incomplete."

If you need help in completing 4-H enrollment, please contact your club's Volunteer Enrollment Coordinator

or visit the "How to Join" page on your county's 4-H website.

4-H Camp will be held at Sweetwater Youth Camp in Mariposa, CA

County	Drop-Off / Pick-Up Location	Drop-Off	Pick-Up
Alameda, Contra Costa, San Joaquin	TBD via Chartered Bus	Monday, June 17, 8 am	Saturday, June 22, 3 pm
Mariposa	Sweetwater Youth Camp	Monday, June 17, 11 am	Saturday, June 22, 11 am

*Camp Staff will be on-site Sunday, June 16 (9 am) - June 22 (12 pm bus pick up)

✻ = Required

Camper's Last Name: ✻

Camper's First Name: ✻

Preferred Name:

Best email address for all notices: ✻

What County 4-H Program is the camper enrolled in? ✻

What 4-H Club (and County if not listed above) is the camper involved in: ✻

Shirt Size: (One T-shirt is included with camp registration)

Shirts are not guaranteed for waitlist registrations received after May 15.

A = Adult Size

Y = Youth Size ✻

YM YL AS AM AL AXL A2XL A3XL

Cabin and sleeping areas are assigned according to gender.

Please indicate the gender of the camper in the list below. ✻

Male Female Nonbinary Gender not listed Prefer not to state

FOR COMPLETION BY PARENT or GUARDIAN:

Parent's Name: ✻

ARCHERY SPORTS PERMISSION -- I do hereby give permission to the Contra Costa County 4-H Youth Development Program, and to all officers, instructors, and assistants participating in the archery activity at the Contra Costa County 4-H camp, to furnish a bow, arrow, targets, instructional literature, instruction in archery safety and marksmanship, and other equipment and materials pertinent to the instruction in archery safety and marksmanship, with the understanding that:

(a) The above named minor will receive attentive instruction and supervision by a qualified person or persons during the course of the Archery activity;

(c) The bow and arrow which is furnished to the above named minor shall be in good working order;

(d) All archery Activities shall be conducted on an archery range that is suitable for the safe conduct of archery. ✻

Yes No

Parent's Phone#:

Please enter in the format of 000-000-0000 ✻

Parent's Email Address: ✻

Parent: Are you an enrolled 4-H adult volunteer who is available/interested in chaperoning?

Remember, you must already be an enrolled adult volunteer to attend the overnight camp. Please email your county 4-H office. ✻

Yes No

Our goal is to be proactive and to ensure every camper feels welcome, included and safe. Please answer the following questions to the best of your ability

How many times has this camper been to 4-H Camp? (the overnight Camp, not Day Camp)
Please select. ✻

First time Once before Two or more times before

Is there anything about your child that you would like us to know?

(e.g. considerations, support requests, preferred pronouns, lodging requirements) ✻

What concerns, if any, does your child have about going to camp? ✻

Do you have any suggestions on how to handle your child’s concerns? ✻

Does your child have any physical, emotional, or mental healh conditions that the camp nurse should be made aware of? ✻

For the camp kitchen: Does the registering camper have any dietary needs or allergies? ✻

Is there anything else you would like us to know?

It is important that we have reliable emergency contact information during camp.

In the event of any illness, event, or medical need, we will first attempt to reach the parent/guardian.

The emergency contact number you provide below will be the secondary contact for any notifications.

Name of secondary emergency contact (NOT parent listed above) ✻

Secondary emergency contact phone number:

Please enter in the format of 000-000-0000 ✻

Medical Treatment Authorization Forms -

It is not required that you provide a paper Medical Treatment Authorization Form.

PLEASE DO check that the camper's ZSuite enrollment profile is up to date and current with any changes in the camper's medical information.

These online forms will be printed and provided as a resource to the health officer for 4-H Summer Camp. Upon check-in at camp, you will be asked to verify and confirm the information on the printed medical form.

The fee for camp includes all lodging, meals, activities and a camp t-shirt.

One 4-H Camper/Youth Staff = $425.00

NOTE: If you are having trouble with credit card processing, please view this Credit Card Processing Help Guide. ✻

$425.00 required charge

Financial Assistance:

Contra Costa: Complete the Camp Fee Assistance Form

Amount Available: Up to 50% of Registration Fee ($425/staffer/camper); Reimbursement: After member returns from camp and by July 15, 2024:Request Due: May 15, 2024 at 11:59PM

Alameda, Mariposa and San Joaquin - Contact your local 4-H office

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