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2025 Placer County 4-H Summer Camp Youth Registration

2025 Placer County 4-H
Overnight Summer Camp
at Donner Mine Camp

July 7, 2025 - July 11, 2025

Early Bird Camp Registration:
Thru April 30: $340
Regular Camp Registration:
May 1st - June 2nd: $375

Please note: a $13.00 credit card fee will be applied to each transaction. Checks also accepted.

Credit card payment must be received at time of registration or the registration is not complete. Check must be received within 7 days of completion of this camp registration form or youth will be placed on waitlist.

PLEASE NOTE: All youth attending 4-H Summer Camp MUST BE ENROLLED in the 4-H program. If a camper is not currently enrolled in 4-H, there will be an additional program enrollment fee of $67 and enrollment will need to be completed. We will email enrollment information after completion of this camp registration form.

WHO CAN ATTEND
Any 4-H member who is 9 years old by July 7, 2025 and up to but not yet 19 years old by July 11, 2025.

CAMP IS FILLED ON A FIRST-COME, FIRST-SERVED BASIS.

Due to the popularity of this camp, camp registration fills quickly. Once the camp maximum has been reached, a wait list may be formed.

Registration is available online only. Payment with credit card is online only. Payment with check is in-person only.

There are many fun activities provided at 4-H camp for youth to participate in and include arts and crafts, sports, indoor & outdoor activities, fun sessions, and nightly campfires! Campers are divided into groups for daytime activities and paired with teen camp counselors as leaders, as well as adult chaperones. Meals are prepared by experienced cooks and there is a licensed nurse on staff at all times.

REFUND POLICY: No refunds will be given.

REGISTRATION CLOSES MONDAY, JUNE 2nd, 2025 AT 5:00 PM, or when full.

✻ = Required

All Campers MUST BE ENROLLED in 4-H for the program year 2024-2025 to attend camp.

If your child is not currently enrolled in 4-H, please enroll online with your own county. Your child's camp registration will not be accepted until all steps for enrollment have been completed. For Placer county, please click on the link below: PLACER COUNTY ENROLLMENT

Submit a 4-H Enrollment in ZSuite (if not already a member)
Select Unit: Placer County 4-H Camp, Role: Member
Select Project: 4-H Camping (Overnight), Role: Member
Pay $67 enrollment fee here

Please select county of residence (4-H County) ✻

Placer County Other

If Other, please write county name

Camper Information

Camper First Name ✻

Camper Last Name ✻

Mailing Address ✻

City, State, Zipcode ✻

Date of Birth ✻

Camper age on July 7, 2025 ✻

What is camper gender? ✻

Female Male Gender identity not listed

Is camper a current 4-H member? ✻

Yes No

If yes, what is the 4-H Club name?

Please indicate camper T-Shirt size ✻

Adult Size S Adult Size M Adult Size L Adult Size XL Adult Size XXL Adult Size XXXL

Allergies & Medication Information

Does camper have any allergies to medication? ✻

Yes No

If yes, please explain in detail

Does camper have any dietary allergies or restrictions? ✻

Yes No

If yes, please explain

Does camper have any other allergies? ✻

Yes No

If yes, please explain in detail

Does camper have severe reactions to wasp or bee stings? ✻

Yes No

If yes, does camper carry a bee sting kit?

Yes No

Please describe camper's reaction when stung:

Does camper take medication? ✻

Yes No

If yes, please explain

Parent/Guardian Information

Parent/Guardian #1 First Name ✻

Parent/Guardian #1 Last Name ✻

HOME Phone Number ✻

CELL Phone Number ✻

WORK Phone Number ✻

Email ✻

Parent/Guardian #2 First Name

Parent/Guardian #2 Last Name

HOME Phone Number

CELL Phone Number

WORK Phone Number

Email

Emergency Contact Information

Please share the emergency contact information of two people; at least one of these contacts should not be a parent or guardian.

Emergency Contact #1

Emergency Contact Full Name ✻

Relationship to Camper ✻

Home Phone

Cell Phone ✻

Emergency Contact #2

Emergency Contact Full Name ✻

Relationship to Camper ✻

Home Phone

Cell Phone ✻

Additional Camp Information

PLEASE NOTE: Sleeping sections are divided into age groups. Sleeping group requests will be accommodated when possible and are not guaranteed. Day groups for activities will be mixed ages.

I request for my child to be in a sleeping group with

Please state the reason for the request

Can your child participate in ARCHERY? ✻

I do give permission for my child to participate in ARCHERY I do NOT give permission for my child to participate in ARCHERY

Are there any additional details about your camper that you would like to share?

INFORMATION REGARDING PICK-UP OF CHILD(REN)

Who has permission to pick up your child from camp?

(check all that may apply) ✻

Parent/Guardian #1 listed above Parent/Guardian #2 listed above Emergency Contact #1 listed above Emergency Contact #2 listed above Other person not already listed above (must list below)

If you will not be picking up your own child(ren), please fill out the information below so we may release your child to someone else.

If any of the pick-up information above has changed, YOU MUST contact the 4-H Office PRIOR TO PICK-UP DAY.

Your child(ren) will not be released to anyone other than the person(s) listed in this registration form.

Who will be picking up your child? First and Last Name

Phone number

Relationship to child(ren)

The University of California Division of Agriculture & Natural Resources (UCANR) is an equal opportunity provider. (Complete nondiscrimination policy statement can be found at https://ucanr.edu/sites/anrstaff/files/390107.pdf)

Inquiries regarding ANR’s nondiscrimination policies may be directed to UCANR, Affirmative Action Compliance Officer, University of California, Agriculture and Natural Resources, 2801 Second Street, Davis, CA 95618, (530) 750-1343.

PAYMENT INFORMATION

Please note: there will be a $13.00 credit card fee for each transaction.

Payments by check or cash must be made to the Placer County 4-H office (11477 E Ave., Auburn, 95603) within 7 days of submitting this registration form.

Payments not received within 7 days will result in being placed on the waitlist.

REFUND POLICY: There will be no refund

Early Bird Registration cost $340.00
(Thru April 30)

Regular Registration cost $375.00
(May 1 to June 2) ✻

$340.00 required charge

$13.00 Credit Card transaction fee. ✻

$13.00 required charge

Payment Type ✻

Credit Card Check