Mendocino Lake 4-H Camp Registration 2025 - Camper Application

REGISTRATION DEADLINE May 9, 2025

June 23-27, 2025 - Mendocino Woodlands Camp

Mendocino Lake 4-H Camp is open to 4-H members 9 - 13 years of age as of December 31, 2024.

Registration fee is $250 per youth. $100 down to hold your spot; registration fee is due May 9, 2025.

Payments are welcome and some scholarships are available. NO REFUNDS AFTER May 9th!

Space is limited - registrations are accepted on a first come basis.

If you have questions please contact the UCCE office at 263-6838 or Jean Goulart at jgoulart@ucanr.edu

✻ = Required

Camper Information

Camper's First Name: ✻

Camper's Last Name: ✻

Gender ✻

Male Female

4-H Club or Unit ✻

Age (as of 12/31/2024) ✻

Mailing Address (Street address or P. O. Box) ✻

City: ✻

Zip code: ✻

Cell Phone Number: ✻

Second Phone Number: ✻

Email: ✻

T-Shirt included with registration: ✻

Youth sizes small Youth size medium Youth size large Adult size small Adult size medium Adult size large Adult size X large Adult size XX large Adult size XXX large

I am a first time overnight camper. ✻

Yes No

Dietary Restrictions (Please explain).

Parent/Guardian Emergency Contact Information

Name ✻

Relationship ✻

Mailing Address ✻

City/Town ✻

Preferred Phone Number ✻

Email address ✻

Second Adult Emergency Contact Information

Name ✻

Relationship ✻

Mailing Address ✻

City/Town ✻

Preferred Phone Number ✻

Email ✻

I have read the camp code of conduct at the link below and agree to follow it.
https://ucanr.edu/sites/uclakecounty/files/404209.pdf ✻

Yes No

Participants will be considered registered once the following has been received by the Lake County UCCE Office:

**Registration is completed online or a paper packet has been submitted.
**$250 registration fee paid by May 9, 2025

NO REFUNDS WILL BE ISSUED AFTER May 9th!

Would you like to pay the $250.00 registration fee by credit card:

$250.00

Will you pay by check or cash?

Check Cash

Please make checks payable to: 4-H Summer Camp

Mail to: Mendocino-Lake 4-H Summer Camp
883 Lakeport Blvd., Lakeport CA 95453