2008 4 – H Camp Application

To register: Mail application and fees directly to Camp White Eagle.

Note: Children need not be members of 4-H to attend 4-H camp.

Camper Information:

Camper's Name___________________________Grade (Fall of 2008)____Age___Birthdate____/____/_____

Address_________________________________________________________________________________

City________________________________State_____________Zip____________County _______________

Home Phone & Area Code___________________Home Fax_______________Home E-mail______________

If currently enrolled in 4-H, what county and club? ________________________________________________

Is the camper living with both parents? ___Yes ___No If no, send invoice to: ___mother ___father

If not with both parents, parents are ____ divorced or separated ____ mother deceased ____father deceased

Parent Information:

Mother's Name____________________________ Father's Name___________________________________

Address (if different than above)_______________ Address (if different than above) ____________________

________________________________________ ______________________________________________

________________________________________ ______________________________________________

Business Phone: __________________________ Business Phone: _________________________________

Resident Camp Sessions: Check choices

________ 4-H Resident Camp – SOL (Ages 8 to 15) ........................................ June 9 - 13, 2008

(Co-sponsored with Stephenson, Lee, and Ogle Counties)

________ 4-H Resident Camp – Whiteside (Ages 8 to 15) .................................. June 15 - 20, 2008

(Co-sponsored with Whiteside County)

If you would like to bunk with another camper please put his/her name here. __________________________ This is not a guarantee that you will be bunking in the same cabin, thought. Cabin assignments are based on ages and grades.

_______ If you would like to take part in the CIT Training (Counselor in Training), mark here. You must be 15 by June 8, 2009 in order to participate as a CIT in 2008.

Camp Fees:

SOL (4-day session) Whiteside (5-day session)

Register before January 31 $200 $225

Register Feb 1 thru April 15 $210 $240

Register April 16 and later $220 $250

Please make all checks payable to University of Illinois Extension.

Mail application and fees to the office listed below for the week you would like to attend:

SOuL Camp Week Whiteside Camp Week

Ogle County Extension Whiteside Co. Extension

421 W. Pines Rd., Suite 10 100 E. Knox Street

Oregon, IL 61061 Morrison, IL 61270

A minimum $75 deposit must accompany the application form.

A second payment of $75 minimum is due before February 28, 2008.

Any balance due must be paid by April 16, 2008 to receive any discount.

Full payment is due at least 30 days prior to the camp session.

Please make checks payable to Camp White Eagle.

Scholarships: Check all applied for.

______ The Brother/Sister Scholarship

The first child from a family registers at full fee and each subsequent sibling may register at an additional 10% off. (For example, 1^st child pays 100%, 2^nd pays 90%, 3^rd pays 80%, etc.)

Note: Applications must be submitted together; scholarship is available only through April 15.

________ 4-H Scholarship

Note: Contact local extension office for eligibility requirements.

Camp T – Shirt and Design Contest

Each camper will receive a FREE camp T-shirt!!

Size: ____ XSM ____ SM ____ MED ____ LG ____ XLG ____ XXLG

(Note: All shirts are adult sizes)

Cancellations & Refunds

Upon receipt of a written request for cancellation, a refund will be made as below:

· Cancellations 60 days or more prior to the beginning of the camp session – Full refund

· Cancellations more than 30 but less than 60 days prior – 50% of tuition refunded

· Unless there is a written doctor's order stating that the child is unfit for camp, cancellations 30 days or less prior to the beginning of the camp session will result in the loss of all tuition paid.

Authorization Statement

We agree to hold free Camp White Eagle and associated persons, and waive claim for payment for accident, injury, disability or damages to the person or property of the aforementioned camper arising out of or connected with his/her participation in any of the activities of the program.

_____________________________________________________ ________________

Signature of Parent/Guardian Date