4-H Camp Pre-Registration

Butler County 4-H Camp

Please fill out the following form to pre-register for 4-H Camp. Once this form has been completed and processed, a 4-H Camp registration packet will be mailed to you. All registration forms in the packet must be completed and turned into the Butler County Extension Office to be fully registered for 4-H Camp. Camp Fee: $189.00 ($174.00 camp fee + $15.00 bus transportation fee). A late fee of $10.00 will be applied to all applications/payments submitted after June 13th. ***ALL TEEN LEADERS MUST SUBMIT APPLICATIONS/PAYMENTS IN PERSON.
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Camper's Full Name

First NameMiddle NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Camper's Age
Grade as of May 1st
Camper's Birth Date

MonthDayYear
Gender
Ethnicity
Race
School Currently Attending
If Other, please list
Accomodations Needed: (Handicap or other special needs)
If Yes, please specify
Parent or Guardian's Name

First NameLast Name
Home Phone

Area CodePhone Number
Work Phone

Area CodePhone Number
Cell Phone

Area CodePhone Number
Email
4-H Camp Fee
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4-H Camp Fee (By June 13th)$189.00

4-H Camp Fee (After June 13th)$199.00

Total $0.00
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Thank you for your interest in 4-H Camp! We're super excited to see you there!

Educational programs of the Kentucky Cooperative Extension Service serve all people regardless of race, color, age, sex, religion, disability, or national origin. University of Kentucky, Kentucky State University, U.S. Department of Agriculture, and Kentucky Counties, Cooperating. Disabilities accommodated with prior notification.
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Butler County 4-H Camp

4-H Camp Fee*

Thank you for your interest in 4-H Camp! We're super excited to see you there!

4-H Camp Fee