Brookings County 4-H Camp & Conference Fee Assistance Form

BROOKINGS COUNTY 4-H

CAMP & CONFERENCE FEE ASSISTANCE FORM
CAMP & CONFERENCE FEE ASSISTANCE REQUEST
- Any 4-H member may apply for camp fee assistance from the Brookings County Leader's Association.
- The general policy is the Leader's Association will pay up to half the registration fee of the camp; subject to available funding.
- Any questions on eligibility to receive funds from the Leader's Association will be decided by the Leader's Association Executive Board.
- Please complete the expectations and submit or return the form to the Brookings County Extension Office by December 31.
If Mailing:
Brookings County Extension Office
Attn: 4-H Leader's Association Treasurer
2810 22nd Ave. South, Suite 2
Brookings SD 57006
4-H Member's Full Name *
Parent/Guardian's Name *
Contact Email Address *
example@example.com
Address *
City *
State *
Zip *
Please Select your 4-H Club/s *
Years in 4-H *
Which camp/event did you attend? *

4-H Camp Performing Arts Camp Teen Leadership Conference SDSU Livestock Judging Camp SDSU Dairy Judging Camp Other
Total camp/event registration fee: *
Number of years attending this camp/event: *
Why did you want to attend this camp/event and what did you learn from attending? *
The requirements for the next section may not be able to be completed or signed at the time of filling out this form. You can choose to save this form and continue it later, or download and print the form to collect the required signatures. The form is not complete until all the signatures have been collected.
FEE ASSISTANCE EXPECTATIONS:
1. Present to a group (i.e., your 4-H club) and share your camp/event experience.
2. Provide two hours of community service to the 4-H program (Pork Booth, 4-H BBQ, Achievement Day set-up/clean-up, etc.
Name of Group
Group Leader Signature

Clear
Community Service
Service Leader Signature

Clear
I completed the expectations by 'sharing my experience' with the group identified above as well as 'giving back' to 4-H no later than December 31 of the current year.
4-H Member Signature

Clear
Date

Month Day Year
Date
Parent Signature

Clear
Date

Month Day Year
Date
All signatures are required to be eligible.
Form must be received or postmarked by December 31.
Office Use Only: Date Check Issued
Office Use Only: Check Number
Office Use Only: Check Amount
Should be Empty:

BROOKINGS COUNTY 4-H

CAMP & CONFERENCE FEE ASSISTANCE REQUEST