2023 ExploreAg Registration Form
Fill out the form carefully for registration for the 2023 ExploreAg Camp Programs. Please note it will take 15 minutes to complete the application. The application will require you to name one professional reference with their contact information. The following essay question is required: Please outline one agricultural career you are interested in learning more about and why? (1,000 characters max). Please list not applicable if appropriate. APPLICATIONS ARE DUE APRIL 10.
Student Name
*
First Name
Middle Name
Last Name
Birth Date
*
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Gender
*
Please Select
Male
Female
N/A
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Student E-mail
*
example@example.com
Mobile Number
*
Choose one or more races that you consider yourself to be:
*
Black or African American
American Indian or Alaska Native
Asian
Spanish, Hispanic, Latino
Native Hawaiian or Pacific Islander
White
Other
Prefer not to answer
ExploreAg Experience
*
This will be my FIRST ExploreAg Experience
I attended ExploreAg Camps in the past (if you attended ExploreAg in the past, you must 1. attend a different camp session and 2. recruit a friend to attend with you)
What is the highest grade or level of school that you have completed?
*
Middle School (Grades 6-8)
Freshman (Grade 9)
Sophomore (Grade 10)
Junior (Grade 11)
Senior (Grade 12)
Name of Parents/Guardians
*
Address of Parent/Guardian
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email of Parent/Guardian
*
example@example.com
Phone Number of Parent/Guardian
*
Please enter a valid phone number.
Shirt Size
*
XS
Small
Medium
Large
X-Large
XX-Large
Dietary restriction
*
Yes, I have a dietary restriction (please list more detail below)
No, I do not have a dietary restriction
Please List Dietary Restrictions, Food Allergies, Medical Conditions and Allergies
*
Transportation
*
Transportation to or from camp will not be an issue
Transportation to or from camp will be an issue
Transportation will limit my ability to attend camp
My first ExploreAg Camp Session preference is ...
*
Mini Camp: June 4 - 7 Wilmington College
Day Camp FIRST Session: June 9- COLT Electric Lineman 9-12 pm: Mt. Gilead, OH
Weeklong Camp: June 11 - 16 Ohio State Columbus Campus
Weeklong Camp: June 18 - 23 Ohio State ATI Wooster Campus
Day Camp: June 30 - Rio Grande College, Rio Grande, OH
Day Camp: July 7 - John Deere Training Center, Plain City, OH
Weeklong Camp: July 9 - 14 University of Findlay
Mini Camp: July 31 - August 2 Hocking College
Day Camp SECOND Session: June 9- COLT Electric Lineman 1 - 4pm: Mt. Gilead, OH
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My second ExploreAg Camp Session preference is ...
Mini Camp: June 4 - 7 Wilmington College
Weeklong Camp: June 11 - 16 Ohio State Columbus Campus
Weeklong Camp: June 18 - 23 Ohio State ATI Wooster Campus
Day Camp: June 30 - Rio Grande College, Rio Grande, OH
Day Camp: July 7 - John Deere Training Center, Plain City, OH
Weeklong Camp: July 9 - 14 University of Findlay
Mini Camp: July 31 - August 2 Hocking College
Day Camp: June 9 - COLT Electric Lineman: Mt. Gilead, OH
Day Camp SECOND Session: June 9-COLT Electric Linemen 1-4pm, Mt. Gilead, OH
Please List all Leadership, Community, and Volunteer Activities
*
Please List School-Related Honors, Recognition and Awards
*
Name of Reference
*
First Name
Last Name
Phone Number of Reference
Please enter a valid phone number.
Email of Reference
*
example@example.com
Relationship to reference
*
Teacher
Advisor or Community Leader
Mentor
Other
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Essay Question: Please outline one agricultural career you are interested in learning more about and why?
*
0/1000
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Please leave any additional information that you would like us to know in the space provided below.
How would you describe where you live?
*
Urban
Suburban
Rural
Other
How did you hear about ExploreAg
*
Social Media
Teacher
Ohio 4-H
Ohio FFA
Ohio Farm Bureau
Other
Submit
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