VA 4-H Military Teen Adventure Camp Registration

Camper Information
Camper’s Name*

First NameLast Name
Birth Date*

MonthDayYear
FemaleMale
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
SmallMediumLargeXL2XL3XL
Does the camper have any allergies (including dietary needs), chronic illness, or medical conditions? If yes, please describe.*
List any information we as staff should be aware of to help your camper thrive at camp. *
Parent/Guardian Information
Name*

First NameLast Name
Home Number*
Format: (000) 000-0000.
Cell Number*
Format: (000) 000-0000.
E-mail*
example@example.com
Branch of Military*
Status*
Transportation
How will you be getting to camp?*
Will you be needing travel stipend?*
Read over and complete the following forms
Code of Conduct

The Virginia 4-H Code of Coduct reviews expectations of the program. It should be reviewed and signed by both the parent/guardian and the camp participant. Printable version available on our website.

Virginia 4-H Standardize Code of Conduct for Programs/Events
Health History

Please provide detailed health information for determining appropriate supervision, support, and accomodations for camp.

Virginia 4-H Health History Form

My Products*

Teen Registration

Non-refundable Registration Fee

$40.00

Total

$0.00

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Camper Information