Airfield 4-H Farm Camp Registration
November 22-24, 2024
Youth Participant's Name
*
First Name
Last Name
Participant is a:
*
Please Select
Camper (ages 9-14)
Teen Counselor (ages 14-18)
Parent/Guardian Email
*
example@example.com
Age
*
Please Select
9
10
11
12
13
14
15
16
17
18
Adult
Birth Date
*
-
Month
-
Day
Year
Month-Date-Year
Gender
*
Please Select
Male
Female
Non-Binary
Prefer not to answer
County
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent/Guardian Name
*
First Name
Last Name
For Farm Camp, campers are allowed to pick from 3 different class disciplines they are most interested in, which will result in the category of classes they will participate in at camp. Which discipline would your camper like for their class assignments?
Please Select
Gardening/Horticulture
Are you registering more than 1 youth participant?
*
Please Select
Yes
No
Youth Participant's Name
First Name
Last Name
Participant is a:
Please Select
Camper (ages 9-13)
Teen Counselor (ages 14-18)
Age
Please Select
5
6
7
8
9
10
11
12
13
14
15
16
17
18
Adult
Birth Date
-
Month
-
Day
Year
Month-Date-Year
Gender
Please Select
Male
Female
Non-Binary
Prefer not to answer
County
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent/Guardian Name
*
First Name
Last Name
For Farm Camp, campers are allowed to pick from 3 different class disciplines they are most interested in, which will result in the category of classes they will participate in at camp. Which discipline would your camper like for their class assignments?
Please Select
Gardening/Horticulture
Are you registering more than 2 youth participants?
*
Please Select
Yes
No
Youth Participant's Name
First Name
Last Name
Participant is a:
Please Select
Camper (ages 9-13)
Teen Counselor (ages 14-18)
Age
Please Select
5
6
7
8
9
10
11
12
13
14
15
16
17
18
Adult
Birth Date
-
Month
-
Day
Year
Month-Date-Year
Gender
Please Select
Male
Female
Non-Binary
Prefer not to answer
County
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent/Guardian Name
*
First Name
Last Name
For Farm Camp, campers are allowed to pick from 3 different class disciplines they are most interested in, which will result in the category of classes they will participate in at camp. Which discipline would your camper like for their class assignments?
Please Select
Gardening/Horticulture
Are you registering any other adults?
*
Please Select
Yes
No
Adult's Name
First Name
Last Name
Participant is a:
Please Select
Trained Adult Volunteer
Extension Agent Staff
Email
example@example.com
Gender
Please Select
Male
Female
Non-Binary
Prefer not to answer
County
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Roommate Request (we will do our best to accommodate roommate preferences based on numbers and lodging)
Camping Registration Fees
*
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next
( X )
Camper
$
130.00
Quantity
1
2
3
4
5
6
7
8
9
10
Trained Adult Volunteer or Trained Teen Counselor
$
25.00
Quantity
1
2
3
4
5
6
7
8
9
10
Extension Agent
$
Free
Quantity
1
2
3
4
5
6
7
8
9
10
Credit Card
Any payment received before the deadline (11/8/24) will be fully refunded minus credit card fees. Any cancellations after 11/8/24 can not be refunded.
Submit
Should be Empty: