Winter Camp Cloverbud Registration

Registration Limit of 50

THIS IS A DROP OFF CAMP.

Parents are asked to check their child in

and return at pick up time.

REGISTRATION DEADLINE 2/7/26

LIVE ANIMALS, BEDDING & FEED WILL BE ONSITE

4-H CLOVERBUD MEMBERS-FREE

ALL OTHER YOUTH 5-8 YEARS OLD--$25.00

Age is as of December 31, 2025

Open to any 5-8 year old (not limited to Weld County)

Open to 4-H Members & Non Members

Non Members fee $25

Held at

Southeast Weld Co. Fairgrounds

7758 CR 59, Keenesburg CO

Lunch will be served,

if your child has special dietary needs, please

be sure to pack a lunch. Refridgerator available.

Child's Name*

First NameLast Name

Parent Or Legal Guardian*

First NameLast Name

Child's age as of 12/31/2025*

Phone Number*

Cell Number*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

E-mail*

example@example.com

I am a 4-H Member*

Yes, Weld CountyYes, another CountyNo, I am not a 4-H Member

Club Name, County:*

Child's Legal Name*

First NameLast Name

Emergency Contact:*

Emergency Phone #*

List past history of serious lacerations, injuries, illnesses or disease that we need to be aware of:

List any known allergies and drug reactions:

Special Diet?

Has youth had a physical Exam in past 24 months?*

YesNo

Is child up to date on vaccinations per Colorado State Records?*

YesNo

Photos will be taken during this event and used for the purpose of promoting Weld County 4-H.

I give permission for my child's photo to be used by Weld County 4-H.*

Yes, permission to use photosNo, Photos may NOT be used

I give my permission for my child to participate in all event activities with the following exceptions:

Activities not allowed to participate in:

Date*

Date

RELEASE OF LIABILITY

In consideration of allowing my child:

Child's legal name*

First NameLast Name

To participate in the 4-H Camp Cloverbud, I assume all risks in connection with the activities involved and agree to release Weld County, Colorado State University, Extension, and their employees, from any injury or damage which may befall him/her while participating in said activities whether foreseen or unseen. I hereby release Weld County, Colorado State University, Extension, & their employees, from any and all action, causes of action, claims, damages, cost, expenses, compensation, personal loss or any other loss or injury received or incurred by my child during his/her participation in Weld County 4-H Camp Cloverbud. I agree to hold all listed parties harmless from any claim by me or my family estate, heirs, or assigns arising out of said child's participation in these activities. I have read the contents of this affirmation and understand its contents. I understand that with any activity there is a potential for injury or damages to participants.

Parent or Legal guardian *

Date*

Date

Do you have any questions?

Colorado State University Extension is an equal opportunity provider. | Colorado State University does not discriminate on the basis of disability and is committed to providing reasonable accommodations. | CSU’s Office of Engagement and Extension ensures meaningful access and equal opportunities to participate to individuals whose first language is not English.

Colorado State University Extension es un proveedor que ofrece igualdad de oportunidades. | Colorado State University no discrimina por motivos de discapacidad y se compromete a proporcionar adaptaciones razonables. | Office of Engagement and Extension de CSU garantiza acceso significativo e igualdad de oportunidades para participar a las personas quienes su primer idioma no es el