Author: mharding

July 23-27, 2018

4-H Jr. Camp at the

EarlyBird
Special!

Cost: $240
when paid in full
by May 1
Or $260 when balance paid after May 1

For more information, contact Wendy Herdman at (804) 333-3420.

Join youth ages 9-13* from Westmoreland, Richmond County, Northumberland, Lancaster & Hampton for great classes and fun! *Youth must reach their 9th birthday by 9/30/2018.

If you are a person with a disability and desire any assistive devices, services or other accommodations to participate in this activity, please contact the Richmond Co Extension Office at 804-333-3420/TDD* during business hours of 8a.m. and 5p.m. to discuss accommodations 30 days prior to the event. *TDD number is (800) 828-1120.

4-H CAMP REGISTRATION (please print clearly)
Camper’s full name __________________________________________
(underline or add name camper likes to be called)
Date of birth (mm/dd/yyyy) _____________________________
Age ________ Grade _________ Gender ________
T-shirt Size Circle: Youth or Adult + Circle: S M L XL XXL
Name of parent/guardian ____________________________________
Mailing Address ______________________________________________
City _________________________ State_______ Zip ___________
Phone (home ) _______________ Phone (work) ______________
Phone (cell) _________________ Email _______________________
Parent/Guardian’s signature ___________________________________
Payment: $80 deposit $240 full payment early bird special
Deposit not refundable after 6/15/18
Full payment not refundable after 7/2/18
**Scholarships available. Please request application.
Registration & $ accepted until space is full or 7/2 whichever comes first.
(A $50 fee will be charged for all returned checks.)
Make check payable to:
VCE-Richmond County and bring/mail to:
Richmond County Extension Office
460 Main Street
PO Box 152
Warsaw, VA 22572

Optional payment schedule to achieve early bird discount
Deposit required by 3/5 $80
2nd payment due 4/2 $80
Final payment due 5/1 $80

Virginia Cooperative Extension programs and employment are open to all, regardless of age, color, disability, gender, gender identity, gender expression, national origin, political affiliation, race, religion, sexual orientation, genetic information, veteran status, or any other basis protected by law. An equal opportunity/affirmative action employer. Issued in furtherance of Cooperative Extension work, Virginia Polytechnic Institute and State University, Virginia State University, and the U.S. Department of Agriculture cooperating. Edwin J. Jones, Director, Virginia Cooperative Extension, Virginia Tech, Blacksburg; M. Ray McKinnie, Administrator, 1890 Extension Program, Virginia State University, Petersburg.