2021 Campership Application

Hartford County 4-H Camp, Inc. Campership Application for 2021

Please complete one application per family.

Camper's Name Camper's Name * First Last
Are they in a 4-H Club?

Are they in a 4-H Club? Yes No If yes, which? If yes, which?
2nd Camper's Name 2nd Camper's Name First Last
Are they in a 4-H Club?

Are they in a 4-H Club? Yes No If yes, which? If yes, which?
3rd Camper's Name 3rd Camper's Name First Last
Are they in a 4-H Club?

Are they in a 4-H Club? Yes No If yes, which? If yes, which?
Camper's Address Camper's Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Parent/Guardian Name Parent/Guardian Name * First Last
If you are an active Service Member or Veteran, upload your ID card here.

Attach Files
Parent/Guardian Email *
Phone Phone * - ### - ### ####
Secondary Address (complete if different than address above) Secondary Address (complete if different than address above)
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Has this child received a 4-H Campership in any previous years? If so, how many years? *

Has this child received a 4-H Campership in any previous years? If so, how many years? No Yes, 1 year Yes, 2 years Yes, 3 or more years
Has your child attended Hartford County 4-H Camp before? If so, how many years? *

Has your child attended Hartford County 4-H Camp before? If so, how many years? No Yes, 1 year Yes, 2 years Yes, 3 or more years
How many minor children live at home with you? *

How many minor children live at home with you? 1 2 3 4 5+
Number of children attending Hartford County 4-H Camp this year? *

Number of children attending Hartford County 4-H Camp this year? 1 2 3 4 5+
How many Camperships are you requesting this year? *

How many Camperships are you requesting this year? 1 2 3

You can fill out additional Campership Applications for other children, or simply explain your request in the comment section below.
Each year, Hartford County 4-H camp receives many requests for Campership Assistance and we try to assist as many families as possible. In light of this, we strongly encourage families to pay a portion of the camp fee. In doing so, we can assist more families with Campership Assistance.

Consider what you can financially afford per camper. Please indicate the amount of this request:

What camp week did you want your child(ren) to attend? *Enter your choices in order of preference*.

Camp Dates can be found on our Website @ www.hartfordcounty4hcamp.org/camp-session-dates/
	1st	2nd	3rd	4th	5th	6th	7th	8th
Special Horse Camp	Special Horse Camp1st	Special Horse Camp2nd	Special Horse Camp3rd	Special Horse Camp4th	Special Horse Camp5th	Special Horse Camp6th	Special Horse Camp7th	Special Horse Camp8th
Overnight Camp - Session 1	Overnight Camp - Session 11st	Overnight Camp - Session 12nd	Overnight Camp - Session 13rd	Overnight Camp - Session 14th	Overnight Camp - Session 15th	Overnight Camp - Session 16th	Overnight Camp - Session 17th	Overnight Camp - Session 18th
Day Camp - Session 1	Day Camp - Session 11st	Day Camp - Session 12nd	Day Camp - Session 13rd	Day Camp - Session 14th	Day Camp - Session 15th	Day Camp - Session 16th	Day Camp - Session 17th	Day Camp - Session 18th
Overnight Camp - Session 2	Overnight Camp - Session 21st	Overnight Camp - Session 22nd	Overnight Camp - Session 23rd	Overnight Camp - Session 24th	Overnight Camp - Session 25th	Overnight Camp - Session 26th	Overnight Camp - Session 27th	Overnight Camp - Session 28th
Day Camp - Session 2	Day Camp - Session 21st	Day Camp - Session 22nd	Day Camp - Session 23rd	Day Camp - Session 24th	Day Camp - Session 25th	Day Camp - Session 26th	Day Camp - Session 27th	Day Camp - Session 28th
Overnight Camp - Session 3	Overnight Camp - Session 31st	Overnight Camp - Session 32nd	Overnight Camp - Session 33rd	Overnight Camp - Session 34th	Overnight Camp - Session 35th	Overnight Camp - Session 36th	Overnight Camp - Session 37th	Overnight Camp - Session 38th
Day Camp - Session 3	Day Camp - Session 31st	Day Camp - Session 32nd	Day Camp - Session 33rd	Day Camp - Session 34th	Day Camp - Session 35th	Day Camp - Session 36th	Day Camp - Session 37th	Day Camp - Session 38th
Overnight Camp - Session 4	Overnight Camp - Session 41st	Overnight Camp - Session 42nd	Overnight Camp - Session 43rd	Overnight Camp - Session 44th	Overnight Camp - Session 45th	Overnight Camp - Session 46th	Overnight Camp - Session 47th	Overnight Camp - Session 48th
Day Camp - Session 4	Day Camp - Session 41st	Day Camp - Session 42nd	Day Camp - Session 43rd	Day Camp - Session 44th	Day Camp - Session 45th	Day Camp - Session 46th	Day Camp - Session 47th	Day Camp - Session 48th
Overnight Camp - Session 5	Overnight Camp - Session 51st	Overnight Camp - Session 52nd	Overnight Camp - Session 53rd	Overnight Camp - Session 54th	Overnight Camp - Session 55th	Overnight Camp - Session 56th	Overnight Camp - Session 57th	Overnight Camp - Session 58th
Day Camp - Session 5	Day Camp - Session 51st	Day Camp - Session 52nd	Day Camp - Session 53rd	Day Camp - Session 54th	Day Camp - Session 55th	Day Camp - Session 56th	Day Camp - Session 57th	Day Camp - Session 58th
Overnight Camp - Session 6	Overnight Camp - Session 61st	Overnight Camp - Session 62nd	Overnight Camp - Session 63rd	Overnight Camp - Session 64th	Overnight Camp - Session 65th	Overnight Camp - Session 66th	Overnight Camp - Session 67th	Overnight Camp - Session 68th
Day Camp - Session 6	Day Camp - Session 61st	Day Camp - Session 62nd	Day Camp - Session 63rd	Day Camp - Session 64th	Day Camp - Session 65th	Day Camp - Session 66th	Day Camp - Session 67th	Day Camp - Session 68th
Overnight Camp - Session 7	Overnight Camp - Session 71st	Overnight Camp - Session 72nd	Overnight Camp - Session 73rd	Overnight Camp - Session 74th	Overnight Camp - Session 75th	Overnight Camp - Session 76th	Overnight Camp - Session 77th	Overnight Camp - Session 78th
Day Camp - Session 7	Day Camp - Session 71st	Day Camp - Session 72nd	Day Camp - Session 73rd	Day Camp - Session 74th	Day Camp - Session 75th	Day Camp - Session 76th	Day Camp - Session 77th	Day Camp - Session 78th

Please check appropriately. Your family income bracket after taxes, mandatory wage deductions, and child care expenses: *

Please check appropriately. Your family income bracket after taxes, mandatory wage deductions, and child care expenses: Less than $20,000 Less than $25,000 Less than $31,000
What are the special circumstances, which have contributed to the need for financial assistance? Please explain: *
Upload your tax form.

Attach Files
I understand that this information will be held confidential, and will be seen only by authorized persons for consideration in granting 4-H Campership Assistance.

Draw your signature into the box below. *

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
Name Name First Last
Date Date / MM / DD YYYY