2024 HC4-H Campership Application

Hartford County 4-H Camp, Inc. Campership Application for 2024

Please complete one application per family.

Camper's Name Camper's Name First Last
Is your camper a 4-H Club Member?

Is your camper a 4-H Club Member? No Yes (list club below) Yes (list club below)
2nd Camper's Name 2nd Camper's Name First Last
Is your camper a 4-H Club Member?

Is your camper a 4-H Club Member? No Yes (list club below) Yes (list club below)
3rd Camper's Name 3rd Camper's Name First Last
Is your camper a 4-H Club Member?

Is your camper a 4-H Club Member? No Yes (list club below) Yes (list club below)
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
Relationship to Camper
Parent/Guardian Email
Phone Phone - ### - ### ####
If you are an active Service Member or Veteran, upload your ID card here.

Attach Files
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+

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

Exact Dates can be found on our Website: Camp Sessions and Dates
	BYO Horse Camp	Mini Camp	Week 1	Week 2	Week 3	Week 4	Week 5	Week 6	Week 7
1st Choice	1st ChoiceBYO Horse Camp	1st ChoiceMini Camp	1st ChoiceWeek 1	1st ChoiceWeek 2	1st ChoiceWeek 3	1st ChoiceWeek 4	1st ChoiceWeek 5	1st ChoiceWeek 6	1st ChoiceWeek 7
2nd Choice	2nd ChoiceBYO Horse Camp	2nd ChoiceMini Camp	2nd ChoiceWeek 1	2nd ChoiceWeek 2	2nd ChoiceWeek 3	2nd ChoiceWeek 4	2nd ChoiceWeek 5	2nd ChoiceWeek 6	2nd ChoiceWeek 7
3rd Choice	3rd ChoiceBYO Horse Camp	3rd ChoiceMini Camp	3rd ChoiceWeek 1	3rd ChoiceWeek 2	3rd ChoiceWeek 3	3rd ChoiceWeek 4	3rd ChoiceWeek 5	3rd ChoiceWeek 6	3rd ChoiceWeek 7

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 that you can pay toward your camper(s) session fee(s).
Please indicate your annual family net income after taxes and wage deductions.

Please indicate your annual family net income after taxes and wage deductions. Less than $20,000 Less than $40,000 Less than $60,000 Other Other
What are the special circumstances, which have contributed to the need for financial assistance? Please explain:
Upload your most recent 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.

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Full Name

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