2020 Campership Application

Hartford County 4-H Camp, Inc. Campership Application for 2020

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*.

**Note**: **Increased chance of receiving campership if first traditional camp session (6/28-7/4) is requested.**
	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
Mini-Camp	Mini-Camp1st	Mini-Camp2nd	Mini-Camp3rd	Mini-Camp4th	Mini-Camp5th	Mini-Camp6th	Mini-Camp7th	Mini-Camp8th
Traditional Camp - Session 1	Traditional Camp - Session 11st	Traditional Camp - Session 12nd	Traditional Camp - Session 13rd	Traditional Camp - Session 14th	Traditional Camp - Session 15th	Traditional Camp - Session 16th	Traditional Camp - Session 17th	Traditional Camp - Session 18th
Traditional Camp - Session 2	Traditional Camp - Session 21st	Traditional Camp - Session 22nd	Traditional Camp - Session 23rd	Traditional Camp - Session 24th	Traditional Camp - Session 25th	Traditional Camp - Session 26th	Traditional Camp - Session 27th	Traditional Camp - Session 28th
Traditional Camp - Session 3	Traditional Camp - Session 31st	Traditional Camp - Session 32nd	Traditional Camp - Session 33rd	Traditional Camp - Session 34th	Traditional Camp - Session 35th	Traditional Camp - Session 36th	Traditional Camp - Session 37th	Traditional Camp - Session 38th
Traditional Camp - Session 4	Traditional Camp - Session 41st	Traditional Camp - Session 42nd	Traditional Camp - Session 43rd	Traditional Camp - Session 44th	Traditional Camp - Session 45th	Traditional Camp - Session 46th	Traditional Camp - Session 47th	Traditional Camp - Session 48th
Traditional Camp - Session 5	Traditional Camp - Session 51st	Traditional Camp - Session 52nd	Traditional Camp - Session 53rd	Traditional Camp - Session 54th	Traditional Camp - Session 55th	Traditional Camp - Session 56th	Traditional Camp - Session 57th	Traditional Camp - Session 58th
Traditional Camp - Session 6	Traditional Camp - Session 61st	Traditional Camp - Session 62nd	Traditional Camp - Session 63rd	Traditional Camp - Session 64th	Traditional Camp - Session 65th	Traditional Camp - Session 66th	Traditional Camp - Session 67th	Traditional Camp - Session 68th
Traditional Camp - Session 7	Traditional Camp - Session 71st	Traditional Camp - Session 72nd	Traditional Camp - Session 73rd	Traditional Camp - Session 74th	Traditional Camp - Session 75th	Traditional Camp - Session 76th	Traditional Camp - Session 77th	Traditional 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