2023 HC4-H Campership Application

Hartford County 4-H Camp, Inc. Campership Application for 2023

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
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 you can pay of our session fee. *

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
	1st	2nd	3rd
Bring Your OwnHorse Camp	Bring Your OwnHorse Camp1st	Bring Your OwnHorse Camp2nd	Bring Your OwnHorse Camp3rd
Mini Camp	Mini Camp1st	Mini Camp2nd	Mini Camp3rd
Overnight Camp - Week 1	Overnight Camp - Week 11st	Overnight Camp - Week 12nd	Overnight Camp - Week 13rd
Overnight Camp - Week 2	Overnight Camp - Week 21st	Overnight Camp - Week 22nd	Overnight Camp - Week 23rd
Overnight Camp - Week 3	Overnight Camp - Week 31st	Overnight Camp - Week 32nd	Overnight Camp - Week 33rd
Overnight Camp - Week 4	Overnight Camp - Week 41st	Overnight Camp - Week 42nd	Overnight Camp - Week 43rd
Overnight Camp - Week 5	Overnight Camp - Week 51st	Overnight Camp - Week 52nd	Overnight Camp - Week 53rd
Overnight Camp - Week 6	Overnight Camp - Week 61st	Overnight Camp - Week 62nd	Overnight Camp - Week 63rd
Overnight Camp - Week 7	Overnight Camp - Week 71st	Overnight Camp - Week 72nd	Overnight Camp - Week 73rd

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 $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. *

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