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Special Information for
Parents
Camp Registration Form
Camper’s Name _______________________
2015 SE District Teen
Camp
Address _____________________________
City _______________ State ____________
1.
Arrival Time:
7:00 p.m. on Sunday, August 23
Departure Time:
9:30 a.m. on Tuesday, August 25
2.
A formal camper code of conduct form, a
media release form, and health history
form will be sent to parents for
completion upon the receipt of this
registration form accompanied by the fee.
ZIP ______ Birth Date _________ Age ____
Gender: M__ F__ Phone _______________
Email________________________________
Parent/Guardian
_____________________________________
Please circle the payment amount you are making.
Refer to information in the Camp Fee section:
$75 / $90 / $105 / Teen Counselor
Checks or money orders should be made payable
to: “Jamestown 4-H Educational Center.” A
registration form must be completed for each child
and received by the registration deadline along
with payment. The camp fee is non-refundable
after August 15, 2015.
Return with payment to:
3751 4-H Club Road
Williamsburg, VA 23185
(757) 253-4931
Fax (757) 253-7231
Jamestown4h@gmail.com
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
Ruben Brown, Jamestown 4-H Center, at 757-2534931/TDD* during the business hours of 8:30 a.m.
and 5:00 p.m. to discuss accommodations 5 days
prior to the event. *TDD number is (800) 8281120.
Jamestown 4-H Center
Attn: SE District Teen Camp
3751 4-H Club Road
Williamsburg, VA 23185
There will be a charge of $25 for all returned
checks due to insufficient funds. The fee plus
the original amount of the check will be
payable by money order or cashier’s check
only. No exceptions will be made.
August 23-25, 2015
www.jamestown4hcenter.org
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.
What will I get to do?
Teen Camp
C
Aftter working hard all summer and
be
eing role models to
t all of the
ca
ampers that come
e to camp, this is
the
e time for you to be
b campers
yo
ourselves!!
Yo
ou will be able to choose your
cla
asses to take: Arc
chery, Riflery,
Ca
anoeing, Kayaking, and many
mo
ore!
Po
ool time is always
s a plus in the hott
sun! You will also be
b doing a service
e
pro
oject as well to giive back.
It h
has been a long time
t
since all of
the
e teens of the dis
strict have gotten
tog
gether and had a ton of fun and
wa
as able to turn ba
ack the clock for
wh
hen you were cam
mpers! Didn’t hav
ve
tha
at opportunity, the
en you will get to
exxperience it! Sign up today and be
ab
big kid!
Schedule
S
Sunday
7pm – Registra
ation
8pm – Introducctions
8:30pm – Get Acquainted
A
Game
es
9pm – Free Tim
me
12am – Lights Out
Monday
8am – Flag Ra
aising
8:15am - Break
kfast
9am – Class 1
10am – Class 2
11am – Class 3
11:50am – Line
e up for Lunch
12pm – Lunch
1pm – Free Tim
me
2pm – Pool Tim
me
4pm – Service Project
5:15pm – Flag Lowering
5:30pm – Dinner
6:30pm – Spec
cial Program
7:45pm – Snac
ck
8:30pm – Cam
mpfire
9:30pm – Free
e Time
12am – Lights out
Tuesday
8am – Flag Ra
aising
8:15am – Brea
akfast
8:45am – Evaluations/Picture/P
Pack-up
9:30am – Closing Slideshow
How much does this camp
cost?
Realizing that ffamilies have differing
g abilities to
pay, we are offe
ering a voluntary 3-tie
er pricing
program at the 4-H Center. Please take a
ons below
moment to lookk at the rate descriptio
and determine which of the prices yo
our family is
o pay for your child’s camp
able & willing to
experience.
The first price (($75) is our historicallyy subsidized
rate ($90) is a p
partially subsidized ra
ate ($105)
represents the true cost of camp.
ose the price),
This program iss voluntary (you choo
and in no way influences the quality of
experience eacch child receives.
ncial assistance may b
be available
Additional finan
to ensure all ch
hildren have this wond
derful
opportunity to a
attend camp.
Registration Inform
mation
How old is my
y camper?
Youth 14-19 ye
ears of age may attend. Youth
must reach their fourteenth birthday by
September 30, 2015.
olunteering?
What about vo
Counselor and leadership opportunitties are
dult volunteers. Adultss are free.
available for Ad
camp?
Where is the c
Jamestown 4-H
H Center is located on
n the beautiful
James River, ju
ust one mile from Jam
mestown
Island and the C
Colonial Parkway, and five miles
from Colonial W
Williamsburg. It is an e
easy drive
from anywhere in Hampton Roads o
or Richmond.