Wild West 4-H Camp Lakeside

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June 9th & 10th
Camper Age (on Jan 1): 7-9 years of age
Counselor Age ( on Jan 1): 14-18 years of age
Payment Deadline: May 3rd, 2021

County *

Camper, Counselor, Agent/Volunteer *

If you are a counselor are you VIP?

Childs Last Name *

Childs First Name *

Gender

Female

Male

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Age (Jan 1) *

Parent Name *

Phone Number *

Email Address *

TShirt Size *

Allergies/ Dietary Needs *

None

Other:

Additional Information:

I acknowledge that I will make payment to my local extension office by May 3rd. *

Yes

Required

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