2022 4-H Summer Camp - Chaperone form

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Sunday, August 14- Tuesday, August 16, 2022 at Upham Woods in Wisconsin Dells. Transportation included.

Open to all youth who finished grades 3 - 8. Deadline to enroll is June 30, 2022.

Cost: Adult Chaperones are free! We just really need your help!

First and Last Name *

Family 4-H Club

Phone *

Address *

Email Address *

Emergency Contact During Camp *

Emergency Contact Phone During Camp *

Please select any below if you are:

an enrolled 4-H volunteer

CPR Certified

Lifeguard

Archery Certified

EMP/L[N/RN

Your Gender

Male

Female

Other:

Clear selection

Your T-Shirt Size

List any dietary needs or accommodations you need for camp.

Describe past camp and/or chaperoning experiences:

What interests you about chaperoning and what are your expectations for camp? *

Thank you! We will reach out to you to discuss your role at camp!

An EEO/AA employer, University of Madison-Division of Extension provides equal opportunities in employment and programming. Including Title VI, Title IX, and the Americans with Disabilities Act (ADA) requirements.

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