Camper's Name

Guardian's Name

Address

City

State Zip   County

Phone (Home -- with area code)

Phone (Work -- with area code) Mother's Father's

Phone (Cell -- with area code) Mother's Father's

Guardian's Email

How did you hear about camp
Previous camper, friend, relative, school, internet search, mall camp fair, Upstate or Low Country
Parent mag., extension office/agent, newspaper (which), 1 page flyer, or other (please tell us)

4-H Camper Information

Age at time of camp Sex Grade

Date of birth (MM/DD/YYYY)

School attend if in South Carolina

1-week sessions for ages 8-14: Must be 8 by the time camp starts
        1. June 8-13
       2. June 15-20 (full)
      3. June 22-27 (full)
      4. July 6-11 (full)
     5. July 13-18 (full)
       6. July 20-25
       7. July 27-Aug 1

Session for ages 12-16: 8. August 3-8   No Date selected

2-week sessions for ages 8-14: Must be 8 by the time camp starts:
    June 15-27  (full)
    July 6-18 (full)

If you would like to placed on the waiting list for a week that is closed,
please call 864-878-1041.

T-shirts
Size: Youth: M (10-12) L (14-16)

  Adult: S M L XL (sizes run a little small)

Credit Card Information

Please call (864) 878-1041 to pay the $100 non-refundable deposit by credit card or you may now pay on-line.

Campers are considered registered upon receipt of the non-refundable deposit. Campers must complete a Camper Information Form to attend.

Roommate request, comments or questions:

Once you submit this form, you'll be automatically redirected to our Thank you page. If this does not occur, please call 864-878-1041.