4-H RES-Q 2009 Summer Day Camp
Please Please fill out a separate form for each registrant. Camper ages: 7 – 12 years
Hours: Tuesday – Friday, 9:00 am – 3:00 pm each day (sessions 1-6)
Monday – Friday, 7:30 am – 5:30 pm each day (session 7, Aug 3-7)
MUST HAVE A MINIMUM OF 10 CHILDREN FOR CAMP
WILL NOTIFY PARENTS 10 DAYS PRIOR TO CAMP DATE IF CANCELLED
st nd rd
SessioSession Dates - (Place 1 by your 1 choice, 2 by your 2 and 3 by your 3 )
st nd rd th th th th
1 2 3 4 5 6 7
Session Session Session Session Session Session Session
June 16-19 June 23-26 July 7-10 July 14-17 July 21-24 July 28-31 Aug 3-7
Child’s Name Age Check one: Boy Girl
City State Zip
T-Shirt Size Youth: S M L Adult: S M L
How did you hear about RES-Q Summer Day Camp? Returning Camper Friend Kid’s Directory
Flier (school) L.R. Family Camps Guide Other
Check one: White Black/African American Am. Indian/Alaskan Native Hawaiian/Pacific Island
Asian Two or More Races/Other Race Check Ethnicity: Hispanic
This information is requested solely for the purposes of determining compliance with federal civil rights laws, and your response will not affect your
eligibility to participate in Extension programs. By providing this information, you will assist us in assuring that this program is administered in a
Please mail this registration form and check (made payable to CES) as soon as possible to address below. (Make copies for
Registration fee is $150.00 per child per 4 day session. Fee includes a day camp Tee-shirt.
Registration fee is $250.00 per child for the 5 day session. Fee includes a day camp Tee-Shirt.
Camp fee (less $25.00 processing fee) will be refunded if cancellation is at least 2 weeks prior to your camp start date.
Cancellations made less than 2 weeks before your camp start date will result in no refund.
Your will receive a health/activity form, code of conduct and publications release after the registration form and check
have been received. If you do not receive within a week, please call.
If you have any questions, please contact:
4-H RES-Q Summer Day Camp Coordinator
Arkansas 4-H Center
#1 4-H Way
Little Rock, AR 72223
501-821-6884 or email@example.com
University of Arkansas, United States Department of Agriculture and County Governments Cooperating.
The Arkansas Cooperative Extension Service offers its programs to all eligible persons regardless of race, color,
national origin, religion, gender, age, disability, marital or veteran status, or any other legally protected status, and is
an Affirmative Action/Equal Opportunity Employer.