Summer 2012 Registration Form

Camper Name Address City State Zip Code

Hidden Valley 4-H Camp

323 Owego St., Unit #5, Montour Falls, NY 14865 607-535-7161 || hiddenvalley4hcamp@cornell.edu www.hiddenvalley4hcamp.org

Camper Information
Camper Birthdate (MM/DD/YYYY)
Camper Gender (M/F)

Camper age AT CAMP

County (If camper lives in New York, please indicate which county)

New Camper

Return Camper

How did you hear about Hidden Valley 4-H Camp?

Family Information
Parent/Guardian Name Home Phone email Work Phone Cell Phone

Camp Sessions Information (Please check all that apply)

Overnight Camp ($300/wk) Day Camp ($155/week)
LatePickup Day Camp (includes dinner) $20/wk

FEES (Will automatically calculate)

Number of weeks of OVERNIGHT camp: Number of weeks of DAY camp # of weeks DAY camp LATE PICKUP

Week 1 -- July 8-13 Week 2 -- July 15-20 Week 3 -- July 22-27 Week 4 -- July 29-August 3 Week 5 -- August 5-10 Week 6 -- August 12-17

Week 1 -- July 9-13 Week 2 --16-20 Week 3 -- 23-27 Week 4 -- July 30-August 3 Week 5 -- August 6-10 Week 6 -- August 13-17

Wk 1 Wk 2 Wk 3 Wk 4 Wk 5 Wk 6

Number of WEEKEND STAYOVERS MINUS discounts

Weekend Stayovers ($100/each)

Total Camp Fees Due: Amount Enclosed: Balance Due:

Print Form to mail w/check

W/E Between Weeks 2-3 (July 20-22) W/E Between Weeks 4-5 (Aug. 3-5)
DISCOUNTS (will be verified). $15/week. Residential Camp only (no CIT or Day camp). Maximum of 2 discounts ($30 total) per camp week will be allowed.

Early Bird Discount-Registrations posted by April 15, 2012 Schuyler County Residents Siblings Discount

Submit by Email

Applications ONLY can be emailed to: hv4hcampapps@cornell.edu All other correspondence, please use hiddenvalley4hcamp@cornell.edu

NOTES: CAMP FEES BALANCE AND ALL PAPERWORK, INCLUDING HEALTH FORMS, ARE DUE NO LATER THAN THE WEDNESDAY BEFORE YOUR CAMPER ATTENDS CAMP. ALL BALANCES MUST BE PAID IN FULL BY REGISTRATION OR CAMPER WILL NOT BE PERMITTED TO STAY AT CAMP.
All registrations must be accompanied by at least $100 Non-Refundable deposit per week, per camper. Email registrations will not be finalized until payment is received. You may pay in full at any time. To pay by credit card, please call 607-535-7161. Check here if interested in CIT. You will be contacted CIT (Counselor in Training): with further information. If you are interested in participating in the CIT program, you must be 15 years old and/or have completed 10th grade. Cornell Cooperative Extension of Schuyler County provides equal program and employment opportunities. If you need assistance to participate in any of our programs, please contact our office.