Boyle-Lincoln-Powell
4-H SUMMER CAMP
July 10-14,
2017
J.M. Feltner 4-H Camp
London, Kentucky
Open to
youth
ages 9-14
Cost: $200
Includes lodging, meals, t-shirt, activities, and class fees
Deadline: June 16, 2017
but space is limited and first come/first served!
Important Info!
Who Can Go: Youth do not have to be currently enrolled in 4-H! Camp is for youth ages 9-14 or
who have completed 3rd grade (includes 8-yr olds). Youth ages 15-17 can apply to serve as Junior Counselors (JCs). Applications are available at the Extension Office. All 14-year-old campers
will participate in the Counselor-in-Training Leadership Experience.
Adult Counselors: Any parent or adult interested in attending camp should contact the Extension Office for a registration packet. All adults must undergo a background check, reference
check, interview, and be approved by Committee before attending 4-H Camp. There is no charge
for adults selected to attend.
How to Sign Up: All camp forms and fees are due no later than June 16. SPACE IS LIMITED!
 Make checks payable to Boyle County 4-H.
 ONLY Complete registration (paperwork plus $200 or $100 and completed scholarship application) will hold a spot for camp. If all available beds are full and your application is incomplete, it will move to the waiting list.
Lodging & Meals: Camp registration is $200 and includes meals, lodging, transportation, use of
equipment, a camp t-shirt and class fees. All campers will stay in cabins with 10-20 other youth
and at least one adult and one teen leader (except 14 year olds; see enclosed details).
Scholarships: A limited number of full and half scholarships are available. Scholarships must be
recommended by FRYSC coordinator and are based on financial need. Please have FRYSC coordinator complete and return the enclosed form to apply. All scholarship applications must be received no later than June 9, 2017! Scholarship winners will be notified on or around June 16.
Health Forms: We require you provide all health information. We do not require a physical.
Medical Insurance Card: Each camper must submit a copy of his/her Medical Insurance Card.
Head Lice Checks: All campers are required to have a head lice check done before camp. More
details will be given at Camper Orientation. NO camper is permitted to board the bus without a
signed head lice check form.
What to Bring: Shorts, shirts, jacket, socks, at least two pairs of shoes (with closed
toes and a back or strap) including one pair of tennis shoes; shower shoes; bedding
(twin sheet & blanket or sleeping bag) with pillow; toiletries; washcloths & towels;
swimsuit & beach towel. A complete list will be provided at Camper Orientation.
Campers should bring loose change for Mason Steigerwald Scholarship Fund
to win a chance to pie a AC/JC/Camp Staffer!
Camper Orientation: All campers and at least one parent/guardian MUST attend
one session of Camper Orientation on June 26 (any campers), June 29 (returning
campers only) or July 6 (any campers) at 5:30 p.m. at the Extension Office. Campers will receive class schedules and cabin assignments at these meetings.
Orientation is mandatory for camp attendance. No exceptions.
Kentucky 4-H Camping Program Camper Code of Conduct/Expectations (OM-4, 9)
1. Possession or use of alcohol or illegal drugs by any person involved in the 4-H Camp Program is strictly prohibited.
2. Any weapon or article construed to be a weapon, including hunting or pocket knife, must be checked in with the Extension Agent from the
camper’s county upon arrival at camp. These items may be returned at the end of camp. The best prevention is to leave these items at
home.
3. Use of tobacco products is not allowed for campers/teens at 4-H camp. Should county(counties) decide to permit adults (18 years and
older) to use them, it may occur only in areas designated by the Camp Director. Absolutely no tobacco products in cabins, woods or other
areas of camp.
4. Boys and girls cabin areas are restricted. A camper of the opposite sex is not, at any time, to enter a restricted area unless approved by
the Camp Program Director.
5. Campers are not allowed in the cabins during a class or activity. If a camper is ill, he/she is to stay at the medical center (not in a cabin)
until the Health Care Provider (HCP) feels the camper may return to activities.
6. There is to be no visitation with friends in cabins.
7. Campers are to be attentive, responsive and courteous to any staff, adult or teen counselor making a presentation before the group.
8. Absolutely no phone calls are to be made by campers (camp phone or cell phone) without approval of the County Extension Agent. All
County Extension Agents should be informed of incoming calls to campers.
9. Campers are not permitted to bring cell phones to camp.
10. Accidents or illnesses, no matter how minor, are to be reported to the HCP and County Agent.
11. Obscene, discriminatory, and/or inappropriate language or dress, roughhousing, and insubordination are not acceptable at any time during
camp.
12. Fireworks are not to be used by campers at any time during camp.
13. Swimming, boating, or waterfront activities are not permitted except during designated times and under proper supervision.
14. Appropriate dress, including footwear, should be adhered to as outlined at camper orientation.
15. Campers are always to remain with their groups. Individuals are not to be on trails or near lake without an accompanying adult.
16. Campers are not permitted to leave the grounds at any time without notifying and receiving approval from the Camp Program Director and
home County Extension Agent.
17. All campers are expected to be in their cabins, with lights out, as designated on the camp schedule.
18. No visitors, other than parents or immediate family, may visit campers during the camp.
19. No camper is to be around or on maintenance equipment parked or being used on camp property.
20. Campers having personal conflicts with other campers are encouraged to discuss these with their cabin counselors, dean, or County Extension Agent.
21. Campers are to work with counselors to carry out daily assigned jobs to keep camp running smoothly. Grounds are to be kept clean at all
times.
22. Campers are expected to leave the cabins, facilities, and grounds clean and orderly.
23. Campers are to respect camp property. Any malicious or intentional damage to camp property or buses shall be paid for by the camper
and/or parent or guardian, including graffiti on any camp property.
24. All medications must be turned in to the designated adult and picked up by the parent/guardian at the bus pick up site. The HCP will be
responsible for securing all medications at camp.
25. Electrical appliances (hair dryers, curling irons, etc.) are to be used in cabins only, not in restrooms.
26. Camp is not responsible for the personal property of any camper, volunteer, or staff.
27. We care about your child’s safety. Incidents of serious misbehavior (i.e., fighting, bullying, causing injury, alcohol/drug incidents, any altercations between adults and/or minors, intentional property damage/vandalism, etc.) will be reported to the Camp Director and an incident
report will be completed.
28. Campers should demonstrate respect toward others. Bullying, hazing, or malicious pranks (i.e., shaving cream, toothpaste in pillow/
sleeping bags, defacing property, inappropriate use of electronics or social media, etc.) will not be tolerated and may result in perpetrator
(s) being sent home.
29. Any conduct inconsistent with the above rules may result in consequences such as the camper/family/friend being sent home, restricting
future participation in 4-H activities, termination of 4–H membership, or other consequences determined by the county’s or state’s policy.
30. If a camper must be sent home, it will be the responsibility of the parent/guardian to pick him/her up at camp. There is no refund of the
camper fee for an early departure.
To confirm you and your camper have read and discussed this Code of Conduct, please sign the Authorizations/Releases Form.
Name:
School Attended in ‘16-’17:
If possible, I would like to be in a cabin with (same gender only):
1. _________________________
2._______________________
Please note: All efforts are made to place campers in cabins with those they request, but only a small number of cabins are available. All reasonable efforts will be made to accommodate your requests. Also, please
note that we have a strict “no bullying” policy. Parents please notify agents if there are existing issues.
Camp Classes!
Please rank your top 7 choices (total) for your camp classes, with “1” being first and
“7” being your last choice. Classes fill on a first come-first serve basis, so turn in
your application early! Note: Only mark “Swimming” if you want lessons. Everyone
will receive “Free Swim.” Rising high school freshmen (completed 8th grade) do not
need to sign up for classes.
___ Advanced Swimming
___ Ropes
___ Archery
___ Soccer
___ Arts and Crafts
___ Improv
___ Basketball
___ Nature
___ Beginning Swimming
___ Newscast/Photography
___ Canoeing
___ Riflery
___ Cooking Class
___ Robotics
___ Dance/Recreation
___ Movie Magic
___ Field Games
___ Rocketry
___ Fishing
___ CIT Leadership
Select Tee-Shirt Size:
Youth S
Adult M
Youth M
Adult L
Youth L
Adult XL
Youth XL
Adult 2X
Adult S
Adult 3X
CIT Leadership for rising
freshmen!
Available for all campers who have completed
the 8th grade or higher. No need to sign up
for classes!
This training program builds strong leaders
and offers campers a different 4-H camping
experience. Participants will take
Counselor-in-Training classes and assist
with the instruction of other classes.
4-H Camp Scholarship Application
A limited number of half and full scholarships are available. Scholarships must be recommended and submitted by FRYSC coordinator and are based on financial need.
All scholarships are competitive. FRYSC Coordinator: After youth has completed
front page, please complete the back and email to [email protected] OR fax to
859/236-8976. You may also call Kim Ragland or Mary Catherine Rowland at 859/2364484. All scholarship applications must be received no later than June 9, 2017!
Scholarship winners will be notified on/about June 16.
Youth Name: __________________________________ Grade: ____________ Requesting:
School Attending in 2016-2017: ____________________
HALF
FULL
FRYSC Coordinator: _______________________________
Why do you want to go to 4-H Camp? Must be completed by youth. Attach separate page if needed.
What other 4-H clubs or activities have you participated in during 2016-17?
Please provide the following information as you would for Free and Reduced Price School Meal Application:
1. The total number of people living in your household, including adults, infants, children, and students: _________
2. Please indicate the total income range for all members of your household, including earnings from work, public
assistance, disability payments, child support, alimony, pensions, retirement, and all other income:
Yearly Income
Check Your Income Range
$21,978 or less
$21,979-$29,637
$29,638-$37,296
$37,297-$44,955
$44,956-$52,614
$52,615-$60,273
$60,274-$67,951
$67,952-$75,647
Above $75,647
3. Does anyone in your household receive benefits from SNAP, TANF, or FDPIR?
Yes
No
4-H Camp Scholarship Application, continued
Ask your Family Resource/Youth Services Center Director to complete the following
(unless you are related; then have Principal complete).
Homeschool families please provide the following information:
Signature and Title: ____________________________________________________________________________
Please describe in general your level and type of contact (assistance needed) with this family:
So we may serve youth most in need of financial assistance, please explain why this youth deserves support for this event:
Boyle County 4-H Camp Refund Schedule
June 16 Completed camp applications due
June 16 First cancellation deadline: If 4-Her notifies Boyle Co. 4-H in writing received
by the end of business on June 16 he/she does not want to go to camp, camper will be refunded 100% of fee paid.
June 30 Second cancellation deadline: If 4-Her notifies Boyle Co. 4-H in writing received by the end of business on July 7 he/she does not want to go to camp,
camper will be refunded 50% of fee paid.
July 10 Final cancellation deadline/depart for camp: If 4-Her notifies Boyle Co. 4-H in
writing received after end of business July 7 and before camper boards bus on
July 10, along with legitimate doctor’s excuse, camper will be refunded 40% of
fee paid.
Once camper has boarded the bus, no part of fees shall be returned.
Please Don’t Forget!
Every camper and parent/guardian must attend one mandatory camp orientation
on June 26 (any camper), June 29 (returning only), or July 6 (any camper) at
5:30 p.m. at the Boyle County Extension Office. No exceptions.
Camp Checklist
Please make sure you’ve completed all items below before submitting this application
by June 16, 2017.
Return to Boyle Co. Extension, 99 Corporate Drive, Danville, KY
Does this application include:
_____Camper Participant Registration with Authorizations/Releases (3 pages)
_____Copy of camper’s medical insurance card
_____Completed Camp Class Choices form showing preferences and t-shirt size
_____Payment in full of $200 (checks made payable to Boyle County 4-H) if not
applying for a scholarship OR
_____Payment of $100 and name of FRYSC Coordinator from whom we should
expect Camp Scholarship Application form (forms MUST come from FRYSC
coordinator unless home-schooled). If scholarship is not awarded, camper must pay
additional fee by June 23 or request refund. Youth receiving full scholarships will
have their $100 payments refunded.