Holiday Lake 4-H Educational Center

Family Camp Registration

May 28-June 1, 2012

Fill out & submit the form below and mail your check to:
Mail Check to:
Holiday Lake 4H Educational Center
1267 4-H Camp Road
Appomattox, VA 24522

Address*

Phone Number*
- Area Code Phone Number
E-mail*
# in family(household) attending*
# of Non-Household attending
For each person attending please include the following information: NAME, GENDER, BIRTHDAY, SHIRT SIZE*
Should be Empty:

Payment

$200 deposit with registration

Final payment and all signed forms due April 20, 2012

Final payment may be send any time, however we as that only 2 checks be sent.

An information packet and all relevant forms will be mailed to you upon receipt of registration and deposit.

Refunds

Full by April 20, 2012

50% by May 4, 2012

Nonrefundable after May 4, 2012