Grades 3-6 as of 2017-18 school year $200 4-H members$250 General Camp Rate

Base campers will enjoy a wide variety of camp activities including archery, arts and crafts, swimming, canoeing, hiking, and nature programs. Evening programs will include traditional campfire fun.

Grades 7-8 as of 2017-18 school year $200 4-H members$250 General Camp Rate

Outpost campers will enjoy a wide variety of camp activities including wilderness camping, hiking, fishing, swimming, and fun explorations of Mirror Lake State Park. Evening programs will include traditional campfire fun.

General Camp Information Camp Upham consists of six large cabins and a large dining hall where three nutritious meals are served each day. Campers participate in programs in the large recreation hall, arts and crafts building, and nature building. Convenient showers and bathroom facilities are provided. Camp staff consists of full-time adult paid staff and volunteers along with youth counselors who serve as chaperones, role models, and activity directors. Qualified health personnel are on hand to handle any health or accident incidents. All campers are covered by accident insurance. Visitors are not permitted at camp.

Camp fees includes lodging, meals, snacks, crafts, equipment, transportation, insurance, and other activity costs.

Cabin Mate Each camper may request on their registration form to have ONE other camper as their cabin mate. Both campers must be in the same grade and list each other on the registration form to ensure the request. Cabin mate requests are not guaranteed but the best part of camp is meeting new friends.

July 8-12, 2018A lifetime of fun packed into 4 nights and 5 days of summer.

Summer Camp Registration FormCamp is filled on a first come, first served basis. Complete and return the registration form with payment, make all checks payable to 4-H Leaders Association, by May 7, 2018. Refund Policy: All cancellations must be made prior to July 1, 2018. A non-refundable $50 deposit will be deducted.

Camper Name

Gender BirthdayCabin Mate Request(not guaranteed)

Address

City State Zip

Grade4-H Club (if applicable)

Parent Name(s)

Address

City State Zip

Phone Email

DemographicsThis information is voluntary and is only used for reporting purposes only.

Are you Hispanic Yes No

Race Ethnicity White Black or African American American Indian or Alaska Native Asian Native Hawaiian or Other Pacific Islander Prefer not to state

Residence Farm Rural/Non Farm, or town less than 10,000 people Town / City 10,000-50,000 people Suburb of City over 50,000 people City over 50,000 people Prefer not to state

Adult S Adult M Adult L Adult XL Adult XXL

Youth S Youth M Youth L Youth XL

Base | $200 4-H member Outpost | $200 4-H member Base | $250 General Camp Rate Outpost | $250 General Camp Rate

Base | Scholarship* Outpost |Scholarship*

*Scholarships are based on financial need and require 4-H Educator approval. A non-refundable $50 deposit must be made prior to requesting a scholarship .

T-Shirt SizeSpecify special accommodations needed for camper to participate in any camp activities (food, allergies, mental/physical health, etc.).

You will be contacted by camp staff prior to camp.

Register Online Outagamie.uwex.edu/summercampBy Phone 920-832-5123 | In Person at UW-Extension Outagamie Office

Mail completed registration form with payment toUW-Extension Outagamie County | Attn: Camp | 3365 W Brewster St | Appleton, WI 54914

Upham Woods Outdoor Learning Center is a residential facility operated by the University of Wisconsin Extension and located on the magnificent Wisconsin River and amidst the bluffs of Upper Wisconsin Dells.

Since 1941, the center has provided educational programs focused on environmental and leadership education. The property includes exclusive use of Blackhawk Island, a state-of-the-art low ropes challenge course, cabins, dormitory, main lodge, nature center and multiple learning environments.

Mirror Lake State Park has a 137 acre lake perfect for canoeing, kayaking, fishing, and swimming along with over 25 miles of hiking trails and picnic areas.

In the operation of the summer camp program, no child, as defined by the program regulations, will be discriminated against because of race, color,

national origin, sexual orientation, age, or disability.

An EEO/AA employer, University of Wisconsin-Extension provides equal opportunities in employment and programming, including Title VI, Title IX, and

the Americans with Disabilities Act (ADA) requirements.