ATTENTION To open the 2024 Registration Form, which will be attached to your confirmation email, you will need Adobe® PDF Reader or a similar application.

Camper's First Name

Camper's Last Name

Choose Your Camp Week Please make sure to verify you have selected the correct option for your camper, we are unable to edit selections electronically.

Camper Date of Birth please use MM/DD/YY format

Age of Camper during the camp session Campers must be between the ages of 8-16 AT the time of their Camp Session.

Are you a currently enrolled 2023-2024 Illinois 4-H member? Enter your Member ID number in the box below, then you will be able to select the member option. If your County cannot verify your 4-H enrollment status, your camp registration will be placed on hold and could be voided. To avoid a delay, contact your local Extension Office or your club lead, prior to registering for camp with any questions.

What is your 4-H ID?

Please select your home County or please select the County that you are currently enrolled as a 4-H member. Adams Alexander Bond Boone Brown Bureau Calhoun Carroll Cass Champaign Christian Clark Clay Clinton Coles Cook Crawford Cumberland DeKalb DeWitt Douglas DuPage Edgar Edwards Effingham Fayette Ford Franklin Fulton Gallatin Greene Grundy Hamilton Hancock Hardin Henderson Henry Iroquois Jackson Jasper Jefferson Jersey JoDaviess Johnson Kane Kankakee Kendall Knox Lake LaSalle Lawrence Lee Livingston Logan Macon Macoupin Madison Marion Marshall Mason Massac McDonough McHenry McLean Menard Mercer Monroe Montgomery Morgan Moultrie Ogle Peoria Perry Piatt Pike Pope Pulaski Putnam Randolph Richland Rock Island Saline Sangamon Schuyler Scott Shelby St. Clair Stark Stephenson Tazewell Union Vermilion Wabash Warren Washington Wayne White Whiteside Will Williamson Winnebago Woodford Out of State

How many years have you attended this youth camp?

My Bunk Mate choice is (First Name): You may list one, same-gender bunk mate within 2 years of age. We make every attempt to accommodate bunk mate requests, however, it is not always possible.

Bunk Mate Choice (Last Name)

Parent/Guardian First Name This is your campers parent/guardian info, not bunk mate.

Parent/Guardian Last Name This is your campers parent/guardian info, not bunk mate.

Parent/Guardian Street Address

City

State

Zip Code

Best Contact Day Phone Please use format xxx-xxx-xxxx In case of emergency, we will contact you at this phone number. If it is your cell phone, we suggest that you add the 4-H Camp phone number to your contacts. (217) 762-2741

Best Contact Evening Phone Please use format xxx-xxx-xxxx Please use format xxx-xxx-xxxx In case of emergency, we will contact you at this phone number. If it is your cell phone, we suggest that you add the 4-H Camp phone number to your contacts. (217) 762-2741

Parent/Guardian Email Address Please use an email that is your best contact or that you use on your smart phone. We will use this email to send you a confirmation of registration, send your packing list information as well as any important updates or alerts. Any news regarding your child's camp session will FIRST be sent by email, so please use one that you check often. This should be the same email as listed in the contact information at the beginning of the registration.

Alternate Contact First Name In the event of an emergency, if we cannot reach the parent, please list an additional person that we may contact.

Alternate Contact Last Name

Relationship to Camper

Alternate Contact Phone Number Please use format xxx-xxx-xxxx

Alternate Contact Email Address

Residence

Race Select one

Languages spoken at home Languages spoken at home

Hispanic or Latino? Hispanic or Latino?

Ethnicity If you are Hispanic, please select all that apply

WHAT COMES NEXT? In Step 2, you will have the opportunity to correct any errors. Look over the information you provided and make any corrections by hitting your browser's back button. Your confirmation email will be sent to the email listed in the contact information, please verify that this is an email you check regularly.

Once you proceed to Step 3, the system does not allow you to return to previous pages.

In Step 3 you will select a payment type of either CHECK or CREDIT CARD. Charges on your credit card statement will say UNIVERSITY OF ILLINOIS.

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Final Step

TEN business days. If, after ten business days, we have not received your registration form, 4-H Memorial Camp reserves the right to void your payment without notice. The registration form will be attached to your confirmation email.

Each camper will receive a shirt. Please choose your size.