POLK COUNTY

4-H Youth Development

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Po-Croix-Dun 4-H Camp Online Registration Form

Please note that to use this form you must be connected to the internet and provide a valid email address for yourself. Complete one form per camper.
If you prefer, you can print out, complete and mail in the Camp registration brochure with your information and fee. Per the instructions in the brochure.
The cost is $40 per camper. Make checks payable to "Po-Croix-Dun" and Mail to: Polk County UWEX Office, 100 Polk Co Plaza, Suite 210, Balsam Lake, WI 54810.
Registration is due May 23, 2008

Your Name:

Select your Gender:
Male
Female

Your Grade:

Parents Name:

Address:

City:

Zip:

County:

Phone (xxx-xxx-xxxx):

Email Address (required):

Select a Camp:
Older Camp - June 23-25: Grades 5-7
Younger Camp - June 25-27: Grades 3-5

I would like to stay in the same cabin as:

If you have special dietary or other needs, describe here:

Select your bus pick up location:
Amery
Baldwin
Balsam Lake
Four Corners (hwy 63, 64, and 46)
Fredric
Houlton
Menomonie
New Richmond

Return to the 4-H home

Patti Jo Andersen
Polk County - UW Extension
100 Polk County Plaza
Suite 210
Balsam Lake, WI 54810
Phone: 715-485-8600
Fax: 715-485-8601
Email: PATTIJOA@co.polk.wi.us

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