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High Desert Youth Range Camp Application 2014 Please return application with a completed letter of recommendation. Campers will be selected only from applications postmarked by the first day of May 2014. On or before May 10, you will be notified if you are accepted as a delegate to the High Desert Youth Range Camp. Once your application is accepted, you must submit a health form and pay a deposit of $50.
Range Camp begins Wednesday, June 18th and ends Saturday, June 21st I,
, submit this application as a delegate to the High Desert Youth Range
Camp. If selected, I pledge to be an active participant in all camp activities and learn about the use and conservation of Eastern Oregon’s natural resources. I promise to observe the camp requirements and pay a fee of $175 (Made payable to Harney County Watershed Council). If a sponsor pays my camp fee, I agree to relate my experience to the sponsor or sponsoring group. I understand that I may be photographed while participating in camp activities and give permission for photos to be published to promote the High Desert Youth Range Camp. APPLICANT NAME: NAME OF PARENT(S)/GUARDIAN:
BIRTH DATE:
PHONE NUMBER:
CELL NUMBER:
ADDRESS:
CITY, STATE, ZIP:
COUNTY:
E-MAIL ADDRESS:
NAME OF SCHOOL:
CURRENT GRADE:
SCHOOL ADDRESS:
CITY, STATE, ZIP:
NAME OF REFERENCE: T-shirt size? _______ A minimum payment is due once the application is accepted. Many delegates to Range Camp are sponsored inpart by their local conservation district or other organizations. Are you interested in receiving a scholarship in the amount of $125? Yes No Please mail, fax, or e-mail applications to: Brenda Smith, Eastern Oregon Agricultural Research Center, 67826-A Hwy 205, Burns, OR 97720, (fax) 541-573-3042, brenda.smith@oregonstate.edu A letter of recommendation must accompany your application. The letter of recommendation must be from an adult other than a parent or sibling. If you e-mail the application, the letter of recommendation must be a scanned copy of his/her letter and signature or typed on the adult’s official stationary. Letter must include reference’s full contact information including name, address, phone number, and relationship to student. Signature of Applicant
Date:
Signature of Parent/Guardian
Date: Last Updated 12/3/13