Transcript REGISTRATION FORM

2016 Junior 4-H Trip
August 2nd –3rd
COST: $110.00
This trip will be an overnight trip! The bus and trip schedule is
attached . Once you sign up for this AWESOME trip you will
receive more information on what you will need to bring for the
trip. Fill out the bottom portion and remit with payment to
your local Extension Office by June 1st. Check should be made
payable to Davis County Extension. Please call your CYC if you
have any questions.
Name ___________________________________________________
Address _________________________________________________
City/Town _____________________________ Zip _______________
Phone ________________________________ Grade _____________
County __________________________________________________
Email ____________________________________________________
Pick-Up Location(Circle One): Albia
Centerville
Corydon
There are 40 spots available for this trip. It will be first come, first serve so please don’t
wait to turn in your registration form!
* Registrations are due to your county office by June 1, 2016
Extension programs are available to all without regard to race, color, national origin, religion, sex, age, and disability.
The fees for service will be used to offset direct expenses and to support the Families County Extension Program.