Camper Forms & Information

Camp Fee

The cost of camp is $285.00 and includes a 4-H t-shirt, lodging, meals, programs, instructional class materials, and transportation by chartered bus.


  • Payment may be made by check or money order only and should be made payable to “Henrico 4-H Fund.”
  • All cancellations, regardless of date, must be made in writing to receive a refund. After July 5th, no refunds will be provided when vacancies are created without medical justification.
  • Payment plans may be arranged in some circumstances.
  • Some scholarship assistance may be available.
  • In the event your check is returned unpaid, an additional service charge of $50.00 will be added to your amount due for the processing of the returned item as allowed by the Code of Virginia and the Code of Henrico County.

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The following forms must be printed, filled out completely, and mailed, along with the camp fee, to:

PO BOX 90775
HENRICO, VA 23273-0775

Required Forms:

Health History Form

Code of Conduct Form

Henrico 4-H Participant Form



Health History Form

Please provide detailed health information for determining appropriate supervision, support, and accommodations for your camper. If the camper is a person with a disability and desires any assistive devices, services or other accommodations to participate in this activity, please contact the Henrico Extension office during business hours to discuss accommodations prior to registering for camp. Complete all information as requested. Don’t forget to:

  1. Participant Identification
    • Underline the name by which the camper would like to be called.
    • Correctly indicate the camper’s gender.
    • Correctly list the camper’s age and birthdate
    • Indicate the camper’s ethnicity and race. Why do we ask for ethnicity and race?
  2. Parent/Guardian Identification
  3. Physician/Insurance Information
  4. Emergency Contact Information
  5. 4-H Participant Media Release
    • Check YES -or- NO as desired.
  6. Participant Health and Medical History
    • Disclose your camper’s special dietary needs; heath conditions; current problems that the camper may be receiving medical care or taking medication for; changes in health status like surgery, injury, illness, and/or allergy in the last year; and anything else you would like us to know about your camper.
  7. Approval/Emergency Authorization
    • Have both the PARENT/GUARDIAN and CAMPER sign!
  8. Immunization History
    • Immunization information – Check YES -or- NO.  Proof of a doctor’s visit or physical IS NOT REQUIRED.
    • List DATE OF LAST TETANUS SHOT– Month/Year.
  9. Release Authorization
    • List all persons, including yourself, to whom you give permission to pick up your camper from camp for any reason.

Code of Conduct Form

The Code of Conduct Form requires both the PARENT and CAMPER’S signatures! Also, please place camper’s name on the top, front of the form.

Henrico 4-H Participant Form

The Henrico 4-H Participant Form requires participant name, participant type, and t-shirt size. This form can also be used to purchase Henrico 4-H Camp Souvenirs (optional).


(**What happened to the Class Selection and Medication forms? Campers will select classes at camp again this year.  We will ask for Medication forms (if needed) closer to the date of camp.)




Henrico 4-H Camp Orientation

  • When: Thursday, July 18th
  • Time: 6:30pm – 7:30pm
  • Where: Eastern Henrico Recreation Center
    1440 N. Laburnum Avenue, Henrico, VA  23223

On Thursday, July 18th, there will be a 4-H Camp Orientation for both the campers and their parents. This will be a time to hear more details about the registration check-in, what to expect at 4-H camp, and the check-in and check-out procedures. We will also give tips on how to prepare your camper for being away from home. There will be time afterwards for individual questions and answers. Teen Counselors will be on-hand to meet the campers and parents. This orientation, while not mandatory, is highly suggested for new campers.



Jamestown 4-H Center

Jamestown 4-H Education Center
Family Fun Day & Open House

  • When: Sunday, June 2nd
  • Time: 1:00pm – 4:00pm
  • Where: Jamestown 4-H Center
    3751 4-H Club Road, Williamsburg, VA 23185
    (757) 253-4931

Join us at the Jamestown 4-H Education Center Family Fun Day and Open House on Sunday, June 2, from 1:00pm – 4:00pm.  Jamestown 4-H Educational Center is located outside of Williamsburg along the banks of the James River. With 16 wooded and open acres, Jamestown 4-H Center maintains a rustic atmosphere.

Amenities include:

  • Air-conditioned Lodges and Cabins
  • Swimming Pool w/ diving boards & lifeguards
  • Camp Store & Craft Shop
  • Archery & Rifle Ranges
  • Pier
  • Aquatic Science Lab
  • Ropes Course
  • Basketball Courts & Athletic Field
  • Picnic Pavilions
  • Air-conditioned Dining/Recreation Halls
  • Amphitheater
  • Clinic with EMT



Check-In, Transportation & Pick-up

Check-In and Pick-Up point is FAIRFIELD MIDDLE SCHOOL. Transportation will be by chartered bus.

HENRICO, VA  23223


Check-In: 8:15am on Monday, July 29th.

At check-in, campers will verify their names, deposit funds in the camp bank, turn in all medication (with medication form), and obtain a boarding pass for the bus.


Pick-up: About 12 noon on Friday, August 2nd.

Adults should arrive by 11:45am (no earlier than 11:30am) on Friday to pick up campers. Check-out procedure can begin prior to the campers arrival.

CHECK-OUT PROCEDURE– Campers will remain on the bus until signed out. Adults will be returned their camper’s bank envelope and medication. They will then receive a pass to take to the bus to claim their camper. This check-out policy is for the youth and the parent’s protection to assure the appropriate permitted person is the one who will be picking up the youth. Please list persons permitted to pick up camper on the bottom of the Health History Form.

**Please note: Abandoned campers will be placed in police custody if parents cannot be reached.



Campers, CITs, or Teens who will not be riding the bus for whatever reason must have a letter on file with the Extension Office stating that fact. Otherwise, we will expect all Campers, CITs, and Teens to ride the bus to and from camp.


Medication is any substance a person takes to maintain and/or improve their health.  This includes over-the-counter medications for headaches or colds, vitamins, natural remedies, etc.

Will your camper be taking medication to camp?  To keep changes to a minimum this year, we will be asking for Medication Forms to be completed and returned closer to the date of camp.

Medication is kept in the Jamestown 4-H Center Clinic and distributed by camp medical staff.

  1. Youth under 18 years old will not be allowed to keep ANY medicines with them at camp.
  2. The only exception to this rule is that of a second inhaler. Those bringing inhalers must bring two (2)– one to carry and one to keep at the clinic.  If only one (1) inhaler is brought to camp, it must be kept in the clinic.
  3. Medications are to be turned in at camp check-in. The staff at the medication table will match the medication and dosage information to the Medication form before accepting.

Medication must be in it’s original container.

  1. All medication must be in its original container with the camper’s name printed on the container.
  2. If a prescription, medication must be in the original prescription container with camper’s name printed on prescription label.
  3. If over-the-counter, please print the camper’s name on the original container.
  4. Bags, other bottles, bottles printed with someone else’s name, or any other type of containter besides the original, will not be accepted.

Dosage on the bottle must match dosage listed on Medication Form.

  1. Actual dosage listed on the bottle will be followed unless there is a written note from the prescribing doctor outlining different indications.
  2. This pertains to both prescription and over-the-counter medications.
  3. Please provide enough medication to last the entire time while at camp.

All medication containers must be placed in a gallon-sized, Ziploc-type plastic bag along with a copy of the Medication Form.

  1. Place all medication containers in a gallon-sized, Ziploc-type plastic bag.  A copy of the Medication Form must also be in this bag.
  2. All bags of medication must be labeled in BOLD PRINT with the “camper’s last name, first name,” our county “Henrico,” and the camper’s bus number “Bus #” as shown below and include a copy of the medication form. ***Note: A Medication form will be distributed closer to camp. Also, you will be informed of your camper’s bus number in a future mailing.


It is not necessary to send over-the-counter medication for conditions that presently do not exist.

  1. If needed, over-the-counter medication is provided and distributed by the camp medical staff to manage illness and injury while at camp. These medications include:
    • Acetaminophen (Tylenol)
    • Sore Throat Spray
    • Ibuprofen (Advil, Motrin)
    • Bacitracin/First Aid Cream
    • Robitussin
    • Antacid (Mylanta, Tums, Pepto Bismol)
    • Pseudoephedrine decongestant (Sudafed)
    • Aloe
    • Antihistamine/allergy medicine
    • Orasol/Ambesol
    • Ivy Block/Tecnu
    • Lice Shampoo (Nix)
    • Calagel, Calamine, Hydrocortisone
    • Diphenhydramine antihistamine/allergy medicine (Benadryl)
    • Generic Cough Drops
  2. If your camper should NOT be given any of the over-the-counter medications listed above for any reason, please note this on the Health History Form.

Have questions or concerns?  Please contact us prior to camp registration to discuss your camper’s requirements.

What to Bring to CampBring2Camp

  • Sleeping bag or 2 sheets and a blanket for twin mattress
  • Pillow and pillow case
  • Towels-2 (one for bathing and one for swimming), wash cloths, and toiletry articles (toothbrush, toothpaste, soap, shampoo, deodorant, etc.)
  • Clothes for the week (comfortable casual clothes for warm weather – no dress clothes are needed) including long pants and a lightweight jacket for cool evenings/mornings.
    • Shorts: the length of shorts/skirts should follow the finger-length rule –extend arms down by your side; your shorts/skirt must fall at or below the fingertips.
    • Shirts: No excessively low-cut shirts; clothing that exposes the back or midriff; or clothing that undergarments may be seen. Tank top straps must be a minimum of one inch in width.
    • No clothing, jewelry, or other accessories with lettering, slogans, signs, symbols, logos, or advertisements of controlled substances or obscene messages. Clothing should not offend any segment of the camp population on the grounds of ethnicity, race, religion, gender, sexuality, handicap, or national or geographic origin or residence.
  • Shoes: Two pair of comfortable shoes or sneakers, one of which should be able to get wet and should hold the heels of the feet well (not flip-flops). Remember, closed toe shoes (like sneakers) are required for riflery and to play gau-gau!
  • Swimwear: Swim trunks or swimsuit; Any swimsuit that does not meet to cover the stomach must be worn with a dark colored t-shirt over it that completely covers the swimsuit and torso.
  • Hat, Sunglasses, Water Bottle, Flip-flops.
  • Sunscreen, Bug Spray (remember-no aerosol cans)
  • Lightweight Jacket (cool nights or possibly rain)
  • Plastic bag for wet items going home
  • Watch, Camera
  • Pen & paper with self-addressed, stamped envelopes for writing home
  • Money for Camp Store (souvenirs and snacks)—small bills are preferred
  • Necessary medication & medication form (in a gallon sized zip lock bag with name and bus written)


  • Cell Phones are not allowed at 4-H camp!

    If a cell phone is discovered at camp, it will be confiscated and returned to the camper’s parent on Friday during check out

  • Anything in an aerosol spray can
  • Handheld video games, iPods, TVs, MP3 players, or anything expensive or easily broken
  • Knives, fireworks, matches, or similar articles


It is suggested that campers bring no more than $10-$15 cash (one dollar bills, please) to spend at the camp store. The camp store has drinks, snacks, post cards, crafts, etc. If you plan to buy a Jamestown t-shirt or other souvenirs at camp, extra funds may be needed. Remember, Henrico 4-H water pouches and backpacks are only available in advance by filling out the Henrico 4-H Participant Form.

Contact Information

Henrico Extension Office–(804) 501-5160

Jamestown 4-H Center (Emergency Use Only)–(757) 253-4931

Please do not encourage campers to call home and “check-in” as campers are not allowed to use phones except in an emergency. Phone lines are limited and our camper audience is large.

*Participants are not allowed to bring cell phones to camp.


You may send correspondence to your camper by mailing notes, letters, or cards.  Care packages may also be sent, however it is encouraged that you do not send food or candy as food and candy are not allowed in the cabins or lodges.

Worried your correspondence will not reach your camper while at camp?  Mail it early (before the Monday of camp) or give it to our 4-H Extension Agent when you drop off your camper.

Correspondence may be sent to the following address:


Jamestown 4-H Center
Henrico County
ATTN: (Insert camper’s name here)
3751 4-H Club Road
Williamsburg, VA 23185




Contact Us

Extension Office

Physical Address
8600 Dixon Powers Dr.
Henrico Government Complex
Human Services Building
Henrico, VA 23228

(804) 501-5160

(804) 501-5169

Mailing Address
P. O. Box 90775
Henrico, VA 23273-0775


Office hours:
8:00 a.m.- 4:30 p.m. EST,
Monday through Friday

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