Cedar County 4-H Lock-In - sponsored by Cedar County Youth Council
THIS FORM MUST BE SUBMITTED FOR ALL ATTENDEES!!

Event Timing: January 18-19th, 2020 (check-in 8:30-9pm; pick-up 7-7:15am)
Event Address: Tipton High School (enter thru northeast door off of Plum St.)

ALL 4th-8th grade welcome (do not need to be 4-H members)
4-H members may bring guests (also in 4th-8th grade)
$25 per youth (checks made to Cedar County Extension) by 1/19/20 at 4pm; $30 at the door
Food and beverage will be provided, please do not bring any food
No phones or electronics may be brought in!

Please bring warm gloves, hats, or mittens for a Service Project.  Those who bring an item will be entered into a drawing for prizes!

Contact us at (563) 886-6157 or tbohlman@iastate.edu
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Name of 4-H member (if you are not a 4-H member or guest of one please write N/A) *
Name of Guest or non 4-H member
Parent/guardian *
My child is a: *
Parent/guardian Phone number *
Emergency contact name and number (other than parent listed above) *
Email of parent *
Who will pick youth up? *
Youth - I understand that no alcohol, tobacco, smoking, drugs (unless prescription) or inappropriate behavior are allowed.  I understand that once I arrive I will not leave unless permission is granted by my parent/guardian and approved by the chaperoning staff. I understand that no cell phones, electronics, or food should be brought to the lock-in. *
Required
Parent - I, the parent/guardian of the above-named youth, hereby, give permission to participate in the 2020 Cedar County 4-H Lock-In.  I also give permission for first aid and admittance to a hospital for necessary medical care in case of emergency. *
Required
Parent - If your youth is a 4-H member:  I understand that they must be enrolled in 4hOnline and that information will serve as their medical and release information.  If your youth is a guest of a 4-H member or a non 4-H member:  I understand that I must complete an Iowa 4-H Medical Information/Release Form prior to their admittance.  You can print that form from this website: https://www.extension.iastate.edu/cedar/ *
I understand that I will have to pay $25 per youth (checks made our to Cedar County Extension) prior to 4pm on 1/17/20 or $30 per youth upon arrival to the Lock-In for admittance. *
Required
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