Project In A Box Sign Up for 4-H members (free!)
Fill out this form for EACH household which will be utilizing the Project In A Box. If your household has more than 3 youth who will be using the box, please fill out this form again to include the additional participants. Thank you!
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Household Last Name: *
Which Box Would You Like to Reserve? *
What date would you like to pick up your box? *
First and last name of Youth Participant 1 who will be using the Project In A Box: *
Youth Participant 1 Race (federal reporting requirement): *
必填
Youth 1 Participant Ethnicity (federal reporting requirement): *
必填
First and last name of Youth Participant 2 who will be using the Project In A Box (if not applicable, leave blank):
Youth Participant 2 Race ((federal reporting requirement) - If not applicable, leave blank:
Youth Participant 2 Ethnicity (federal reporting requirement) - If not applicable, leave blank:
First and last name of Youth Participant 3 who will be using the Project In A Box (if not applicable, leave blank):
Youth Participant 3 Race (federal reporting requirement) - If not applicable, leave blank:
Youth Participant 3 Ethnicity (federal reporting requirement) - If not applicable, leave blank:
Household Email Address: *
Household Phone Number: *
Household Address (where box will be located): *
Does anyone in your household require an accommodation to participate in this activity? (If yes, please describe your request in "Other." Thank you!
Would you like the information inside the box to be translated into a language other than English? If yes, please list the language requested in the "Other" box.
How did you hear about this activity? *
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