4-H Liability Waiver Form: Youth

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"Due to COVID-19 our 4-H policies and procedures have been updated. Our standard liability waivers contains new language which require updated consents. Please take a minute and review the information and complete the form."

Email *

Option 1

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Option 1

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Full Name of Participant *

Participant Mailing Address *

Participant County of Residence *

The Participant Lives: *

Farm

Town under 10k or Rural Non-Farm

City 10k-50k

Suburbs

City over 50k

Military Installation

Other:

Participant Gender *

Male

Female

Other

Participant Ethnicity *

Hispanic or Latino

Non-Hispanic or Latino

Required

Participant Race *

American Indian or Alaska Native

Asian

Black or African-American

Native Hawaiian or other Pacific Islander

White or Caucasian

Other

Participant Grade in School *

Does this individual require any special accommodations participate in this program? If so please describe the need below.

Is the participant a member of 4-H and registered in 4-HOnline?

Yes

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Parent / Guardian Full Name *

Parent / Guardian Mailing Address if different than above

Cell Number *In case you need to be reached during a program. *

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