Workshop Registration

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Pick From:
Culture Camp FREE
Home On The Range $5 member $10 non-members
A Day In The Life of A Scientist $5 member $10 non-members
Become A Better Showman FREE
Strong Body Healthy Mind FREE
Catch It All On Video $10 member $15 non-member
Photo Finish $10 member $15 non-members
Electricity + Sewing = Monster Creation $15 member $20 non-members

Name *

Parent's Name *

Parent's Phone Number *

Parent's Email Address *

Additional Emergency Contact *

Workshop/s *

Culture Camp June 20th 5:30pm-7:30pm UNL Panhandle Research and Extension Center

Home On The Range June 20th 9am-12pm UNL Panhandle Research and Extension Center

A Day In The Life Of A Scientist June 22nd 9am-11:30am AGES 5-7 UNL Panhandle Research and Extension Center

Become A Better Showman @ Scotts Bluff County Fairgrounds July 6th 5-7pm

Become A Better Showman @ Morrill County Fairgrounds July 12th 5-7pm

Strong Body Healthy Mind July 11th 10am-1pm Guadalupe Center

Photo Finish July 16th at Fairgrounds

Required

Are you a 4H member? *

Member

Non-Member

Required

Dietary restrictions *

None

Vegetarian

Vegan

Gluten-free

Other:

Does your student/s require any additional accommodations? *

I understand that I will have to pay for the workshop in which my student/s will be participating in at the time of the event. *

Yes

Required

I (the parent/guardian) understand that the 4H program will not be responsable for any injuries that could potentially occur while participating. *

By submitting this form I agree to the terms outlined above.

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