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Summer Workshop Series Registration
PLEASE COMPLETE ONLY 1 FORM PER INDIVIDUAL.
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* Indicates required question
Email
*
Your email
Youth Name
*
Your answer
4-H County
*
Your answer
Age (as of 1/1/18)
*
Your answer
Is youth a 4-H member?
*
Yes
No
If not, would you like to learn how to join?
Yes, email me!
No, thank you.
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Parent/Guardian Name
*
Your answer
Parent/Guardian Email
*
Your answer
Emergency Contact Name
*
Your answer
Emergency Contact Phone Number
*
Your answer
Youth's known allergies
Your answer
I grant Nebraska Extension in Washington County permission to use my child's photo for any lawful purpose.
*
Yes, I agree to the above Photo Release.
No, do not take my child's photo.
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