Event Registration for 4-H Meets Wolcott Farming 101 Animals and Agriculture

Youth Information

* First Name

* Last Name

Pronouns

* Address

Addt'l Address

* City

* State

* Country

* Zipcode

* Phone Number

* E-mail If you supply an e-mail address, a receipt for your registration will automatically be sent to that account. An e-mail address is required to pay using a credit card.

Contact Information Cont.

Are you interested in receiving text message reminders for this program? * Yes No

If you selected yes, please enter a phone number that can accept text messages Family is responsible for any charges that may be charged by the phone carry to deliver messages.

* Emergency Contact: Please provide the name of the parent/guardian who should be contacted in case of emergency.

* Emergency phone number Pleas provide the phone number of your emergency contact

Event Registration

* I would like to register for this event
You must register for at least one class.

Please check which classes you plan to attend. (Check as many as you want): * Nov 2 -Kickoff, Introduction and Tour November 16 - Horses November 30 - Goats December 14 - Sheep January 11 - Poultry January 25 - Rabbits

Youth Demographics

MSU Extension is interested to know more about who is attending programs to help identify potential gaps in audience reach. The following questions are optional to answer but we would appreciate any information you would be willing to give to help us understand more about our audiences served.

Parents or guardians will need to fill out demographic information for the youth if a youth is under the age of 18.

* Residence Type

* Grade

* The youth is enrolled in a special education program

Military Status - Parent * No one in my family is serving in the military I have/had a parent serving in the military Choose Not To Respond

* Branch and Component of Service - Parent

Military Status - Sibling * No one in my family is serving in the military I have/had a sibling serving in the military Choose Not To Respond

* Branch and Component of Service - Sibling

4-H Information

* 4-H Age (age as of January 1) Enter a whole number between 1 and 19.

* The youth is enrolled in 4-H Online

* If you selected no, are you interested in learning more about 4-H?

* County Enrolled in 4-H

Photo Media release

I authorize Michigan State University to record my image and voice (or that of my minor child named here) and give Michigan State University and all persons or entities acting pursuant to MSU's permission or authority, all rights to use these recorded images. I understand that said images will be used for educational, advertising and promotional purposes in all conventional and electronic media, and any future media. I also authorize the use of any printed material in connection therewith. I understand and agree that these images and recordings may be duplicated, distributed with or without charge, and/or altered in any form or manner without future/further compensation or liability, in perpetuity.

* Please Indicate your authorization