Tuesday Take Homes Registration

Tuesday Take Homes Registration

Please fill out a registration for each student participating.
Student Name*

First NameLast Name
Parent Name

First NameLast Name
Student Birth Date

MonthDayYear
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
E-mail*
example@example.com
Mobile Number*

Area CodePhone Number
Sign up for the rest of the summer.

Yes, please!No, thank you. Just this week!
Are you currently a member of 4-H?*

YesNo
If you are a 4-H member, you do not have to answer the following questions. If you selected no, the following questions are voluntary.
Gender
Grade
Residence

FarmRural (pop under 10,000)Town (pop 10,000 - 50,000)Suburb (pop over 50,000)City (pop over 50,000)
Race

WhiteBlack or African AmericanAmerican Indian or Alaska NativeAsianNative Hawaiian/Pacific IslanderOther
Ethnicity

HispanicNon-HispanicPrefer Not to Answer
If have been participating in Tuesday Takes Homes, please rate your experience. We would love any of your feedback to better serve out community!
Additional Comments
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