Post-Activity Report

Post-Activity Report

Use this form to report required information from your 4-H Activity. This report should be filed within 48 hours of completion of the activity.
Activity Leader's Name *

First Name Last Name
Activity Leader's 4-H Title *
4-H Volunteer, 4-H Program Assistant, 4-H Club Leader, etc
Email *
Email of Activity Leader filing this report
Phone Number *
Phone number of Activity Leader filing the report.
4-H County/City *
4-H county/city program where 4-H activity was held
Name of 4-H Activity *
Name approved in the 4-H activity request. (October Club meeting, Fall service project, Hippology practice, etc.)
4-H Activity Type *
Choose the type that BEST describes the 4-H activity.
Activity Date *

Month Day Year
Date the activity was held.
Activity Time (Start-End) *
4-H activity's start time and end times. (EXAMPLE: 7:00 pm - 8:30 pm)
Activity Location *
Name of location where the 4-H activity was held (Clover Park, Clover County 4-H Office Parking Lot, Cloverville Church, etc
Did this 4-H Activity include more than one session? *

Yes No

If this 4-H Activity held more than one session, provide the information about EACH session below.

Time

Location

# Participants

Leader #1

Leader #2

Session 1

Session 2

Session 3

Session 4

Session 5

Names of 4-H Activity Leaders *
Type the first and last names of the adult leaders of this 4-H activity. If this activity had multiple sessions, include names for ALL session leaders here.
Names of 4-H Activity participants *
Type the first and last names of all youth/others who participated in this 4-H activity. Include only those who were physically on-site, if a virtual participation option was offered. If this activity had multiple sessions, include names for ALL session participants here. Names listed here should match the Attendance Record(s).
Upload the completed Attendance Record *

Must use the form found on the Maryland 4-H Website COVID-19 Resources for Volunteers page
Cancel of
Were completed Health Pledges collected from all participants? *

Yes No
If Health Pledges were NOT collected from all participants, explain why.
Did anyone leave this 4-H Activity because they did not feel well or displayed symptoms of illness? *

Yes No
Was anyone turned away from this 4-H Activity because they did not present a Health Pledge or because they presented a Health Pledge with "Yes" answers to a health-related question? *

Yes No
Was a 4-H Incident Report completed for something that happened at this 4-H Activity? *

Yes No
Upload 4-H Incident Report(s) completed for this 4-H Activity

4-H Incident Report Form & Instructions can be found on the Maryland 4-H Website COVID-19 Resources for Volunteers page
Cancel of
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