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
*
Please Select
Allegany County
Anne Arundel County
Baltimore City
Baltimore County
Calvert County
Caroline County
Carroll County
Cecil County
Charles County
Dorchester County
Frederick County
Garrett County
Harford County
Howard County
Kent County
Montgomery County
Prince Georges County
Queen Anne's County
St. Mary's County
Somerset County
Talbot County
Washington County
Wicomico County
Worcester County
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
*
Please Select
Club meeting
Project meeting or work session
Community service
Field Trip
Workshop, training, or practice
Competitive even (show, contest, etc)
Other
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
*
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Must use the form found on the Maryland 4-H Website COVID-19 Resources for Volunteers page
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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
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4-H Incident Report Form & Instructions can be found on the Maryland 4-H Website COVID-19 Resources for Volunteers page
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