4-H Winter Registration 2021

POLK COUNTY 4-H FALL REGISTRATION

2021 4-H Options for Fall Semester
Personal and Demographic Information
Child's Name*

First NameLast Name
Child's Current Age*
Child's Current Grade Level (as of the 2021/2022 school year)*
Gender of Child*
Parent or Guardian Name*

First NameLast Name
Relationship to Participant*
TIME-SAVING ANNOUNCEMENT!

If you are registering more than one child, you only need to fill out the following address, phone number and email fields ONCE. For all additional online registration forms for children in the same family, you may leave these fields blank.

However, if you are only registering one child, PLEASE FILL OUT ALL FIELDS BELOW.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone (if applicable)

Area CodePhone Number
Cell Phone (if applicable)

Area CodePhone Number
Best number to reach you for class changes, cancellations, or emergencies*

Area CodePhone Number
Parent Email*
example@example.com

POLK COUNTY 4-H FALL REGISTRATION