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 Name Last 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 Name Last 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

City State / Province

Postal / Zip Code
Home Phone (if applicable)

Area Code Phone Number
Cell Phone (if applicable)

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

Area Code Phone Number
Parent Email *
example@example.com

4-H Opportunities for Fall
PROGRAM DESCRIPTIONS (DOWNLOADABLE PDF)
For Fall, we have six different programs to choose from -- five in-person clubs and one virtual one. If you are not able to download or view a copy of our program descriptions above, please email Kerry Jones to request a copy prior to registering.

Registration is on a first-come/first-served basis. We recommend that you register your child as soon as possible to ensure his/her spot in your chosen programs.
Cloverbud 4-H Discovery (ages 5-8)
Polk Poultry Program (ages 9 & up)
Science of Racing (ages 9-12)
Clover Kitchen (ages 9 & up)
Teen Council (ages 12 & up)
Intro to Graphic Design - Virtual Class (ages 12 & up)
Have questions before you click "Submit" to submit your registration below? Contact Polk County 4-H Agent Helen Blackwell by phone at 828-894-8218 or by email.
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POLK COUNTY 4-H FALL REGISTRATION