Speak Out For Agriculture XVII Registration Form
South Dakota-bound! Please note, you will pay $50 (check payable to Adair County Extension) and sign a waiver and complete a Health Form. These will need to be turned in to your County Extension Office or mailed. Registration is due May 24th.
Name of Youth Attending
*
First Name
Last Name
Current Age:
*
Address:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
School:
*
Grade Completed Spring 2022:
*
8th
9th
10th
11th
12th
Youth Cell Phone:
*
Please enter a valid phone number.
Dietary Restrictions:
Special Accommodations:
Parent/Guardian Name:
*
First Name
Last Name
Phone Number:
*
Please enter a valid phone number.
Secondary Contact Name:
*
First Name
Last Name
Phone Number:
*
Please enter a valid phone number.
Participant T-Shirt Size:
*
Please Select
Small
Medium
Large
XL
XXL
XXXL
June 14th Pick-Up and June 15th Drop-Off Point:
*
Please Select
Home Store and More parking lot, Greenfield
Cass County Extension Office, Atlantic
Love's Travel Stop, Shelby
The participant and parent/guardian know that on June 15th, the dress code for the day includes full-length pants (no shorts) and closed-toed shoes (no sandals). A SOFA t-shirt will also be provided to be worn on the 15th. Failure to dress accordingly will bar the youth from going on a tour, and they will have to wait on the bus.
*
Yes; the participant will pack accordingly.
Check the boxes of the Code of Conduct to show that both the parent/guardian and participant have read them. Checking the box also indicates that the participant is agreeing to the Code of Conduct.
*
Submit
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