New User Account Request Form
Manitoba 4-H Council Inc. (M4HC) 658 10th Street Unit A Brandon, MB R7A 4G5
Note: Complete only ONE form for each new volunteer to be enrolled.
Name (Please Use Legal Name)
*
First Name
Middle Name
Last Name
Date
*
-
Month
-
Day
Year
Date
Email
example@example.com
Address
Street/Site/Comp/Group
Box/Apt/RR
City
State / Province
Postal / Zip Code
Primary Phone
Please enter a valid phone number.
Alternate Phone
Please enter a valid phone number.
Date of Birth
-
Year
-
Month
Day
Date
Consent Section
Communication Consent - There are many events and opportunities for 4-H Leaders offered by 4-H Manitoba. 4-H Canada and our other partners. Manitoba 4-H Council Inc. uses electronic communications to make 4-H families aware of the opportunities available to them. By giving your consent, we can send you important information about scholarships, travel awards, program, fundraising opportunities, events, and competitions. You can unsubscribe from electronic messages at any time.
Communication Consent
*
Yes, I consent
No, I do not consent
I hereby request that a User Account be created on the 4-H Manitoba database. Once created, my User Account Username and Password will be emailed to me.
I understand that to enroll as a New Leader in a club, I must first be approved by M4HC staff. I intend to enroll as a :
*
Head Leader
Head Leader Designate
Leader
Undesignated Volunteer
The club I intend to enroll in is within the following area council:
*
Please Select
Valleys North
North Parkland
South Parkland
Southwest
Pembina
Red River
North Interlake
South Interlake
Eastman
Central Plains
Unknown
I understand that I must complete a Infectious Diseases waiver to enroll/participate in 4-H Manitoba clubs/activities.
References
Head Leaders, Head Leader Designates, and Leaders please fill out at minimum two of the below areas. Name and Email MUST be filled out. Spouses/Partners are not to be used as references.
Your Name
First Name
Last Name
Reference 1 Name
*
Reference 1 Email
*
example@example.com
Relation to Reference 1
*
Reference 2 Name
*
Reference 2 Email
*
example@example.com
Relation to Reference 2
*
Reference 3 Name
Reference 3 Email
example@example.com
Relation to Reference 3
Date
*
-
Month
-
Day
Year
Date
Signature
*
Back
Next
Thank you!
Thank you for completing the New Volunteer Onboarding Form, your outlined references will automatically be contacted. Once you click "Submit" below, you will receive an email with the documentation you will need to complete for your Child Abuse Registry Check (please follow the directions on the documents). You will now be forwarded to the Criminal Record Check Form, please fill out all of the information. Once completed a PDF will be generated which you will take to your local detachment. You will then be forwarded on to the New Volunteer Onboarding Series which will satisfy your Youth Safety at 4-H in Canada course!
Submit
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