Discover 4-H Day - Registration and Participation Agreement

Discover 4-H Day!

Registration Form and Participant Agreement
February 1, 2025 2pm-4pm
Iron Bridge Recreation Centre - 1 Chiblow Lake Road

Contact us at: huronshores4h@gmail.com
Child Information
Child's Name*

First NameLast Name
Birth Date*

MonthDayYear
Gender

MaleFemalePrefer not to disclose
Address*

Street Address

Street Address Line 2

CityProvince

Postal CodeCountry
Parent/Guardian Information
Name*

First NameLast Name
Cell Number*

Area CodePhone Number
Home Number (if applicable)

Area CodePhone Number
E-mail*
Does the child have any allergies, chronic illness, or medical conditions? If yes, please describe.
Emergency Contact Information
Emergency Contact #1*

First NameLast Name
Phone Number*

Area CodePhone Number
Emergency Contact #2*

First NameLast Name
Phone Number*

Area CodePhone Number
Informed Consent and Acknowledgement

I hereby give my approval for my child’s participation in any and all activities prepared by the Iron Bridge 4-H Club during the Discovery 4-H event.

Photo Release

I grant the Iron Bridge 4-H Club and the Municipality of Huron Shores permission to publish photographs and/or video recordings of this event in which my child may be included, for advertising and promotion purposes.
YesNo
Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
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Discover 4-H Day!