2025 Jr. Master Gardener Program
NEW this year- Warren County Extension and Outreach is hosting a 6 week Jr. Master Gardener program for 2nd & 3rd graders. This program will be hosted Friday mornings from 9AM - 10AM at the Warren County Master Gardeners Community Garden, located just east of the Indianola Parks and Recreation Building. Youth will learn from local Master Gardeners who will share their knowledge about (topics) through fun, interactive activities. Cost is $50 per youth, which covers your very own JMG book, off-set direct expenses and to support the 4-H Youth Development County Extension Program.
Name of Parent/Guardian
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Name of Child (One per form)
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Email
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Phone Number
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Grade just Completed
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Second Grade
Third Grade
Gender Information
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Male
Female
Non-binary
Prefer not to say
Gender Identity Not Listed
Emergency Contact Information
Name
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Relationship
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Phone Number
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Health Information
Does your child have any allergies (food, medications, etc.)
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Yes
No
If yes:
Does your child have any medical conditions?
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Yes
No
If yes:
Program Dates
Fridays beginning June 6th - July 18th. WE WILL NOT MEET FRIDAY JULY 4TH!
I understand that in order for my child to receive the Jr. Master Gardener Certification, they must attend ALL 6 days.
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Yes, I understand
Is this youth a current Warren County Clover Kids member? - Enrollment is not required to attend.
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Yes
No
4-H assumption of Risk and Release of Liability:
I give my permission for__________________ to participate in the Iowa 4-H program. I understand that 4-H club project activities/events may involve certain risks of physical activity and possible injury and that Iowa State University and its4-H program will provide each participant with reasonable care, but that ISU cannot guarantee that I or my child will remain free of injury. In addition, some 4-H projects including but not limited to: shooting sports, horse or livestock projects, water activities, and other sporting activities have a higher degree of risk. I nonetheless wish to have myself or my child participate as an Iowa 4-H club member in the 4-H club program and ASSUME the RISK of participating. I hereby RELEASEFROM LIABILITY AND COVENANT NOT TO SUE, the State of Iowa; the Board of Regents for the State of Iowa; Iowa State University; ISUEO, and the County Agricultural Extension District, and all of their respective officers, employees, agents, and volunteers (the “Releasees”) from any and all liability, claim and/or cause of action arising out of or related to any loss, damage or injury, including death, that may be sustained by myself or my child, or to my property resulting, in whole or in part, from my own or my child’s participation in the Program, to the fullest extent permitted by law. In addition, the undersigned, on behalf of themselves and any personal representatives, heirs, assigns, and next of kin, HEREBY AGREES TOINDEMNIFY AND HOLD HARMLESS the Releasees from any and all liability for injury, including illness, disability, and death, and property loss or damage that may result from, arise out of, or be related to my own or my child’s participation in the Program, to the fullest extent permitted by law.
I HAVE READ THIS AGREEMENTIN FULL, AND I UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UPSUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUTANY INDUCEMENT.
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Yes
No
Publicity/Image/Voice Permission
The Iowa State University Extension and Outreach 4-H Program normally takes photographs, video, and/or tape recording of our programs. During activities, a photograph or video/audio recording may be taken of you. Unless you request otherwise, your consent below will be considered permission for Iowa State University, the County Agricultural Extension District, and the 4-H Program to photograph, film, audio/video tape, record and/or televise your image and/or voice for use in any publications or promotional materials, in any medium now known or developed in the future without any restrictions.
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Yes
No
I understand that workshops are limited capacity and I may be put on a waitlist. (You will be notified).
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Yes
Payment
All registrants will be sent an invoice for the $50 Program Fee. This fee covers your very own JMG book, off-set direct expenses and to support the 4-H Youth Development County Extension Program. If you are in need of financial assistance, please contact Bethany Cecot at bcecot@iastate.edu
I understand that I will be sent an invoice for the $50 Program Fee. I understand that the invoice must be paid by Friday May, 30th for my child to participate in the program.
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Yes
By signing below, I give my child permission to attend Warren County Extension and Outreach workshop.
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Submit
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