The Farmer and the Belle 2
Extras Information
Name
*
First Name
Last Name
Is the Registrant a Minor?
*
Please Select
Yes
No
If so, please list Minor's Age
If so, please list Parent's Name
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Please select one:
*
Male
Female
What is your Ethnicity?
*
American Indian or Alaska Native
Asian
Black or African American
Caucasian
Hispanic or Latino
Mediterranean
Middle Eastern
North African
Native Hawaiian or Pacific Islander
Other Ethnicity (Please Specify) -
What is your First Language and what Language do you predominantly speak?
*
Are you interested in a Speaking Role?
*
Please Select
Yes
No
Are you, the registrant, comfortable with animals? (chickens, goats, donkeys, etc.)
*
Please Select
Yes
No
Are you allergic to Animals?
*
Please Select
Yes
No
If you are allergic, which ones?
Are you allergic to peanuts?
*
Please Select
Yes
No
Any other food allergies? Please list here:
Do you have a car to travel to Camp New Dawn in Chickamauga, GA?
*
Please Select
Yes
No
Please check if you were involved or previously involved in any of the following?
*
None of the Following
FFA
4H
Other Agricultural Programs (please list)
Is there anything else you'd like to let us know?
Thank you so much for your interest in being a part of The Farmer and the Belle 2!
Submit
Should be Empty: