About Your Family! About You! Your Family! About You! ... _____ Gender: Male Female Month / Day / Year Your cell ... Animals Agriculture the ones
Post on 20-Mar-2018
About Your Family!
Family email:__________________________________ Last name:___________________________________ Best email to reach your parent or guardian
Mailing address:____________________________________________________________________________ Number and street name or P.O. Box
City:________________________________________ State:____________________ ZIP:_________________
Home phone:______________________________ Cell phone:______________________________________
Your name:____________________________________ Your email:___________________________________ First Name Last Name
Birthdate:______________________________________ Gender: Male Female Month / Day / Year
Your cell phone:________________________________________ Can we text you? Yes No
If yes, who is your cell provider? ______________________________________________________________ Verizon, Sprint, T-Mobile, etc.
Parent/Guardian 1:_______________________ First Name _______________________ Last Name
Parent/Guardian 2:_______________________ First Name _______________________ Last Name
Race: White Black or African American American Indian or Alaskan Native Native Hawaiian or Pacific Islander Asian Other combination Prefer not to state
Residence: Farm Town under 10,000 and rural nonfarm Town/city 10,000-50,000 and its suburbs Suburb of city more than 50,000 Central city more than 50,000
Ethnicity: Are you of Hispanic ethnicity? Yes No
4-H Year: 2017-2018
Online enrollment can be found at al.4honline.com
What would you like to do in 4-H?Animals & Agriculture the ones you like Creative Arts
the ones you like
Science & Technology the ones you like Environmental Education the ones
Healthy Living the ones you like Outdoor Recreation the ones
Leadership & Citizenship the ones you like Other the ones
4HYD-2258 The Alabama Cooperative Extension System (Alabama A&M University and Auburn University) is an equal opportunity educator and employer. Everyone is welcome! 2017 Alabama Cooperative Extension System. All rights reserved.
Teacher: School: Grade: Club: Family email: Last name: Mailing address: City: State: ZIP: Home phone: Cell phone: Your name: Your email: Birthdate: Gender: Your cell phone: Can we text you: If yes who is your cell provider: ParentGuardian 1 1: ParentGuardian 1 2: ParentGuardian 2 1: ParentGuardian 2 2: Cell phone_2: Cell phone_3: Ethnicity Are you of Hispanic ethnicity: Animals AgricultureRow1: Creative ArtsRow1: Animals AgricultureRow2: Creative ArtsRow2: Animals AgricultureRow3: Creative ArtsRow3: Animals AgricultureRow4: Creative ArtsRow4: Animals AgricultureRow5: Creative ArtsRow5: Animals AgricultureRow6: Creative ArtsRow6: Science TechnologyRow1: Environmental EducationRow1: Science TechnologyRow2: Environmental EducationRow2: Science TechnologyRow3: Environmental EducationRow3: Science TechnologyRow4: Environmental EducationRow4: Science TechnologyRow5: Environmental EducationRow5: Science TechnologyRow6: Environmental EducationRow6: Healthy LivingRow1: Outdoor RecreationRow1: Healthy LivingRow2: Outdoor RecreationRow2: Healthy LivingRow3: Outdoor RecreationRow3: Healthy LivingRow4: Outdoor RecreationRow4: Healthy LivingRow5: Outdoor RecreationRow5: Healthy LivingRow6: Outdoor RecreationRow6: Leadership CitizenshipRow1: OtherRow1: Leadership CitizenshipRow2: OtherRow2: Leadership CitizenshipRow3: OtherRow3: Leadership CitizenshipRow4: OtherRow4: Leadership CitizenshipRow5: OtherRow5: Leadership CitizenshipRow6: OtherRow6: County Editable Area: Place county specific information here.County Name: County Name Hereselection: Enter the number of projects youth can select.