4-H Enrollment Form and Information

Enrollment Form - front side

Enrollment Form - back side

Iowa 4-H Information & Health Form (Please turn in completed form with enrollment form)

(If you are a current 4-H'er and re-enrolling, please contact your club leader or the Extension Office for a copy of your enrollment form that has all of your current project areas listed)

Instructions for filling out Enrollment Form

Write with pencil:

  • Check either Member (grade 4 and above) or Cloverbud (under 4th grade)
  • Check New Enrollment if this is the first time you have enrolled in 4-H or re-enrollment if you have been in 4-H before. (Those who were enrolled in 4-H last year will receive a pre-printed enrollment form with your name, address and project information - check to see if information is current)
  • name
  • address
  • school
  • year in 4-H (including this year)
  • Birthdate
  • Age as of September 15 of current year
  • Grade
  • Male or Female
  • Ethnic
  • If you live on a farm, or in town (rural, under 10,000)
  • e-mail address of 4-H'er and parents
  • parent information

Have a parent review form for mistakes. If all is correct, they should sign the form.

Enrollment form and program fee of $10 should be given to the club leader. Check should be made out to Winnebago County Extension.

Cloverbuds (under 4th grade) do not pay the program fee.

 
Sheryl Davids 9/16/2004