4-H Sustainable Fisheries Club Enrollment
4-H Sustainable Fisheries Club
Name
*
First
Middle
Last
Preferred Name (if different from legal name)
Email
*
Enter Email
Confirm Email
Primary Phone
Mobile Phone
Address
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
County
*
Birth Date
*
MM slash DD slash YYYY
School Grade
*
Name of School
*
Parent/Guardian 1 Name
*
First
Last
Parent/Guardian 1 Phone
*
Parent/Guardian 1 Email
*
Enter Email
Confirm Email
Parent/Guardian 2 Name
First
Last
Parent/Guardian 2 Phone
Parent/Guardian 2 Email
Enter Email
Confirm Email
Optional: Demographic Information
Please provide this optional information about the participating youth so that we may report to our federal partners.
Gender Identity
Male
Female
Other
Prefer not to state
Hispanic Ethnicity
Yes - Hispanic or Latino Ethnicity
No - Not Hispanic or Latino Ethnicity
Prefer not to state
Racial Groups
White
Black or African American
American Indian or Alaskan Native
Native Hawaiian or Other Pacific Islander
Asian
Prefer Not to State
Check all that apply.
Residence
*
Farm
Rural non-farm or town less than 10,000
Town/City 10,000 to 50,000
Suburb of City over 50,000
City over 50,000
Optional: Military Family
Family Member
Parent Serving
Sibling Serving
Parent Retired
Parent Served
Other Family Member Serving
Branch
Air Force
Army
Coast Guard
DOD Civilian
Marines
Navy
Component
Active Duty
National Guard
Reserves
Comments
This field is for validation purposes and should be left unchanged.
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4-H Sustainable Fisheries Club Enrollment