4-H Nature in Focus SPIN Club Registration - Cooperative Extension in Washington County - University of Maine Cooperative Extension

Parent Name*

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone*

Email*

Youth in your Family*

To add more than one name, click on the small plus (+) sign at the end of the row. Note: As a way to document those we are reaching, we are seeking Gender and Race/Ethnicity information on an optional basis. It is important that we ensure equal opportunity to all who might benefit from our programs.

Name	Age	Gender	Ethnicity

4-H Affiliation*

My child/children are enrolled in 4-H.
My child/children are NOT enrolled in 4-H.

Camera

I would like to borrow a camera.

4-H Nature in Focus Expectations

1. Attend all sessions in 2022: July 26, August 2, 9, 16, 25 & 30

2. Abide by all UMaine and State/Federal safety COVID-19 guidelines

3. Agree to treat borrowed UMaine devices/materials respectfully and return in their original condition

Expectations Consent*

Yes, I have read the 4-H Nature in Focus expectations and agree to this statement.

Type your name here to sign electronically.*