4-H Nature in Focus SPIN Club Registration

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.*

Name	Age	Gender	Ethnicity

Cooperative Extension in Washington County