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UFIR



4-H enrollment form
http://edis.ifas.ufl.edu/ ( Publisher's URL )
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Permanent Link: http://ufdc.ufl.edu/IR00000949/00001
 Material Information
Title: 4-H enrollment form
Physical Description: Form
Creator: Florida 4-H Youth Development, Florida Cooperative Extension Service, University of Florida
Publisher: University of Florida Cooperative Extension Service, Institute of Food and Agriculture Sciences, EDIS
Place of Publication: Gainesville, Fla.
Publication Date: 2006
 Notes
Acquisition: Collected for University of Florida's Institutional Repository by the UFIR Self-Submittal tool. Submitted by Diana Hagan.
Publication Status: Published
General Note: "4H GCM 00."
General Note: PDF file created 7/2/1996, modified 9/22/2006.
 Record Information
Source Institution: University of Florida Institutional Repository
Holding Location: University of Florida
Rights Management: All rights reserved by the submitter.
System ID: IR00000949:00001

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4-HENROLLMENTFORM DATEBIRTHDATEPHONENO.() NAME Last First MiddleADDRESS NumberandStreet City ZipCodePARENTS'INFORMATION: MOTHER'SNAME:() Address WorkPhoneFATHER'SNAME: () Address WorkPhoneAGE GRADESEXTHISWILLBEMY YEARIN4-H MembershipintheFlorida4-HProgramoftheFloridaCooperativeExtension Serviceisopentoallyoungpeoplefromtheageof8through18years.NAMEOF4-HCLUBORGROUP SCHOOL ThisinformationisutilizedforreportstotheUnitedStatesDepartmentofAgriculture. OFFICECIRCLETHENUMBERWHICHDESCRIBESWHERE YOULIVE: 1.Farm4.SuburbsofCityover50,000 2.Townsunder10,000 andRuralNon-Farm 5.CentralCitiesover50,000 3.TownsandCities 10,000to50,000 CIRCLETHENUMBERWHICHDESCRIBESYOUR RACE: 1.White(notofHispanic Origin 3.AmericanIndianorAlaska Native 2.Black(notofHispanic Origin) 4.Hispanic 5.AsianorPacificIslanderUSE FROMTHEPROJECTS OFFERED,IWISHTO TAKETHEFOLLOWING PROJECT(S)THISYEAR PROJECT BOOK NEEDED AA,ETC EFNEPONLY: MYFAMILYISENROLLEDIN/GRADUATEDFROMEFNEPYESNO MEMBER'SSIGNATURE PARENT'SSIGNATURE LEADER'SSIGNATURE