4H – Aldermere Farm

Participant's First Name *

First

Participant's Last Name *

Last

Participant's age as of the start of the session. (Must be between 12-18) *

Choose your Project Area:

Beef Club Show

Beef Club Care

Indepedent

Parent/Guardian's First Name *

First

Parent/Guardian's Last Name *

Last

Parent/Guardian's Email Address *

Enter Email

Confirm Parent/Guardian's Email Address *

Confirm Email

Primary Phone *

Other Phone (optional)

Mailing Address *

Physical Address (if different from mailing address)

Town *

State *

Zip *

How did you hear about 4-H? *

Related Experience / Comments *

Allergies / Medical Info (If none, please enter "none".) *

Emergency Contacts & Designated Person(s) for Pickup

Emergency Contact 1 Full Name

Emergency Contact 1 Phone

Emergency Contact 1 Relationship to Child

EC 1 Permission to Pick Up

This person has permission to pick up child.

Emergency Contact 2 Full Name

Emergency Contact 2 Phone

Emergency Contact 2 Relationship to Child

EC 2 Permission to Pick Up

This person has permission to pick up child.

Emergency Contact 3 Full Name

Emergency Contact 3 Phone

Emergency Contact 3 Relationship to Child

EC3 Permission to Pick Up

This person has permission to pick up child.

Permission to Walk/Ride Bike

I give my child permission to walk/ride bike to and from Aldermere Farm.

Safety Agreement

I, the Participant, agree to follow farm rules for my own safety and the safety of my group. I understand that this means: (1) I will treat my peers and leaders with kindness, compassion, and respect. (2) I will only enter the barnyard and Staff Only areas when permitted or accompanied by an Aldermere staff member. (3) I will wear appropriate clothing, including boots, long pants, and gloves. (4) I will listen and follow directions. (5) I will respect the cattle, farm property, tools, and equipment. (6) I will use appropriate behavior around the cattle. This means: • Speak quietly (no loud voices) • No running or rough-housing • Be aware of my surroundings • Be gentle, patient and move slowly • Watch out for my own safety and the safety of those around me. I understand that if I do not wear appropriate clothing or demonstrate acceptable behavior, I may be asked to sit out from activities.

*

By checking this box, I agree to the statement above.

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4H

4-H Registration

Emergency Contacts & Designated Person(s) for Pickup

Safety Agreement