Canyon County 4-H Interest Form
Complete this form if you are new to 4-H in Canyon County and would like more information about the 4-H program. The information you provide on this form will allow us to better serve you by allowing us to research some options for your family before we contact you; you will be contacted within 2-4 business days.
Parent's Name
*
First Name
Last Name
Mailing Address (Street)
*
City
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State
*
Zip code
*
Primary Phone Number
*
Email address
*
Number of Children Interested in 4-H
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Select One
1
2
3
4
5
6 +
Youth # 1 Name
*
First Name
Last Name
Youth # 1 Gender
*
Select One
Male
Female
Youth # 1 Date of Birth
*
Please select a month
January
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Month
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Please select a year
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Youth # 2 Name (if applicable)
First Name
Last Name
Youth # 2 Gender (if applicable)
Youth # 2 Date of Birth (if applicable)
Please select a month
January
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2009
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Year
Youth # 3 Name (if applicable)
First Name
Last Name
Youth # 3 Gender (if applicable)
Select One
Male
Female
Youth # 3 Date of Birth (if applicable)
Please select a month
January
February
March
April
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Month
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Please select a year
2009
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Year
Youth # 4 Name (if applicable)
First Name
Last Name
Youth # 4 Gender (if applicable)
Youth # 4 Date of Birth (if applicable)
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
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Please select a year
2009
2008
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Year
Youth # 5 Name (if applicable)
First Name
Last Name
Youth # 5 Gender (if applicable)
Youth # 5 Date of Birth (if applicable)
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
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Day
Please select a year
2009
2008
2007
2006
2005
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2003
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2001
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1999
1998
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1996
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Year
Areas of Interest
*
4-H for 5-7 year olds- "Cloverbuds"
Small Animals (cat, dog, rabbit, etc)
Livestock (pig, sheep, cow, goat, etc)
Horse (members ages 8+ only)
Visual & Tactile Arts (photography, ceramics, leathercraft, etc)
Performing Arts (theater, cowboy poetry, etc)
Foods (cooking, baking, cake decorating, etc)
Healthy Living (first aid, gardening, etc)
Outdoors (hiking, bicycle, fishing, etc)
Personal Development, Leadership, Citizenship, etc
Science (aerospace, geology, veterinary science, etc)
Technology (computers, robotics, engines, etc)
Shooting Sports (Archery, Rifle, Shotgun, pistol, etc)
Other
I would like to learn more about
*
Enrolling my child(ren) in a 4-H Club
4-H Day Camps
4-H Overnight Camps
Special activities for 4-H Teens
Becoming a certified 4-H Volunteer
Starting a new 4-H Club
Other
Anything else you'd like to tell us?
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