Georgia 4-H Enrollment V2

Enroll in Georgia 4-H -- Hall County

Please Select your School and Club. Then fill out all of the appropriate information..

Student Information
* required CLUB_NAME:
* required SCHOOL_NAME:
* required GRADE:
* required FIRST_NAME:
* required LAST_NAME:
* required PREFERRED_NAME:
* required ADDRESS_1:
* required ADDRESS_2:
* required CITY:
* required STATE:
* required ZIP:
* required DATE_OF_BIRTH:
* required EMAIL:
* required CELL_PHONE:
* required HOME_PHONE:
* required T_SHIRT Size:
  Race and Ethnicity (check all that apply) (optional)
  Black or African American
  American Indian or Alaska Native
  Native Hawaiian or Other Pacific Islander
  Hispanic or Latino


Other Information

  Are you a member of a military family?
(Please select this box if you have a parent or legal guardian
who is actively serving in any branch of the military.)
* required Select your residence
Health concerns or special needs you'd like the extension office to be aware of:
Parent 1 Information
* required PARENT1_FIRST_NAME:
* required PARENT1_LAST_NAME:
* required PARENT1_ADDRESS_1:
* required PARENT1_ADDRESS_2:
* required PARENT1_CITY:
* required STATE:
* required PARENT1_ZIP:
* required PARENT1_EMAIL:
* required PARENT1_HOME_PHONE:
* required PARENT1_WORK_PHONE:
* required PARENT1_CELL_PHONE:
* required RELATIONSHIP to Student:
Parent 2 Information
* required PARENT2_FIRST_NAME:
* required PARENT2_LAST_NAME:
* required PARENT2_ADDRESS_1:
* required PARENT2_ADDRESS_2:
* required PARENT2_CITY:
* required STATE:
* required PARENT2_ZIP:
* required PARENT2_EMAIL:
* required PARENT2_HOME_PHONE:
* required PARENT2_WORK_PHONE:
* required PARENT2_CELL_PHONE:
* required RELATIONSHIP to Student:
Enter text from the image to the right:
(Do not include spaces)
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The University of Georgia College of Agricultural and Environmental Sciences (working cooperatively with Fort Valley State University, the U.S. Department of Agriculture, and the counties of Georgia) offers its educational programs, assistance, and materials to all people without regard to race, color, religion, sex, national origin, disability, gender identity, sexual orientation or protected veteran status and is an Equal Opportunity, Affirmative Action organization.