4-H Enrollment V2

Georgia 4-H Enrollment V2

Enroll in Georgia 4-H -- Liberty 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 DATE_OF_BIRTH:

GENDER:

T_SHIRT Size:

Race and Ethnicity (check all that apply) (optional)

White

Black or African American

American Indian or Alaska Native

Asian

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

Parent 1 Information

PARENT1_FIRST_NAME:

PARENT1_LAST_NAME:

PARENT1_ADDRESS_1:

PARENT1_ADDRESS_2:

PARENT1_CITY:

STATE:

PARENT1_ZIP:

GENDER:

PARENT1_EMAIL:

PARENT1_CELL_PHONE:

RELATIONSHIP to Student:

Enter text from the image to the right:
(Do not include spaces)

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.