Animal Scoops

Participant Information

We are excited to have you join us! Please take a few minutes to answer the registration questions below. Thank you!

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* 1. First and Last Name

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* 2. What is your mailing address?

Street

City

State

Zipcode

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* 3. What is your email address?

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* 4. What is your parent/legal guardian's email address?

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* 5. What county do you live in?

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* 6. What is your gender?

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* 7. What is your grade in school?

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* 8. Check one (for statistical purposed only)

Non-Hispanic

Hispanic

Prefer not to answer

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* 9. Check one (for statistical purposes only)

White only

Black or African American only

American Indian or Alaska Native only

Asian only

Native Hawaiian / Other Pacific Islander only

Balance (other combinations)

Prefer not to answer

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* 10. I live:

Farm

Rural

10K-50K

50K+

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* 11. I am currently in a 4-H club:

Yes

No

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* 12. I would like to receive the weekly online 4-H newsletter to learn about additional youth programs and opportunities.

Yes

No