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! OK Question Title * 1. First and Last Name OK Question Title * 2. What is your mailing address? Street City State Zipcode OK Question Title * 3. What is your email address? OK Question Title * 4. What is your parent/legal guardian's email address? OK Question Title * 5. What county do you live in? Addison Bennington Caledonia Chittenden Essex Franklin Grand Isle Lamoille Orange Orleans Rutland Washington Windham Windsor Out of State OK Question Title * 6. What is your gender? OK Question Title * 7. What is your grade in school? Grade K Grade 1 Grade 2 Grade 3 Grade 4 Grade 5 Grade 6 Grade 7 Grade 8 Grade 9 Grade 10 Grade 11 Grade 12 Adult Other (please specify) OK Question Title * 8. Check one (for statistical purposed only) Non-Hispanic Hispanic Prefer not to answer OK Question Title * 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 OK Question Title * 10. I live: Farm Rural 10K-50K 50K+ OK Question Title * 11. I am currently in a 4-H club: Yes No OK Question Title * 12. I would like to receive the weekly online 4-H newsletter to learn about additional youth programs and opportunities. Yes No OK NEXT
