4H ExCEL Training Registration

Information About You

 
 25% 
1. Opt out of evaluation?
2. Is the youth active?
*
3. Parent/Guardian INFORMATION
*
4. TEEN INFORMATION
*
5. Date of Birth
MM DD YYYY
Date of Birth
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6. Ethnicity
7. Race
*
8. Gender
*
9. Residence (please choose the type of community which best describes where you live)
*
10. Name of School
11. Grade for 2012-13 school Year
*
12. How did you find out about this Program
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