Bring Your Kids to Work Day
National 4-H Week
Alaska 4-H and Michaels SPIN Summer 2013 Session 1
Grade (2013-14 school year)
Emergency Contact (Name and Cell)
Please provide a name and cell number in which a responsible adult (may be parent) can be contacted while child attends session.
By initialing here I give the National 4-H Council, University of Alaska Fairbanks, 4-H Cooperative Extension Service, USDA/NIFA, 4-H Clubs and programs, its nominees, agents and assigns unlimited permissions to copyright and use, publish and republish for purpose of advertising, public relations, trade or any other lawful use, information about me and reproduction of my likeness (photographic or otherwise) and my voice, whether or not related to any affiliation with 4-H, with or without my name. I hereby waive any right that I may have to inspect or approve the copy and/or finished product or products that may be used in connection therewith or the use to which it may be applied.
Hispanic or Latino
Not Hispanic or Latino
Alaska Native/ American Indian
Black or African American
Native Hawaiian/Other Pacific Is.
More than one race
Place of Residence
Town under 10,000 and rural (non-farm)
Town or city (10,000-50,000) and its suburbs
Suburb of city over 50,000
Central city over 50,000
4-H & Youth Development
University of Alaska Fairbanks
Cooperative Extension State Office
308 Tanana Loop, Room 209
Fairbanks, AK 9977