Winn Parish 4-H Outdoor Skills Registration

Name: __________________________________________________________

Address: ________________________________________________________

Parents: ____________________________ Phone: _____________________

Email address: _______________________DOB: _______________________

School attending: __________________Age as of 12/31: _________________

Please choose only 2 disciplines.

DisciplineJr (age group 9-13)Sr (age group 14-19)
22 Rifle
Black powder
Hunting Skills
Pellet Pistol
22 PistolSenior Only

I, ________________________, give my permission for ___________________ to participate in all 4-H activities related to 4-H outdoor skills.

Parents Signature & Date: ________________________________________

Student Signature and Date: _______________________________________

Office Use Only:

Date___________cash or check #__________ receipt #___________

4/6/2020 2:31:46 PM
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