4-H Youth Advocacy and Leadership Coalition Member Enrollment Form

The 4-H Youth Advocacy and Leadership Coalition (YALC) is a civic leadership program for youth ages 13-18 in Cuyahoga County. The YALC develops young adult leaders by training and supporting them in advocating for youth issues and links them to their communities through service-learning experiences.

4-H CODE OF CONDUCT
4-H members, parents, and other adults participating in 4-H activities will:
1) Adhere to program rules, curfews, dress codes, policies, and rules of the facility being used.
2) Conduct themselves in a courteous, respectful manner, use appropriate language, exhibit good sportsmanship, and provide positive role models.
3) Abstain from illegal behaviors, use of alcohol, illegal or illicit drugs, and tobacco during 4-H events and activities.
4) Fully participate in scheduled activities.
5) Respect other's property and privacy and rights.
6) Abstain from child abuse (physical and/or verbal) and harassment.
7) Accept personal responsibility for behavior including financial damage.
8) Be responsible for any financial damage caused by inappropriate behavior.
9) Adhere to rules of safety.
10) I will uphold and support the responsible and lawful use of social media. In so doing, I will not create or post social media content that is abusive, threatening, defamatory, obscene, harassing or creates a hostile environment.

Consequences for violating any part of this code of conduct may include but are not limited to: removal from participation in the event in which the code of conduct has been violated (at the individual's expense); sanctions on participating in future 4-H events; forfeiture of financial support for the event; removal from offices held, etc.

Behavior outside of 4-H activities can affect "member in good standing" or "volunteer in good standing" status.

It is the responsibility of all program participants to reinforce the code of conduct and intervene when necessary to enforce the rules.

I have read, understand and thus agree to the above ACKNOWLEDGEMENT OF RESPONSIBILITY AND RELEASE, PERMISSION TO USE CHILD'S PHOTOGRAPHIC FORM FOR PROMOTION, and 4-H CODE OF CONDUCT MENTIONED ABOVE.

Name (First, Middle, Last) *

Email *

Mailing Address *

Phone number *

Date of Birth *

Preferred Gender Pronouns (he/she/they) *

T-Shirt Size

Parent/Guardian Name (First, Last) *

Parent/Guardian Email Address *

Parent/Guardian Address (if different).

Parent/Guardian Cell Phone *

Parent/Guardian Work Phone *

Student Ethnicity *

Hispanic

Non-Hispanic

Student Race (check all that apply) *

White

Black

American Indian/Alaskan Native

Hawaiian/Pacific Islander

Asian

Required

Residence *

Town (10,000 to 50,000)

Suburb (more than 50,000)

City (more than 50,000)

Grade *

7th

8th

9th

10th

11th

12th

School Name *

Anticipated Graduation Year *

Health Considerations (i.e. food allergy, diabetes, etc.)

PERMISSION TO USE CHILD'S PHOTOGRAPHIC FORM FOR PROMOTION. Ohio State University Extension would like to share the positive results of youth participation in Extension and 4-H Youth Development events. However, in some cases, parents or guardians may prefer not to permit such publicity. Please select one. *

I GIVE the Ohio State University permission to publish in print, electronic, or video formats the likeness or image of my child. I release all claims against the University with respect to copyright ownership and publication including any claim for compensation related to use of the materials. If this section is not completed, publicity about this child's participation will not be used by Ohio State University Extension.

I DO NOT GIVE the Ohio State University permission to publish in print, electronic, or video formats the likeness or image of my child.

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