2019 Fall 4-H Shooting Sports Workshop
April 5th - 7th, 2019 - Ross Camp, Tippecanoe County

Each year IDNR's Hunter Education Program, in relation with Purdue University, provides two training workshops for the 4-H Shooting Sports Program. This training is required to be a volunteer instructor in a county 4-H Shooting Sports Program.

We greatly appreciate the support that 4-H Volunteers provide to the 4-H Shooting Sports program and are happy to make this investment as we continue our partnership with the Indiana Department of Natural Resources. We also want to thank you for your commitment to serving Indiana youth through the 4-H Shooting Sports educational program!

If you have any questions please contact:

Tim Beck
I.D.N.R Law Enforcement
P.O. Box 917, Jasper, IN 47547

Phone: (812) 482-3093
Cell: (317) 694-7531
E-mail: tbeck@dnr.in.gov

Form Directions
Payment Information is available after this form has been filled out and submitted.
Registration Steps:

1. Fill out the information below and click 'Submit'
2. An email will be sent to the provided email.
3. Print and sign the email.
3. Mail the registration with your Check or Money Order to the address provided on the email.

Personal Information
First Name *
Your answer
Last Name *
Your answer
Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Home Phone Number *
Your answer
Cell Phone Number
Your answer
Email Address *
Your answer
Gender *
Extension Educator *
Your answer
County *
Your answer
Participation & Discipline Selection
Enrollment is $150.00 for all participants.

New Participants: Friday Night - Sunday Afternoon

For participants that are returning, you will have a couple of options.

Returning Option 1: Saturday 8:00am - Sunday Afternoon (Saturday Breakfast NOT Included)

Returning Option 2: Friday Night - Sunday Afternoon (Saturday Breakfast Included)

Participation Status
Friday Night Session (For Returning Participants Only)
If you are a returning participant and would like to attend Friday night's Advance Session, please indicate it below. This sessions is for returning participants only and will address 4 major topics in the course of two hours: Grant Writing, Program Development, Youth Participation, & Recruitment.
Discipline *
Can we share you name and address with other participants? *
Sleeping Arrangements *
Medical & Emergency Information
Do you require a lower bunk due to a medical necessity: *
Date of Birth (mm/dd/yyyy) *
Your answer
Physical Record of Participant: *
Heart Condition
List medicines allergic to
Your answer
List other allergies (i.e., food, dust, pollen, animals):
Your answer
Date of most recent tetanus shot:
Your answer
Any other medical record information that would be beneficial during the program or in an emergency:
Your answer
List any activities the participant should avoid (i.e., swimming):
Your answer
Emergency Contact Name *
Your answer
Emergency Contact Address *
Your answer
Emergency Contact Phone Number *
Your answer
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