Jr. Leader Road Trip
Please enter your information to enroll in the Jr. Leader Road Trip.
Adventure Grows Here
First Name *
Your answer
Last Name *
Your answer
Grade (2016-2017 School Year) *
Your answer
Age *
Your answer
Address *
Your answer
City *
Your answer
Zip *
Your answer
Parents Name *
Your answer
Home Phone *
Your answer
Cell Phone
Your answer
Email Address
Your answer
Does your child have any allergies?
Please list any allergies.
Your answer
Club *
Please Choose your club from the list below. If you are not a 4-H Member please choose the last selection "Monroe County Youth (Not a 4-H Member)".
Medical Information
We will also use the Medical Information from the 4-H Online Profile to care for your child. Please make sure you update no later than July 1st, as that will guide us in caring for your child in an emergency.
Payment
Please print the confirmation page and mail with payment to the address below. The price is $15 for each youth attending.
(If you are entering multiple youth, you may just print the final confirmation page.)
Please mail confirmation and payment to the Extension office as soon as possible.
Monroe County 4-H
14345 County Hwy. B, Room 1
Sparta, WI 54656
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