West District 4-H Teen Retreat Registration
Dear 4-H Families: Thank you for your patience as we adapted 4-H Teen Retreat to a virtual format. We are holding two exciting workshops where participants will learn Cherokee Stories and how to "Lead the Way" using their 4-H experiences. Elections will be held for West District Officers. You will be receiving a West District 4-H Teen Retreat Shirt with your registration fee ($12 - contact your 4-H Agent regarding payment).
Participant First Name
Participant Last Name
Parent/Legal Guardian Full Name
Parent/Guardian Email Address
Youth Email Address (Optional, if you would like your child to receive the 4-H Teen Retreat Zoom link directly)
Is your child an active 4-H member in 4-H Online?
This is a requirement since voting for District 4-H Officers takes place at Teen Retreat.
Yes, my child's 4-H online profile is Active
Not yet; I will enroll my child at
County of 4-H Participation
Are you campaigning for State 4-H Office?
American Indian or Alaska Native
Black or African American
Native Hawaiian or Other Pacific Islander
Prefer not to say
T-shirt Size (Adult Sizes)
Please read the North Carolina 4-H Youth Development Program Liability Waiver, Assumption of the Risk, Photo & Media Release, and Indemnification Agreement:
I have read this agreement.
Please make your selection below:
I AGREE to photo/media use for any public release by NC State.
I do NOT agree to photo/media use for any public release by NC State.
Please make your selection regarding the North Carolina 4-H Youth Development Program Liability Waiver, Assumption of the Risk, Photo & Media Release, and Indemnification Agreement.
I have read this agreement, I understand it, and I agree to be bound by it. This serves as my electronic signature.
Please read the North Carolina 4-H Program Expectations & Parental Permission:
I have read the agreement.
I understand that I must abide by the Program's expectations.
Parent/Legal Guardian Agreement:
I understand that my child and I must abide by the Program expectations. I understand that Dismissed Participants may not be eligible for a refund for any fees or expenses.
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This form was created inside of North Carolina State University.