G2S 4-H Member Permission Form
Please sign this permission slip by WEDNESDAY, Jan. 20th for your student to participate in activities through a G2S partnership with 4-H. This form was also mailed for your convenience.
G2S is working with 4-H to provide more access to experiences (field trips) and skills (sports, arts, gaming, animal care, and much more.). It will connect our Wolfpack to a diverse range of topics and interests - and other kids who like the same things! More information is available on our website:
Please contact Erica Karmeisool if you have questions or comments about this effort (
We look forward to your permission to get your student enrolled in 4-H!
Student First Name
Student Last Name
Current 4-H Member
Is your student ALREADY a 4-H Member?
By signing this form, I acknowledge the following:
Your signature indicates you have read and agreed to the following, and G2S has your permission to:
1) Use information provided on your student’s G2S enrollment form to complete 4-H enrollment. This includes, and is not limited to:
-- Name, birthdate, address and contact information
-- Demographic information (gender, race, etc.)
-- Emergency contact information
-- Health concerns (allergies, medications, special needs, etc.)
-- Family member’s military service
2) Sign the Medical Release and Consents (Youth Consent Acknowledgment of Risk Waiver, Youth Code of Conduct, Youth Evaluation Acknowledgment, and Youth Media Release) on your behalf
3) Enroll your student in the 4-H program and the G2S Club
4) Require your student to sign and abide by the 4-H Youth Code of Conduct
*4-H enrollment details are here:
I have read the above Acknowledgement and give my permission.
I verify that I am the parent or legal guardian of the named student.
Typing your name here is equivalent to your signature.
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This form was created inside of Gateway to Success Academy.