4-H Enrollment Forms

4-H Youth Enrollment

The 4-H year begins on October 1 and ends on September 30. To enroll a child in 4-H, parents/guardians must complete the 4-H Member Enrollment Form, Code of Conduct, and Acknowledgement of Risk along with the New York State 4-H Permission Slip.

4-H Adult Forms

All adults participating in 4-H events or activities must complete an Acknowledgement of Risk for each event:

Acknowledgement of Risk - Adult

Leaders and volunteers must reenroll each year using the Volunteer Enrollment Forms. To become a 4-H leader/volunteer, adults must complete the Cornell Cooperative Extension Volunteer Application, which includes a Criminal and DMV History Check. Please contact Kristin Ruggiero at klf37@cornell.edu if you are interested in becoming a leader or volunteer.

Submitting Forms

Digital Enrollment Forms

This year, we are able to collect the enrollment forms through a Qualtrics Survey, allowing us to accept digital signatures. If you would like to enroll using the digital system, please contact Kristin Ruggiero at klf37@cornell.edu, so she can email you the survey. Please ensure that a parent/guardian digitally signs the documents.

Hard-Copy Enrollment Forms

If you prefer to enroll with physical signatures, please email Kristin at klf37@cornell.edu to receive the documents. You can print them at home and submit them through email or mail:

Email

Scan (or photograph) your documents and email them to Kristin Ruggiero, klf37@cornell.edu.

Mail

Mail documents to:

Cornell Cooperative Extension of Rockland County
Attn: Kristin Ruggiero
10 Patriot Hills Drive
Stony Point, NY 10980

Last updated September 24, 2024