County Registration Form

This form should must be completed by every county attending congress.

A same sex chaperone is required during dorm hours. If you do not have a male/female chaperon you can designate a chaperone from another county or request a hired chaperone.
Please remember all youth rooms are doubles and youth may not room with adults. If an accommodation is necessary please contact the 4-H Center.
Counties must bring atleast one chaperone for every 10 youth attending. Chaperones must be 21 or older and a certirfied 4-H volunteer or extension staff. *Counties with 2 or less youth may arrange for youth to partiipate with another county.

denotes required fields.

County Information

County

Agent or County Staff Name

Phone

Female Youth Delegates

Female Chaperone Name

County, If NOT your own

Is a hired FEMALE chaperone needed?

YesNo

There is a $35 per youth charge. Please add this fee to payment sent from the county.

Room 1: Female Youth A

Room 1: Female Youth B

Room 2: Female Youth A

Room 2: Female Youth B

Room 3: Female Youth A

Room 3: Female Youth B

Room 4: Female Youth A

Room 4: Female Youth B

Room 5: Female Youth A

Room 5: Female Youth B

Room 6: Female Youth A

Room 6: Female Youth B

Room 7: Female Youth A

Room 7: Female Youth B

Room 8: Female Youth A

Room 8: Female Youth B

Room 9: Female Youth A

Room 9: Female Youth B

Room 10: Female Youth A

Room 10: Female Youth B

Room 11: Female Youth A

Room 11: Female Youth B

Male Youth Delegate Rooming List

Male Chaperone

County, If NOT your own

Is a hired MALE chaperone needed?

YesNo

There is a $35 per youth charge. Please add this fee to payment sent from the county.

Room 1: Male Youth A

Room 1: Male Youth B

Room 2: Male Youth A

Room 2: Male Youth B

Room 3: Male Youth A

Room 3: Male Youth B

Room 4: Male Youth A

Room 4: Male Youth B

Room 5: Male Youth A

Room 5: Male Youth B

Room 6: Male Youth A

Room 6: Male Youth B

Adult Chaperone Rooming List

If a single room is requested in 4honline put name in Adult A and Single in Adult B. Please be sure to select a single room when registering in 4Honline so the correct amount is invoiced. If a single room is indicated below, but not paid for the adult will be assigned to a double room.

Female Chaperone Room 1: Adult A

Female Chaperone Room 1: Adult B

Female Chaperone Room 2: Adult A

Female Chaperone Room 2: Adult B

Female Chaperone Room 3: Adult A

Female Chaperone Room 3: Adult B

Male Chaperone Room 1: Adult A

Male Chaperone Room 1: Adult B

Male Chaperone Room 2: Adult A

Male Chaperone Room 2: Adult B

Are there any housing accommodations or requests?