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Henderson County 4-H Cloverbuds SPIN Club Winter Registration

Cloverbuds is a Special Interest 4-H Club for youth ages 5-7 to learn about the fundamentals and opportunities of 4-H. Each meeting will include fun games, crafts and a mini lesson related to one aspect of 4-H including; agriculture, stem, healthy living, and civic engagement!

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E-posta *
Name of Participant (First and Last) *
Name of Parent/Guardian (First and Last) *
Phone Number *
Emergency Contact Number *
Enrolled in 4-H Online? *
Participant's Age (as of January 1st, 2024) *
Does the participant have any special needs that 4-H Staff need to be aware of?
Please check all classes that you will attend:
Media release Form:

I do ________ or do NOT ________ give permission to North Carolina State University, through its Cooperative Extension program for North Carolina 4-H, and Henderson County Extension staff, to take photographs and/or record video and/or audio or otherwise record images and likenesses of me and/or my property and to use these for 4-H Youth Development nonprofit educational, promotional, and/or marketing materials. I further consent that my name and
identity may be revealed therein or by descriptive text or commentary.
I expressly release North Carolina State University and Henderson County, its agents, employees, licensees and assigns from and any and all claims which I may have for invasion of privacy, right of publicity, defamation, copyright infringement, or any other causes of action arising out of the use, adaptation, reproduction, distribution, broadcast or exhibition of such recordings of my image, voice, or likeness. I understand that my photographs may be edited, copied, and distributed by means of various media, including video presentations, television, news bulletins, mailouts, billboards or signs, brochures, placement on websites, or newspapers.
I understand that although North Carolina State University and Henderson County will endeavor to use my photograph in accordance with standards of good judgment, the North Carolina State University and Henderson County cannot warranty or guarantee that any further dissemination of my photograph will be subject to the North Carolina State University and Henderson County’s supervision or control. Accordingly, I release the North Carolina State and Henderson County from any and all liability related to dissemination of my photograph.
I understand this permission is entirely optional, and that participants who do not give permission will remain eligible for 4-H services, benefits, and privileges the same as those who do give permission.
I have read this document and understand its contents.
 *
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