Registrations | Illinois Extension

Am I a Conservationist?
Join 4-H in partnership with the Children's Museum of Illinois to find out! Learn what conservation is, four different kinds of conservation with a primary focus on wildlife conservation, and leave with some freebies and more information about how to make conservation an everyday practice.

Our presenter Daryl Coates has been in wildlife conservation for over 30 years, spent 23 years as a state biologist with the Illinois Department of Nature Resources, and has a Masters in Zoology.

Youth will learn what they can do in their backyards to help wildlife habitats and how native plants and species help our local ecosystems thrive.

The program is intended for youth ages 8+

Family members ages 2+ are welcome to attend. Cost is $5/person, family max $15.

Stay and Play! Youth are welcome to play in the Children's Museum after the presentation.

Registration ends November 9.

If you need a reasonable accommodation to participate, please contact: ahunt21@illinois.edu

Contact Information

First Name

Last Name

Street Address

Street Address 2

City

State

ZIP

Daytime Phone

Evening Phone

E-mail Address

Please list names of all individuals attending.

Cost: $5 per youth, $10 Youth+1, $15 per family max. Youth are welcome to play in the Children's Museum after the presentation.

$5 per youth ($5.00)

$10 Youth +1 ($10.00)

$15 per family ($15.00)

Age of Participant

Participant grade level

Is the Participant a 4-H member?

Yes, I am a member.

No, I am not a member.

Please list 4-H Club you belong to. * If not in a club please put N/A

Please list any questions you would like answered during the event.

Do you need any support or accommodations to participate in the program? Early requests are encouraged to allow sufficient time for meeting access needs.

Please list any food allergies, sensitivities, or health conditions you have that we should be made aware of.

Photo/Talent Release: I, the undersigned, do hereby consent to the use by The Board of Trustees of the University of Illinois (“University”) of my image, voice, or both described below, in (1) the video, photograph, or audio recording described below; and (2) any video, photograph, or audio recording reproduced either in whole or in part from the video, photograph or audio recording described below: regardless of whether these materials are used for fundraising, advertising, publicity, or any other purpose on behalf of either the University or its Foundation. I warrant that I have the full right and authority to grant this consent. In addition, I waive all claims to compensation or damages based on the use of my image or voice, or both, by either the University or the Foundation. I also waive any right to inspect or approve the finished photograph or video or audio recording. I understand that this consent is perpetual, that I may not revoke it, and that it is binding on me, my heirs and assigns. I warrant that I am at least 18 years of age and that I am competent in my own name insofar as this consent is concerned, or that I am the parent or legal guardian authorized to sign on behalf of a person under age 18. I further attest that I have read this consent form and fully understand its contents. Do you consent to this form?

Yes, I consent.

No, I do not consent.

First and Last Name/Signature of Talent (or parent/legal guardian if under 18):

Civil Rights Compliance - Participant Info

As part of our commitment to providing equal opportunities in our programming, University of Illinois Extension is required to collect and report overall statistics about the race, ethnicity, and gender of program participants. Your responses are voluntary and appreciated.

Gender

Ethnicity

Race

Total Registration Cost $

Am I a Conservationist?

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Contact Information

Civil Rights Compliance - Participant Info