Registrations | Illinois Extension

STEM-MANIA with Blue Ridge 4-H Teen Teachers

Explore the exciting world of Science, Technology, Engineering, and Mathematics through hands-on activities and interactive experiments led by Blue Ridge STEM Club’s very own 4-H Teen Teachers. Participants will have the opportunity to learn by doing; building, creating, and discovering how STEM concepts come to life in fun and meaningful ways, all while being guided by passionate teen leaders.

April 29 | 3:30 PM to 4:30 PM | Schneider Elementary School Cafeteria | 309 N. John Street | Farmer City, IL 61842

Children in grades 3rd through 5th are welcome.

Register by April 24.

To request a reasonable accommodation or fee waiver, please contact Henry Craft.
**NOTE: You do NOT need to create an Extension User Account to register. Please complete the contact information below.**

Contact Information

First Name

Last Name

Street Address

Street Address 2

City

State

ZIP

Daytime Phone

Evening Phone

E-mail Address

What is the name and age of your child? *ex.) John Smith - 5 years old

What grade is your child in?

Are you currently a 4-H Member?

Yes, I am.

No, I am not.

If currently a 4-H Member, what club are you in? *if not a 4-H Member please input N/A

Do you need any support or accommodations to participate in this program? *early requests are encouraged to allow sufficient time for meeting access needs. | If none please input N/A

Please list any food allergies, sensitivities, or health conditions your child may have that we should be aware of. *if none please input N/A

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): *By entering your name you consent to the release of all video/photo/audio recorded during this program. | If you do not consent, please input N/A.

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