2023-2024 4-H Enrollment Fee Waiver Form

Provisions will be made by the 4-H club/unit or county council (VMO) to cover program fees for eligible youth who are unable to pay them. The parent/guardian of an eligible youth for which a program fee waiver or reduction is requested to complete this form. While fees are waived for your family, they are still paid to the State Office by the 4-H club/unit or county council and covered by local fundraising efforts within the county.

Fill in the information below for a full or partial waiver of program fees and to submit a credit card payment for a reduced fee for 4-H enrollment.

Make sure you complete your 4-H Enrollment before submitting this fee waiver or a partial fee payment.

Please submit one form per youth member.

✻ = Required

Parent/Guardian/Payor Information (Please do not use Auto-Fill):

Email address: ✻

Last Name: ✻

First Name: ✻

Daytime Phone Number: ✻

4-H Membership Information
**SUBMIT A SEPARATE WAIVER REQUEST FOR EACH MEMBER**

4-H County: ✻

4-H Club ✻

Member's First Name: ✻

Member's Last Name: ✻

Full Program Fee Waiver
of the $71.00 per Member fee

Are you requesting a waiver of the program fee in full, because your family's monthly household cash income is at or below 185% of the Federal Poverty guidelines.

If your child is eligible for or enrolled in free or reduced price school breakfast or lunch you meet this criteria. (Reference: 2022 Federal Poverty Guidelines Percentage Tool) ✻

Yes No

Partial Program Fee Waiver
of the $71.00 per Member fee

Are you requesting a reduction of the program fee? ✻

Yes No

Partial Fee Payment

Enter payment amount you are paying for this member:

Required Reading - Please check that your name appears below.

Amador County Enrollment Guidelines for Partcipation in County Fair (Click and read if you belong to Amador County 4-H.)

Calaveras County Enrollment Guidelines for Partcipation in County Fair (Click and read if you belong to Calaveras County 4-H.)

El Dorado County Enrollment Guidelines for Partcipation in County Fair (Click and read if you belong to El Dorado County 4-H.)

Tuolumne County Enrollment Guidelines for Participation in County Fair (Click and read if you belong to Tuolumne County 4-H.) ✻

On the next screen you will begin the process for entering your credit card information.

If you are having trouble with the credit card processing, please see this Credit Card Processing Help Guide.

Survey Verification✻

For verification that you are human, please enter the following code in the box below:
TCECBO

(if the code is not entered correctly, the survey will not be submitted)

2023-2024 4-H Enrollment Fee Waiver Form - Central Sierra