2025-2026 4-H Enrollment Payment Form

✻ = Required

Parent/Guardian First Name ✻

Parent/Guardian Last Name ✻

Email Address ✻

List first and last names of all members that are enrolling (youth and adults if applicable) ✻

Club/Unit ✻

YOUTH ENROLLMENT FEES

If you would like to request a scholarship, please email Jennifer jlzink@ucanr.edu

You are eligible if your annual household income is at or below $50,560.00 and/or your child is eligible for/enrolled in school free or reduced price meal program. (See Reference: https://www.fns.usda.gov/cn/income-eligibility-guidelines, 2025-2026 Federal Poverty guidelines.)

Self pay: click the box and select a quantity

$72.00 Quantity:

ADULT VOLUNTEER ENROLLMENT FEES (i.e.: Club and Project Leaders)

If you would like to request a scholarship, please email Jennifer jlzink@ucanr.edu

Self pay: click the box and select a quantity

$33.00 Quantity:

If you are paying by credit card, look for the "charge my card" button on the next page.

Payment Type

Credit Card Check

2025-2026 4-H Enrollment Payment Form - Humboldt County