2025-2026 4-H Enrollment Fee Waiver Form

Fill in the information below to pay for 4-H enrollment(s) with a credit card, using UCANR's secure online system.

Please make sure you complete your 4-H Enrollment before submitting your payment

Please note:

If you would prefer to pay by check instead of by credit card, please make payable to UC Regents and mail to:

UC 4-H YDP, Central Sierra
311 Fair Lane
Placerville, CA 95667

✻ = 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: ✻

Have you submitted an enrollment application via ZSuite for the above listed youth member?

If not, visit https://4h.zsuite.org/ to submit their application right away. ✻

Yes No

Full Program Fee Waiver

Are you requesting a full waiver of the $71.00 4-H program enrollment fee 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: 2024 Federal Poverty Guidelines Percentage Tool) ✻

Yes No

Partial Program Fee Waiver

Are you requesting to pay a reduced portion of the $71.00 4-H enrollment 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.) ✻

If you have requested a reduced fee, you will be prompted to make your payment on the next screen after submitting this form.

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:
VPPZIR

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

2025-2026 4-H Enrollment Fee Waiver Form - Central Sierra