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Get Activity And Event Acceptance Form - UT Extension - The University ... - Utextension Tennessee

Nafide signatures shall be sufficient to disqualify a member from further participation. Activity and Event Acceptance Form for (event or activity) A. Identification of 4-H Member Social Security Number / / Date of Birth / Age / Sex: Male Female Parent or Guardian Home Address (City) (Street/P0 Box) Daytime Phone ( Nighttime Phone ( ) (State) (zip) ) Work Place Address Phone ( (Street/P0 Box) (City) (State) ) (zip) Other Emergency Contact (if appropriate) (Name) ( (Ad.

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