RBG
YEARLY PLAN AND RECORD
WINNEBAGO COUNTY, WI
2015 — 2016
Name:
Grade during the 2015-2016 year:
Name of Club:
Parents’/Guardians’ Name:
List Project(s) and How Many Years You’ve Been Involved
Below are the projects I have carried as a 4-H member.
Name of Project
# of Years
Check if
enrolled in
this year
TABLE OF CONTENTS
 Introductory Page/4-H Story
 My 4-H Goals
 Project Pages (including pictures)
List Project(s) by order in Record Book
 This Year’s 4-H Memories (optional),
i.e. photos, news
clippings, etc. from club activities, county events (pizza making, camp) etc.
 Parent/Guardian Comments
 Organizational/Project/Youth Leader(s)’ Comments
My 4-H Goals
20
Plan to
do
√
Club Participation
Attend regular club meetings
Make contributions to club
meetings
Help with Community Service
Project
Serve on Club Committee
Help with club booth at County
Fair
Help with club fundraiser
Enroll as a Youth Leader
Hold a club officer position
Club Speech/Demonstration
Attend club trip/outing
Please list other club activities:
County Participation
Help in the Dipper Foodstand
Make and/or Sell Pizzas
Fair Exhibitor
Fair Helper, Building Monitor
Speaking/Demo Contest
4-H Teen Winter Camp
4-H Camp
4-H Camp Counselor
Clothing Revue
Animal Project Meetings
County Committees i.e. Dipper,
Basket Raffle, Breakfast at the
Fair
Officer Training
4-H Board of Directors
4-H Ambassador
4-H Family Banquet
Activity / Project Youth Leader
Please list other County
Activities:
Completed
√
Plan to
do
√
District, State, National
District/State
Judging Contest
Interstate Exchange
Winter Leadership Camp
State Dog Show
State Horse Expo
State 4-H Team:
Wisconsin Leadership
Council
State Art/Communication
Workshop or Arts Camp
Space Camp
WI 4-H & Youth
Conference
American Spirit
Citizenship Washington
Focus (CWF)
National 4-H Congress
National 4-H Conference
Fall Forum
4-H International
Exchange (Host / Traveler)
State Fair Exhibitor
State Fair Volunteer /
Activities Station
State Livestock Show
Please list other District,
State, National Activities:
Completed
√
One specific 4-H goal I hope to achieve is …
I plan to achieve this by…
Participating in the activities beyond the club or/and county has benefited or helped me learn…
My 4-H Story
(Tell about this past 4-H year, club outings, 4-H trips, fundraisers, fair, etc.)
Year in 4-H:
Grade Completed:
Photo of
yourself
(Continue on reverse side)
One thing I didn’t do this year that I really want to
do in 4-H is . . .
(Add pages , if you wish)
Parent/Guardian Comments
I certify that I have completed this record book on my own. My parent/guardian may have assisted
me, but they did not complete any section of this book for me.
Youth Signature:
Date:
Parent/Guardian Signature:
Date:
I have the following financial understanding with my parent(s)/guardian(s). Check all that apply.
□
Parent/Guardian covers all costs.
□
I cover my own cost.
□
We share costs.
□
Fundraiser with club.
□
No agreement.
□
Other (explain).
Parent/Guardian: Please comment on how you feel about your child’s participation in 4-H this year.
(Additional page may be added)
Organizational/Project/Youth Leader(s)’ Comments
Please have this section filled out by at least one leader.
1.) Signature/Title:
Date:
2.) Signature/Title:
Date:
3.) Signature/Title:
Date:
4.) Signature/Title:
Date:
Please comment on how you feel about your member’s effort on his/her 4-H year.
1)
2)
(Additional page may be added)
Flag Pledge
I pledge allegiance to the flag of the United States of America, and to the republic for which it
stands, one nation under God, indivisible, with liberty and justice for all.
4-H Pledge
I Pledge …My Head to clearer thinking
…My Heart to greater loyalt y
…My Hands to larger service, and
…My Health to better living, for my Club, my Community, my Country,
and my World.
4-H Club Emblem: The four-leaf clover
4-H Club Colors: Green and White
4-H Club Motto:
“To Make the Best Better”
An EEO/AA employer, University of Wisconsin Extension provides
equal opportunities in employment and programming, including
Title IX and American with Disabilities (ADA) requirements. ©
2004 by the Board of Regents of the University of Wisconsin
System. Developed by the Wisconsin 4-H Office, 431 Lowell Hall,
610 Langdon St., Madison, WI 53703. The 4-H name and
emblem are federally protected under Title 18 US Code 707.