Shooting Sports Enrollment Checklist
Name ___________________________________________________________
_____Enrollment Form (SS and 4-H)
_____Medical History Form
_____Liability Release Form
_____ Discipline schedule
_____Payments
_____________________________________________________________________
Office Use Only
_____ Program Fee $20 (Make checks payable to
U of I Extension)
_____Program Fee paid with other 4-H Club
Check #____________
Amount $__________
Received by ________
Date ______________
_____ Supply Fees (Make check payable to La Salle County 4-H Shooting Sports)
_____Archery $20 / $25
Check #____________
_____.22 Rifle $20 / $25
Amount $__________
_____ Air Rifle $20 / $25
Received by ________
Date ______________
_____Shotgun $45 / $50
______________________________________________________________________
Shooting Sports Enrollment Deadlines
To be determined each new 4-H Year
Air Rifle – _____________________
Limited to ___ participants
Archery – ______________________
Limited to ___ participants
.22 Rifle – ______________________
Limited to ___ participants
Shotgun – ______________________
Limited to ___participants
Enrollment will NOT be processed until all forms and payment are received
Return forms and payment to La Salle County Extension Office
1689 N 31st Rd, Ottawa, Il 61350
815-433-0707
Thank You for participating in our Shooting Sports Program