Illinois 4-H Individual Enrollment Form
2011-2012 Madison-Monroe-St.Clair Counties
This form is primarily for new participants in this group, but may be used by those re-enrolling if a preprinted Illinois 4-H
Individual Re-Enrollment Form is not available. Each youth participant must enroll in at least 1 project yearly.
See project list if attached or check with group’s leader to ensure project enrollment.
 New
 Member
County: ________________Group Name:
 Re-enroll
 Youth Leader
 Adult Leader  Cloverbud
First Name:
MI:
Last Name:
Sex:
Yrs in 4-H: ______
 Female
(including this year)
____________________ _____ ____________________________________  Male
Parent’s First Name:
Parent’s Last Name:
Youth/Parent Email Address (optional):
___________________
______________________
______________________________________
Complete Street and Mailing Address (for US mail and/or UPS delivery):
Zip code:
_________________________________ _________________________________
City:
State: County of Residence:
Home Phone:
_________-______
Alternate Phone:
_________________________ ____ __________________ (_____)_____-_____ (_____)_____-_____
Ethnicity:
Hispanic or Latino  Yes  No
Race: (select one or more)
 American Indian or Alaskan Native
 Asian
 Black or African American
 Native Hawaiian or Pacific Islander
 White
Date of Birth
______/_____/________
Grade (KI-12, PO (post-high school)
_____
NO (not in school))
Residence:
 Farm (where income is earned farming)
 Rural/Small Town (under 10,000)
 Medium Town (10,000-50,000)
 Suburb of one of the cities above
 City (includes Bloomington-Normal, C-U, Chicago, Decatur, Joliet,
Peoria, Rockford, Rock Island/Moline, Springfield, or East St. Louis)
Parents or Adult Participants:
I would like information on the Illinois 4-H Foundation and how it supports the 4-H program.
 Yes
 No
I would like information on the county-level Foundation and how it supports the 4-H program.
 Yes
 No
I grant the 4-H Youth Program, University of Illinois Extension, the permission to disclose my (or my child's) identity and to reproduce
and distribute videotapes, films, photographs, and transparencies of me (or my child) and sound recordings arising out of documenting
4-H youth programs.
 Yes
 No
4-H Youth Guidelines: All youth who participate in Illinois 4-H Youth Development programs, which are planned, conducted, and
supervised by University of Illinois Extension, are responsible for their own conduct. Youth participating in 4-H programs are expected
to demonstrate the character traits of trustworthiness, respect, responsibility, fairness, caring, and citizenship. Specifically, 4-H youth
are expected to abide by the following behavior guidelines.
1.
Be courteous and respect others.
2.
Obey all rules established by the University of Illinois Extension 4-H Youth Development program and those of the local
club/group as well as local and state laws.
3.
Treat all people fairly and animals humanely.
4.
Respect the property of others.
5.
Respect the authority of adult or youth volunteers, paid Extension staff, and others in leadership roles.
6.
Use appropriate language and wear acceptable clothing at 4-H activities and events.
7.
Show kindness to others and give assistance when needed.
8.
Be honest and honor commitments.
9.
Strive for personal best and keep trying to improve.
10.
Accept responsibility for personal choices.
We understand and accept the responsibility for following the 4-H Youth Behavior Guidelines. We further understand that failure to do
so may result in disciplinary action and forfeiture of participation privileges.
_______________________________
Signature of Participant
________________________________________________
Signature of Parent/Guardian
____________________
Date
_________________________________________________________________________________________________________
Issued in furtherance of Cooperative Extension Work, Acts of May and June 30, 1914, in cooperation with the U.S. Department of
Agriculture, Dennis Campion, Director, University of Illinois Extension, University of Illinois at Urbana-Champaign. University of Illinois
Extension provides equal opportunities in programs and employment. The 4-H Name and Emblem are Protected Under 18 U.S.C. 707.
revised 8/2004
All enrollment forms must be received by the Extension office no later than
Monday, January 2, 2012
Illinois 4-H Projects for 2011-2012
Madison-Monroe-St. Clair Counties
Participant’s Name
I have enrolled in
County:
Group Name:
projects this year (as noted below.)

Select projects and clearly mark the box to the far left of
the project name.

To order the project manual, clearly mark the circle.
(The circle only appears if project manuals are available for the project.) See the Illinois Clover for details.

If the symbol  replaces the circle, the member manual
is new and should be ordered even if the member has the old project manual.
Aerospace
 Aerospace 2 (grades 3-5)
 Aerospace 3 (grades 6-8)
 Aerospace 4 (grades 9-12)
Beef
 Beef 1 (beginner)
 Beef 2 (intermediate)
 Beef 3 (advanced)
Bicycles
 Bicycle 1 (grades 3-5)
 Bicycle 2 (grades 6-8)
Communications
 Communications 1 (grades 3-5)
 Communications 2 (grades 6-8)
 Communications 3 (grades 9-12)
 Journalism (grades 7-12)
 Public Presentations (all ages)
Computer Science
 Computer Science Intro
(beginner)
 Computer Science 1
(intermediate)
Camping
 Outdoor Adventures 1(beginner)
 Outdoor Adventures 2 (intermediate)
 Outdoor Adventures 3 (advanced)
Cats
 Cat 1 (beginner)
 Cat 2 (intermediate)
 Cat 3 (advanced)
 Computer Science 2 (advanced)
 Computer Science 3 (advanced)
Consumer Ed
 Consumer Savvy 1 (grades 4-5)
 Consumer Savvy 2 (grades 6-8)
 Consumer Savvy 3 (grades 9-12)
 Entrepreneurship (grades 7-12)
 Financial Champions 1
(grades 7-8)
Child Development
 Child Dev. 1 (grades 3-4)
 Child Dev. 2 (grades 5-6)
 Child Dev. 3 (grades 7-10)
Citizenship
 Public Adventures (grades 4-12)
 Citizenship 1 (grades 3-5)
 Citizenship 2 (grades 6-8)
 Citizenship 3 (grades 9-12)
 Service Learning 1 (grades 5-8)
 Service Learning 2 (grades 9-12)
Clothing & Textiles
 Sewing & Textiles 1 (beginner)
 Sewing & Textiles 2 (intermediate)
 Sewing & Textiles 3 (advanced)
 Clothing Decisions 1 (grades 6-8)
 Clothing Decisions 2 (grades 9-12)
 Financial Champions 2
(grades 9-10)
Crops
 Corn (all ages)
 Small Grains (all ages)
 Soybeans (all ages)
Dairy Cattle
 Dairy 1 (beginner)
 Dairy 2 (intermediate)
 Dairy 3 (advanced)
Dogs
 Dog 1 (beginner)
 Dog 2 (intermediate)
 Dog 3 (advanced)
Electricity
 Electricity 1 (beginner)
 Electricity 2 (intermediate)
 Electricity 3 (advanced)
 Electricity 4 (advanced)
Entomology
 Entomology 1 (grades 3-5)
 Entomology 2 (grades 6-8)
 Entomology 3 (grades 9-12)
Food and Nutrition
 4-H Cooking 101 (beginner)
 4-H Cooking 201 (intermediate)
 4-H Cooking 301 (intermediate)
 4-H Cooking 401 (advanced)
 Food Preservation (ages 13+)
 Meat & Other Protein (ages 13+)
 Microwave Magic A (beginner)
 Microwave Magic B (intermediate)
 Microwave Magic C (intermediate)
 Microwave Magic D (advanced)
 Outdoor Meals I (beginner)
Forestry
 Forests of Fun 1 (grades 3-5)
 Forests of Fun 2 (grades 6-8)
 Forests of Fun 3 (grades 9-12)
Geology
 Geology (all ages)
Geospatial
 Explrg Spaces, Going Places 1
 Explrg Spaces, Going Places 2
 Explrg Spaces, Going Places 3
Goats
 Dairy Goat 1 (beginner)
 Dairy Goat 2 (intermediate)
 Dairy Goat 3 (advanced)
 Meat Goat 1 (beginner)
 Meat Goat 2 (intermediate)
 Meat Goat 3 (advanced)
Health & Fitness
_________________________________________________________________________________________________________
Issued in furtherance of Cooperative Extension Work, Acts of May and June 30, 1914, in cooperation with the U.S. Department of
Agriculture, Dennis Campion, Director, University of Illinois Extension, University of Illinois at Urbana-Champaign. University of Illinois
Extension provides equal opportunities in programs and employment. The 4-H Name and Emblem are Protected Under 18 U.S.C. 707.
revised 8/2004
 Health 1 (beginner)
 Health 2 (beginner)
 Health 3 (intermediate)
Horse and Pony
 Horse 1 (beginner)
 Horse 2 (intermediate)
 Horse 3 (intermediate)
 Horse 4 (advanced)
 Horse 5 (advanced)
Horticulture
 Floriculture A (grades 3-4)
 Floriculture B (grades 5-6)
 Floriculture C (grades 7-9)
 Floriculture D (grades 10-12)
 Vegetable Gardening A
(beginner)

Vegetable Gardening B
(intermediate)

Vegetable Gardening C
(intermediate)

Vegetable Gardening D
Plant & Soil Science
 Plants & Soils 1 (beginner)
 Plants & Soils 2 (intermediate)
 Plants & Soils 3 (advanced)
Poultry
 Poultry 1 (beginner)
 Poultry 2 (intermediate)
 Poultry 3 (advanced)
Rabbits
 Rabbit 1 (beginner)
 Rabbit 2 (intermediate)
 Rabbit 3 (advanced)
(all ages)
Intergenerational
 Walk In My Shoes (all ages)
Interior Design
 Interior Design (ages 12-18)
Leadership
 Leadership 1 (grades 3-6)
 Leadership 2 (grades 7-9)
 Leadership 3 (grades 10-12)
Natural Resources
 Explrng.Your Envirnment 1
(grades 6-8)
 Explrng.Your Envirnment 2
(grades 6-8)
 Natural Resources 1
(beginner)
 Natural Resources 2
(intermediate)
 Natural Resources 3
(advanced)





Sportfishing 1 (grades 3-5)
Sportfishing 2 (grades 6-8)
Sportfishing 3 (grades 9-12)
Wildlife A (grades 3-4)
Wildlife B (grades 5-6)
Photography
 Photography 1 (beginner)
 Photography 2 (intermediate)
 Photography 3 (advanced)
(grades 3-5)
 Veterinary Science 2
(grades 6-8)
 Veterinary Science 3
(grades 9-12)
Video
 Filmmaking (online only)
(beginner)
Robotics (grades 4-12)
 Virtual Robotics
 Junk Drawer Robotics
Level 1
 Junk Drawer Robotics
Level 2
 Junk Drawer Robotics
Level 3
 Robotics Platforms
(advanced)
Intercultural
 Passport to the World
Veterinary Science
 Veterinary Science 1
Visual Arts
 AVA-Draw/Fiber/Sculpt
(grades 7-12)
 AVA-Paint/Print/Graphics
(grades 7-12)
 Visual Arts (all ages)
Welding
 Welding
(grades 7-12)
Sheep
 Sheep 1 (beginner)
 Sheep 2 (intermediate)
 Sheep 3 (advanced)
Shooting Sports (group only)

Archery (ages 8-18)

Rifle (ages 8-18)

Shotgun (ages 10-18)
Small Engines
 Small Engines 1 (beginner)
 Small Engines 2 (intermediate)
 Small Engines 3 (advanced)
Small Pets
 Small Pets 1 (grades 3-4)
 Small Pets 2 (grades 5-7)
 Small Pets 3 (grades 8-12)
Woodworking
 Woodworking 1 (beginner)
 Woodworking 2 (intermediate)
 Woodworking 3 (intermediate)
 Woodworking 4 (advanced)
Clover Challenge

Project Area
_____________

Project Area
_________

Project Area
_____________
Swine
 Swine 1 (beginner)
 Swine 2 (intermediate)
 Swine 3 (advanced)
Theater Arts
 Theater Arts 1 (all ages)
 Theater Arts 2 (all ages)
 Theater Arts 3 (all ages)
Tractor
 Tractor A (beginner)
 Tractor B (intermediate)
 Tractor C (intermediate)
 Tractor D (advanced)
_________________________________________________________________________________________________________
Issued in furtherance of Cooperative Extension Work, Acts of May and June 30, 1914, in cooperation with the U.S. Department of
Agriculture, Dennis Campion, Director, University of Illinois Extension, University of Illinois at Urbana-Champaign. University of Illinois
Extension provides equal opportunities in programs and employment. The 4-H Name and Emblem are Protected Under 18 U.S.C. 707.
revised 8/2004
C L O V E R B U D
O
R
N
E
R
The following projects are available
to CLOVERBUD members 5-7 years
old and not yet in 3rd grade.
They may enroll in these projects in
addition to participating in projects
within their group. No competitive
judging or premiums are permitted.






Aerospace 1
Bicycle 1
Exploring 4-H Group Activities
Exploring Farm Animals
Vegetable Gardening A
Veterinary Science 1
Remember to recycle those
4-H project manuals.
You can do this within your club or by
bringing them to the Extension office.
If you have any 4-H project manuals that
your family is no longer using, please
consider recycling them. The Extension
office is accepting gently used project
manuals without writing in them to
redistribute to 4-H members this year.
All enrollment forms must be received by
the Extension office no later than
Monday, January 2, 2012
_________________________________________________________________________________________________________
Issued in furtherance of Cooperative Extension Work, Acts of May and June 30, 1914, in cooperation with the U.S. Department of
Agriculture, Dennis Campion, Director, University of Illinois Extension, University of Illinois at Urbana-Champaign. University of Illinois
Extension provides equal opportunities in programs and employment. The 4-H Name and Emblem are Protected Under 18 U.S.C. 707.
revised 8/2004