2012 Farm Field Days Registration - Salt Lake County 4-H

*School District

Canyons Granite Jordan Murray Salt Lake City

*Name of School

Characters remaining:

*Principal Name

Characters remaining:

*School Phone:

Characters remaining:

*Contact Person or Teacher:

Characters remaining:

*Contact Email Address:

Characters remaining:

*Cell Number:

Characters remaining:

*School Address:

Characters remaining:

*City:

Characters remaining:

*Zip code:

Characters remaining:

*First Choice

Choose only one of the following: (Please be sure to check the box in front of the day requested.)

(a) Tuesday May 1st / 9:30 am - 11:00 am (b) Tuesday May 1st / 12:30 pm -2:00 pm (d) Wednesday May 2nd/ 11:00 am -12:30 pm

Alternate Choice:

In case of overbooking, select your second choice of day and time.

(a) Tuesday, May 1st / 9:30 am - 11:00 am (b) Tuesday, May 1st / 12:30 pm -2:00 pm (d) Wednesday, May 2nd / 11:00 am - 12:30 pm

*Number of Students in your Class

Characters remaining:

Additional Classes Attending

Please list the teacher's name,and number of children in their class.

Characters remaining:

*Other Teachers' Email addresses

Please provide the email address of all teachers attending with your group.

Characters remaining:

*Verification : Please answer the question below

How many fingers are there on a human hand?