Texas 4-H Youth Development Program - Participation Waiver Guidelines and Form

GUIDELINES

The Texas 4-H Youth Development Program is committed to providing a positive experience for all young people throughout Texas. Annual delivery of the program has become dependent on participation fees as one way of maintaining a strong program for our youth. However, in some cases, our 4-H members need assistance and support in covering their participation fees. In these cases it is the hope that county and/or local 4-H programs, other community organizations, other families, or local donors/supporters would assist in helping provide the positive 4-H experience to youth needing assistance. In the extreme circumstance that county/local 4-H programs do not have access to funds to support participation fees, the state 4-H office does provide limited supplemental assistance.

Waivers will only be considered for those youth who are members of active chartered clubs for the approved 4-H year.
Waivers must be for youth in a specific club/group enrolling by October 31.
A minimum of $10.00 participation fee will need to be paid by the requestor to cover the direct expenses of general liability insurance and accident/incident insurance purchased for each youth by the Texas 4-H Youth Development Program and Texas 4-H Inc.
Waivers will not be granted for future or potential members enrolling after October 31.
(ie counties cannot request 50 waivers for any youth enrolling throughout the year).
If members join after October 31 who need help with funds - please request application.
Each waiver will be given an expiration date and will not be usable after that date.
Waivers must be submitted online by a county Extension agent/Office or Extension employee.
A decision and instructions for enrollment will be sent to the contact person listed on the waiver within 2 weeks of application.

CONTACT INFORMATION FOR PERSON REQUESTING WAIVER

First Name *

Must be submitted by a County Extension Agent/Office or Extension Employee

Last Name *

Title *

Email Address: *

Phone Number *

CLUB/GROUP INFORMATION AND WAIVER INFORMATION

County: *

District:
*

Year

Name of club/group: *

Affiliation of club/group: *

Charter Approved Date: *

Number of Youth In club/group: *

Number of youth requesting waiver: *

Type of Waiver: *

How much is being contributed per youth: *

Club/Group Bank Account?: *

Bank Account Balance:

Did this club/group receive a waiver last year: *

QUESTIONS

How will the required fee per youth be covered from your county/program? *

Has the county Extension office/agent explored all opportunities for support from the county/local 4-H program, other families, community organizations, local businesses, or donors? (Yes/No, and please explain) *

Does the 4-H club/group have a bank account/funds that could be used for the payment of participation fees? If yes, why are funds not being allocated to participation fees? *

Has the 4-H club/group conducted any fund raising events to cover participation fees? If not, why? *

The members of Texas A&M AgriLife will provide equal opportunities in programs and activities, education, and employment to all persons regardless of race, color, sex, religion, national origin, age, disability, genetic information, veteran status, sexual orientation or gender identity and will strive to achieve full and equal employment opportunity throughout Texas A&M AgriLife.