2012 Skillathon Entry Form

2012 State 4-H Livestock Skillathon & Quiz Bowl Contests
NCSU Beef Educational Unit, Raleigh NC

June 27, 2012

**Entry Form Must Be Submitted by County 4-H or Livestock Agent**

Extension Agent  County
Address Phone Number
Coach's Name Coach's Address
Coach's Phone Coach's Email
Contest    

A.

Name
Birthdate
Address
Phone


B.

Name
Birthdate
Address
Phone

C.

Name
Birthdate
Address
Phone

D.

Name
Birthdate
Address
Phone

Individual Contestants

Name
Birthdate
Address
Phone

Total # of
Seniors
Juniors
Others
Total Attending

Please let us know if you have any youth with special needs or consideration so we can make the appropriate adjustments prior to the contest date. Thank You.


Entry Fee :$10 per Youth,$8.00 per Agent/Coach/Adult. Lunch will be provided. Mailed entry forms must be postmarked by June 17, 2011 to Brent Jennings, Box 7621, NCSU, Raleigh, NC 27695-7621 or submitted electronically via this form by 12:00 NOON Friday, June 15, 2012. Make Checks Payable to NCSU.

If you have adult leaders or volunteers accompanying youth to the contest who wish to help with activities during the contest, please indicate their names and the species they would prefer to work with in the space below. This will provide us with the opportunity to utilize their assistance.

Volunteers Name
  

Submitting this form indicates that you understand the rules for the State 4-H Livestock Judging Contest and agree to abide by them. You will also certify that the above individuals are 4-H Members according to the requirements for 4-H members in your County and that you are their 4-H or Livestock Agent.