4-H School Enrichment
4H logo Curriculum Enrollment Form

Pinellas County Extension/4-H, 12520 Ulmerton Road, Largo, FL 33774 or 4-H/Heritage Village, Pony Rt. #2
Phone: (727)582-2528 Fax: 582-2262
School Name
School Address
Pony Route
School Phone
Alternate Phone
Best time to call
* Email

* Required

Teachers Gender Ethnicity
(*coordinator)
Total number of Students: Total Number of Classrooms:

Number of students by Grade:
     
K 1 2 3 4 5  
6 7 8 9 10 11 12
Number of students by Gender:
    Total Male Total Female    
Number of students by Ethnicity:
      
White
Black
Am. Ind/Alaskan Native
Asian
Hawaiian/Pacific Islander
Hispanic
Non-Hispanic

Curriculum only/ no speaker
Curriculum is checked out for 6 weeks

Program
Starting Date
  

 

 
Earth Connections
  
Grade Level
 
Water Wise

 

 
 
H2Ow you make a difference

 

 
 
Marine Science

 

Grade Level
 
Aquatic & Marine Ecosystems
  
 
 
Living in Space Program
 
Grade Level
 
Energy Encounters
 
 
 
Liquid Planet
  
 
 
All about Animals
  
 
 
World of Animals
  
 
 
Plant Connections
    
 
 
Talking with TJ: Teamwork Series
    
 
 
Talking with TJ: Conflict Management
    
 
 
Kidstart -
    
I currently have the curriculum 
 
I want to participate in the:
  Fall drive
  Spring Drive
Fun with Foods
    
 
 
Food Fun Fitness
    
 
 
Food Fundamentals
    
 
 
Building a Better Breakfast
    
 
 
Science and our Food Supply
  
 
 
Would you like to be on the mailing list to receive our monthly Pinellas County/University of Florida educational newsletter “Timely Topics”? Yes No  

 

These curriculum are also available for summer school and camp use.
Please enroll just as you would for regular session.

I agree to abide by the rules and regulations as set forth in the county affirmative action guidelines.

I agree! I disagree

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