Health Statement and Parents' Release

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Cooperative Extension Service	Agricultural Experiment Station
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Publication # C-411

REVISED --

Effective Date --10-1-99

Youth applying for and participating in district, state, national, and international 4-H activities and events must submit with their application a current health statement - FY4-H - 633 (MSWord PDF) and parent's release FY4-H - 703 (MSWord PDF) completed by their parents or guardian. Youth should have in their possession a current health statement signed by their parent or guardian during transportation to and from 4-H activities as well as during the activity. This signed health statement should be given to the 4-H activity/event coordinator and to adults providing transportation to such activities/events. Parents of youth participating in 4-H activities and events should be made aware that, if a medical situation arises, youth who do not have a signed health statement may be refused medical attention unless contact can be made with a parent or guardian.

University of Arkansas • Division of Agriculture
Cooperative Extension Service
2301 South University Avenue
Little Rock, Arkansas 72204 • USA
Phone (501) 671-2000 • Fax (501) 671-2209

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