Kansas Wild Kids - Junior Extension Master Naturalists - April 22, 2023

Participant Information

• * First Name:
• * Last Name:
• * Email Address:
• * Confirm Email Address:
• What county/district Extension office are you associated with?
• *

  Childs Age

  • 8
  • 9
  • 10
  • 11
  • 12

• Fee

  Type	Fee
  Event fee	$5.00

Demographic & Allergy Information:

• Please take a few minutes to share some information about yourself. K-State Extension programs are open to everyone. To ensure civil rights policy adherence and to maintain funding for quality programing, we are required to report program participant race and gender data to the United States Department of Agriculture (USDA). Only aggregated information (total numbers across all programs) about race and gender are reported to the USDA. Providing the following information is voluntary and will be maintained strictly for reporting purposes. These records are kept separately from mailing lists and other participant information. Thank you for taking the time to provide us with this information.

• I identify my gender as: --Choose-- Female Male Prefer not to respond
• I identify my race as: --Choose-- American Indian or Alaska Native Asian African American or Black Native Hawaiian or Pacific Islander White Two or more mixed races Prefer not to respond
• I identify my ethnicity as: --Choose-- Hispanic/Latino Non Hispanic/Latino Prefer not to respond
• For participants under the age of 19, please provide your residence: --Choose-- Farm Rural (under 10,000) Town (10,000-50,000) Suburb of Cities (less than 50,000) Central Cities (greater than 50,000)
• For participants under the age of 19, please provide the grade in school: --Choose-- Kindergarten 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade 6th Grade 7th Grade 8th Grade 9th Grade 10th Grade 11th Grade 12th Grade Post High School Not in School Special Education
• Please list any food allergies:

Participant Information

You may add a maximum of 2