Calaveras 4-H In-Person Activity Request

Date of Event ✻

Leader Name: ✻

Email: ✻

Club/Project Name: ✻

Location name:

Facility Address: ✻

Location Type: ✻

Open to public: ✻

Is the total number of participants (leaders, youth, and guardians) less than 10? ✻

Are you able to maintain 6ft social distancing at this location? ✻

Complete the following:

1. Watch In-Person COVID-19 Mitigation Training Video ( SLIDE PDF )
2. Read UC ANR Awareness of COVID-19 summary sheet
3. Read UC ANR Mitigation Standards Summary for COVID-19, Stage 2
4. Read COVID-19 Phase 2 Safety Protocol Checklist
5. Submit Training Verification: https://ucanr.edu/survey/survey.cfm?surveynumber=32272