2020-2021 San Mateo/San Francisco County 4-H Farm Use Request Application

In order to raise animal(s) or use garden space(s) at a San Mateo/San Francisco (SMSF) County 4-H Farm for experiential learning purposes (not for personal use), primary or youth members must complete the following:

Complete this online application.
Acknowledge that you and your parent/guardian have read and understood the SMSF County Farm Rules.
Acknowledge that you and your parent/guardian have read and understood the Local Farm Rules (read all that apply).

Note: Local farm rules may require a physical signed document. Please check with the local farm manager/boss.

Submission Deadlines for the program year (no later than 11:59 pm)

August 31: Steer/Heifers (deadline changed for 2020 only)
November 15: All other animals (except steer/heifer) including dairy and/or breeding animals, group projects and garden spaces
January 15: Any changes and final requests

County 4-H Farm Management Committee will review and approve farm use requests within 1 to 2 weeks of the submission deadline.

Re-Edit Survey

If you want to re-edit this survey later, provide a password:

Or, if you previously entered a password, and want to access your information:
Enter password to re-edit a survey

✻ = Required

BEFORE BEGINNING YOUR APPLICATION:

Create a password (above) to access your application as you work on it. Write it down.

After your first submission, you will receive an ID to use along with your password to sign in the next time.

Write down your ID and password for future reference.

If you are not ready to answer a required question, place a # in each text box and come back to it later.

You will be able to edit the information when you return to the application.

Press "Submit" at the bottom - EVERY time you close the application.

This will save your edits in a working document.

Primary or Youth Member Information

First Name: ✻

Last Name: ✻

Home Street Address: ✻

City: ✻

Zip Code: ✻

Birthdate (format: MM/DD/YYYY): ✻

Age (as of December 31, 2020): ✻

Years in 4-H: ✻

Youth e-mail (if you don't have an email, please enter N/A): ✻

4-H Club: ✻

Belmont Burlingame/San Mateo Cañada/Redwood City Half Moon Bay Pacifica San Bruno/South San Francisco San Carlos/Eaton Hills San Mateo Park

Parent/Guardian Information

Parent/Guardian Name(s): ✻

Parent/Guardian e-mail: ✻

Parent/Guardian Cell Phone Number (format: XXX-XXX-XXXX): ✻

Request Information

I request farm space for

(enter a whole number or leave blank if not applicable)

# of Market Chickens:

# of Market Turkeys:

# of Market Rabbits:

# of Market Goat(s):

# of Market Lamb(s):

# of Market Hog(s):

# of Market Heifer/Steer:

# of Pygmy Goat(s):

# of Nigerian Dwarf Goat(s):

# of Dairy/Breeding Goat(s):

# of Breeding Ewe(s):

Request Garden Space/Section:

Yes No

If non-market animals or other, please specify:

(separate entries with semicolon if more than one)

# of Non-Market/Other Animals (i.e., laying hens, bantams, rabbits, group projects - specify quantity):

Years in project (enter 0 if this is your first year):

(separate each project with a semicolon. For example, market chicken - 3; market hog - 1) ✻

Please list project leader's name for each specie/garden project:

(separate project entries with semicolon if more than one) ✻

4-H Farm Location Request (please read and understand the rules for each farms you are applying for:

Crystal Spring 4-H Farm Rules

Pacifica 4-H Farm Rules

San Bruno/SSF 4-H Farm Rules

San Carlos 4-H Farm Rules ✻

Crystal Springs Farm Pacifica Farm San Bruno/South San Francisco Farm San Carlos/Eaton Hills Farm

If selecting more than one farm choices, please indicate 1st, 2nd, etc choice

(separate choices with semicolon if more than one)

Start Date for your animal and/or garden project (format: MM/DD/YYYY):

(separate entries with semicolon if more than one) ✻

End Date for your animal and/or garden project (format: MM/DD/YY):

(separate entries with semicolon if more than one) ✻

Project Goals - please complete and be prepared to discuss.

Goals should answer these questions:

What are your goals and what results do you expect from your work (please be specific for EACH space request)?

(max 500 words per space request) ✻

What do you expect to contribute to other 4-H members and/or to the community?

(max 500 words) ✻

Primary or Youth Members and Parent/Guardian Acknowledgments - Electronic Verification

Have you informed the project leader(s) listed above and your local farm manager of your request(s).

Farm Manager:
Crystal Springs Farm - Elizabeth Kurr, ekurr@att.net
Pacifica Farm - Marisa Shaff, gmshaff@comcast.net
San Bruno Farm - Deni Meyerhoff, denimeyerhoff@gmail.com
San Carlos Farm - Erica Thuener, ethuener@gmail.com ✻

Yes No

I hereby acknowledge that I have READ, UNDERSTOOD and AGREE to comply with the SMSF County Farm Rules.

Primary or youth member and parent/guardian initials. ✻

I hereby acknowledge that I have READ, UNDERSTOOD and AGREE to comply with all applicable local farm rules.

Crystal Spring 4-H Farm Rules

Pacifica 4-H Farm Rules

San Bruno/SSF 4-H Farm Rules

San Carlos 4-H Farm Rules

Primary or Youth member and parent/guardian initials. ✻

I acknowledge the information in this form are TRUE, CORRECT, and COMPLETE to the best of my knowledge.

Primary or Youth member and parent/guardian's initials. ✻

Please enter Parent/Guardian name to acknowledge electronically the statement, "I confirm the information in this application are TRUE, CORRECT, and COMPLETE."

For Farm Management Committee Use Only

Approval Date (MM/DD/YYYY):

Request Approved?

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