San Mateo-SF Counties COVID-19 Training Verification Form for 4-H Volunteers

All 4-H youth and adult volunteers must read and confirm understanding of the new guidelines, listed below, before holding any in-person meetings. 4-H adult volunteers are also required to complete the online application to receive approval of limited in-person activities.

Mandatory Reading

✻ = Required

First Name: ✻

Last Name: ✻

Email: ✻

4-H Volunteer: ✻

Adult Youth

Volunteer Role(s):

Please list all roles (i.e., club president, teen leader for poultry project, community club leader, swine project leader, etc). ✻

Verification

Have you read and agree to follow the guidelines in the 4-H Guidance Poster?

✻

Yes

Have you read and agree to follow the guidelines in the Awareness of COVID-19? ✻

Yes

Have you read and agree to follow the guidelines in the Mitigation Standards Summary for COVID-19? ✻

Yes

Did you attend/review the COVID-19 Phase 2 Safety Training? Training held on 9/22/20, 10/6/20 or 10/17/20 ✻

Yes

If you have any questions, please contact Zeva Cho, 4-H Program Coordinator, zfcho@ucanr.edu.

For Staff Use Only