March 27, 2023 YQCA Training-Charlotte CH

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This form is the FIRST step in completing your registration for the YQCA Training that will be held on Monday, March 27th from 6:30 to 8:30 pm at the Charlotte County Extension Office - 133 LeGrande Ave, Charlotte CH, VA 23923

If you have questions or need more information contact Darla Marks at dmarks@vt.edu (434-542-5884) After completion and review of this form, you will receive an email with further instructions and a coupon code that you will need to enter into the YQCAprogram.org portal. This code covers the cost of the training for youth participants. Please allow time for Instructors to process pre-registrations and send your coupon code.

Youth for the Quality Care of Animals (YQCA) is a national multi-species quality assurance program for youth ages 8 to 21. An in-person YQCA workshop requires complete attendance. The program has been designed by extension specialists and national livestock program managers to ensure it is accurate, current and relevant to the needs of the animal industry and shows and is appropriate for youth.

Email *

What is the youth's first name? *

What is the youth's last name? *

Youth's birthdate (Month/Day/Year) *

YYYY

What is the parent/guardian name? *

Parent Contact Phone Number *

In which county or unit do you participate in 4-H or FFA? *

Please list any allergies or sensitivities, including food allergies. Snacks/meals will not be provided but food items may be used in the educational process. *

Please check any of the following assistive services that you may need:

Reader

Wheel chair access

Interpreter

Assistance for Hearing Impaired

Other:

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For the second step of the registration you must use the YQCA portal. I understand that I must register through the YQCA portal prior to the training and if I do not utilize the YQCA portal that I will not receive my certification. *

I understand the above statement, and I will complete my registration through the YQCA portal.

A copy of your responses will be emailed to the address you provided.

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