Fond du Lac County 4-H 400 University Drive Fond du Lac, WI 54935 Telephone: (920)929-3170 711 for Relay Fax: (920)929-3181

4-H Staff Tracy Keifenheim 4-H Program Coordinator Tina Engelhardt 4-H Program Assistant

Table of Contents

• Annual Club Volunteer Training
• Club Officer Information
• Club and Committee Charters
• Health and Photo Forms
• 4-H Members Accident Policy Coverage

Annual Club Volunteer Training 

All 4-H Chartered clubs and groups need to have at least one adult volunteer attend Annual Volunteer Training. All adults and youth leaders are encouraged to attend.

Club Officer Information

One of the requirements of a 4-H Club is to have youth involvement in leadership and decision-making.  As a club office you will gain life skills of decision making, problem solving, responsibility, teamwork, leading groups, conflict resolution and more.  Specific information about each officer role is available at the Wisconsin 4-H Community Club Central.

Secretary, Reporter, and Historian Forms

All secretary minutes and reporter updates can be emailed to Tracy Keifenheim at the Extension Office. Information received by the 15th of each month will be highlighted in the Family Times 4-H Newsletter in the following month.

• Secretary, Reporter, and Historian Record Book Cover
• Attendance Record
• Calendar of Club Activities
• Leader Summary Form
• Minutes of Club Meeting
• Secretary Award
• Secretary Book Award Score Card
• Reporter and Historian Book Award
• Reporter Book Award Score Card

Treasurer Forms

• Treasurer Record Book Cover
• Club Financial Record (Excel format)
• Club Financial Record (Word format)
• Ledger Sheet Form (Excel format)
• Ledger Sheet (Word format)
• Membership Fees/Dues Form
• Club Expense Reimbursement Form (Word format)
• Club Deposit Form (Word format)
• Treasurer Award
• Treasurer Book Award Score Card

Club and Committee Charters

4-H Clubs and committees handling finances must have a 4-H charter, which must be renewed annually.  The 4-H Charter formally recognizes a group’s affiliation with 4-H and grants the group permission to use the 4-H Name and Emblem.  Complete details are available at the Wisconsin 4-H Community Club Central.

• Charter and Committee Renewal Forms

Health and Photo Forms

Many county, state, and national 4-H events require a health form to enable staff and volunteers to provide basic first aid, respond to medical emergencies, and provide accommodations for youth participants.  Use this form for events, when required.

• Youth Health Form
• Youth Health Form – Español

Permission needs to be granted from parents to use photos and comments of minors for UW-Extension reports, articles, and publications designed for educational, information, and promotional purposes.

• Photo General Release Form
• Photo General Release Form – Español

4-H Members Have Accident Policy Coverage

Each member is covered by accident insurance. Clubs are billed for this annually. The American Income Life 4-H annual group accident policy covers individual 4-H clubs and country wide programs.

Plan Highlights

• Includes incurred medical and surgical treatment, X-rays, hospital confinement, and ambulance expense up to the maximum amount
• Covers dental services incurred within 52 weeks of the accident
• Provides a benefit if death occurs as a result of an accident within 100 days of the accident
• Covers loss of limbs up to a set amount
• Optional volunteer leader coverage available. – Clubs pay for this coverage if requested.

If a member is injured a claim form needs to be completed. The form is available at   https://www.ailife.com/SpecialRiskDivision/Claims.  Additionally, the adult in charge of the event should contact Tracy Keifenheim at the Extension office to get the form processed.

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