4-H QUAD COUNTY SHOOTING CONTEST
June 11, 2016
NAME COUNTY (of membership) ______
MAILING ADDRESS ______ City State Zip
PHONE NUMBER ______
4-H AGE ____ (As of January 1, 2016) DATE OF BIRTH ______
CERTIFIED LEADER(S) signature for disciplines entered, verifying member has met project requirements.
Discipline______Signature______
Discipline ______Signature______
Special Needs/Accommodations for shooting? (Circle) YES Please list special needs and suggested accommodations on a separate piece of paper and attach to this form.
CIRCLE Appropriate Age Division (4-H Age- on January 1, 2016) YOUTH (8-10) JUNIOR (11-13) SENIOR (14-18)
Maximum of 2 shooting events for all age divisions
DISCIPLINE / EVENT / ü IF ENTERINGARCHERY
Supply your own arrows / Freestyle Recurve/Longbow (with acc)
Traditional Recurve/Longbow (no acc)
Compound-Fingers (no releases)
Compound-Release aids
AIR RIFLE
Pellet –Standard (open sights)
Pellet - Aperture (peep sights)
.22 RIFLE / Standard (open sights) 4p
Aperture - 4p (peep sights) (NO SR)
Aperture - 3p (peep sights) (NO YTH)
SHOTGUN
(Check appropriate gauge below)
12 GA #______
20 GA #______/ Skeet – Junior (25 targets)
Skeet - Senior (25 targets)
Trap-Junior (25 targets)
Trap– Senior (25 targets)
AIR PISTOL / 10 meters, 15 rounds
.22 PISTOL / 25 yards, 15 rounds
Muzzle Loading / 35 yards, 10 shots in 50 minutes
Hunting & Outdoor Skills
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FEE SCHEDULE:
A. ARCHERY FEE @ $1.00 $______B. AIR RIFLE FEE @ 1.00 $______
C. .22 RIFLE FEE @ $1.00 $______
D. SHOTGUN FEE-TRAP & SKEET @ $5.00 $______
E. AIR PISTOL FEE @ $1.00 $______
G. .22 PISTOL FEE @ $1.00 $______
F. MUZZLE LOADING FEE @ $1.00 $______
TOTAL FEES DUE FOR ALL SECTIONS ABOVE $______
DEADLINE in OFFICE: May 13, 2016
RETURN TO: University of MO Extension, PO Box 408, Jackson, MO 63755
CHECKS PAYABLE TO: Cape County 4-H Shooting Sports
Parent/Guardian Signature______Date______
Member Signature _____ Date
BE SURE YOUR PROJECT LEADERS HAVE COMPLETED HEALTH FORMS AND PARENT PERMISSION FORMS ON FILE!
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