For Community Sites ONLY

Photo Release Form
We encourage Health Rocks! sites to send pictures. However, we are not permitted to use photos without a signed photo release form from the participants and their parents. Mail the orginals of the signed forms to:

State 4-H Office
Box 9641
Mississippi State, MS 39762

Incentives Order Form (Print the form, complete and mail)

Monthly Report
Monthly reports are due by the 5th of every month

Group Enrollment Form
Final Report Form
After completion of Health Rocks! implementation, all demonstration sites are required to submit a group enrollment form and a Final Report Form.

Additional forms to be downloaded at the local level:
Experiential learning

HR! nametag template

News Release to Announce your County Training

News Release to Recognize your Participation

Share Circle cards (pdf)

Wellness cards (pdf)

Special needs form

Data Collection Protocol (pdf)

Protocol for Youth Survey

Parent's Permission Form Youth Survey (pdf)

Parent's Cover Letter for Youth survey (pdf)

Data Collection Protocol HR! Youth Paper Copy

Paper Version of Youth Survey on Survey Monkey

Health Rocks! Action Plan Form

Ice Breaker Activity - Numbers Don't Lie

Certificate of Completion Template