Enrollment Instructions: Enrollment into the program is held on a first come, first serve basis. Limited spaces are available. You will be notified when your child has been accepted into the program. Once the program is full, further enrollments will be placed on a waiting list.

Please complete the enrollment form with as much information as possible. Your child may not start the program until all required enrollment information has been submitted.

Digital Enrollment Form

Download Parent & Participant Handbook

If you cannot access the digital enrollment form, please contact 4-H Afterschool Program Site Coordinator, Dustin Houppert, at dmh359@cornell.edu.

Medication Consent Form & Instructions: The program staff have emergency medication training and are able to administer emergency medication only. Examples of emergency medication include epi-pens, inhalers, and glucagons. For medication that is administered daily, please contact the school nurse and arrange for medication to be administered at the end of the school day. Please be aware that if your child requires emergency medication, you will need to provide an extra prescription to the site coordinator before your child can start the program.

Download Medical Forms

These forms must be printed and signed by the child’s physician before they can be accepted. Please send completed forms to 4-H Afterschool Program Site Coordinator, Dustin Houppert, at dmh359@cornell.edu, or mail to:

Dustin Houppert
CCE Jefferson
203 North Hamilton St.
Watertown, NY 13601