By submitting this form:
BEHAVIOR EXPECTATIONS OF THE PARTICIPANT
It is important to follow the directions of the 4-H Event leader(s) at all times. The youth participant has been told by the parent or guardian and they understand they will be required to participate in sustaining a safe environment and to be respectful of everyone. They have been told by the parent or guardian that for their safety and the safety of others they will be required to follow rules and directions.
MEDICAL EMERGENCY PARENTAL PERMISSION*
I understand that my child must be healthy and reasonably fit in order to safely participate in camp recreation activities and that I will inform the program leader(s) of any medication, ailment, condition, or injury that may affect his/her ability to participate safely. The health history for my child is correct and complete to my knowledge. If an injury or other medical condition occurs or arises, I hereby give permission to the ISU Extension staff or volunteer to provide routine health care and seek emergency treatment including x-rays or routine tests. I agree to the release of any record necessary for treatment, referral, billing or insurance purposes. I understand that I am financially responsible for charges and hereby guarantee full payment to the attending physicians or health care unit (other than those covered by an ISU Extension accident insurance plan). In the event of an emergency where I cannot decide for my child, I give permission to the physician/hospital selected by the ISU Extension staff or volunteer to secure and administer treatment for my child, including hospitalization. (*If you cannot sign this section of the form for any reason, contact the County Extension Staff regarding a legal waiver in order to attend and participate.)
The Iowa State University Extension Program normally takes photographs, video, and/or tape recording of our programs. During activities, a photograph or video/audio recording may be taken of you or your child. Unless you request otherwise, your initial below will be considered permission for Iowa State University and the 4-H Event program to photograph, film, audio/video tape, record and/or televise your image and/or voice or the image and/or voice of your child for use in any publications or promotional materials, in any medium now known or developed in the future without any restrictions. (*If you object to ISU using you or your child’s image or voice in this manner, please notify the ISU Extension Clay County Office.)
ISU EXTENSION 4-H EVENT ASSUMPTION OF RISK AND RELEASE OF LIABILITY
I give permission for my child to participate in the ISU Extension 4-H Event program. I understand that activities/events may involve certain risks of physical activity and possible injury and that Iowa State University and its SpIn Event program will provide each participant with reasonable care, but that ISU cannot guarantee that my child will remain free of injury. In addition, some activities including but not limited to: water activities and other sporting activities have a higher degree of risk. I nonetheless wish to have my child participate in the ISU Extension SpIn Event program and ASSUME the RISK of participating. I agree to RELEASE from LIABILITY, INDEMNIFY and HOLD HARMLESS the State of Iowa, the Board of Regents of the State of Iowa, ISU and ISU Extension and their officers, employees and agents (hereinafter the RELEASEES) from any and all claim and/or cause of action arising out of and related to any injury, loss, penalties, damage, settlement, costs or other expenses or liabilities that occur as a result of my child’s participation in the program. This release, however, is not intended to release the above-mentioned RELEASEES from liability arising out of their sole negligence.