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ASSUMPTION OF RISK

I am the parent or guardian of the child (minor under the age of eighteen, or other person legally incompetent to contract, whose name is set forth on this form. I understand that there are risks in participating in recreational activities and educational workshops at the Washington State University (WSU) Teen Conference.

Risks in participating in 4-H Teen Conference activities, including touring campus laboratories, participating in activities in the WSU Recreations Center, workshops and Challenge activities, include but are not limited to: temporary or permanent muscle soreness, sprains, strains, cuts, abrasions, bruises, ligament and/or cartilage damage, orthopedic damage, head, neck or spinal injuries, eye damage, burns or death. I also recognize that there are both foreseeable and unforeseeable risks of injury or death that WSU cannot specifically anticipate and list here. Further, I recognize that the actions of other participants in the activity may cause harm or loss to my child or property.

PARENT OR GUARDIAN S RELEASE OF CLAIMS AND LIABILITY

I release, the state of Washington, the Regents of WSU, WSU, any subdivision or unit of WSU, its officers, employees, and agents, from any and all liability, claims, costs, expenses, injuries and/or losses to person or property, which I may sustain and/or sustain as a result of death or injury of my child, as a result of or connected with participation in the above event. My child’s participation includes, but is not limited to, travel to and from the event in a private or public vehicle, any activity connected with the event itself, and use of state equipment or facilities for the event whether on or off WSU property. I have carefully read this document, understand its contents and am fully informed about this program and circumstances. I am aware that this document is a contract with WSU and the program sponsors. I sign it freely and voluntarily.

Signature of Parent / Guardian:

_____________________________________________

Date:

________________

Parent / Guardian (please print): ____________________________________________

Witness Signature:

_______________________________________________________

Date:

________________

Witness Name (please print): _______________________________________________

I understand that, unless noted below; photos, video, or audio recordings made of me at 4-H events may be used by WSU Extension, and Washington State 4-H, without compensation, to promote the 4-H Youth Development Program. I understand that my name may be revealed in descriptive text or commentary.

NO Permission

Yes with this condition:

____

_______________________________________________

*I understand that participants at 4-H events and activities may be asked to complete an evaluation. Completion of the evaluation is optional.

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