I understand that the above-named individual will be participating in the New Hampshire 4-H program. The activities include active, hands-on activities that occur at local, county, and statewide venues. Many of these activities are supervised exclusively by volunteers.

We understand the responsibilities, hazards, and dangers inherent in participation in the program, including transportation. It is the policy of UNH Cooperative Extension never to sell or share information with outside agencies.

We may share information with other 4-H Leaders or UNH staff within the county or state for the purpose of planning and promoting events.

We hold harmless the University of New Hampshire, its trustees, officers, agents, employees, and volunteers from and against all claims, demands, actions, and causes of action for damages that may be sustained by the above-named youth or anyone else. This includes personal injury, death, or property damage, whether or not the result of negligent acts or omissions on the part of the University of New Hampshire. If the above-named youth’s participation in the activity causes damage to the property at which the event is taking place, we agree to pay the property owner for such loss.

I agree to the terms above.

I am the legal parent/guardian of the student participating in a UNH youth program.

In the event we cannot be reached to obtain permission, I hereby authorize The University of New Hampshire, youth program staff, and/or its authorized employee representative to act for me in an emergency or other circumstance requiring any medical/mental health treatment or attention on behalf of my child without any further permission.

This consent and authorization shall include, but not be limited to, obtaining necessary hospital, medical, surgical, dental, optical, pharmaceutical, mental health and any related care for my child and to sign any authorization therefore including admissions and/or discharges from any hospital or other care facility.

I also agree to assume financial responsibility for all costs associated with medical treatment and/or transportation.

I further authorize The University of New Hampshire, youth program staff, and/or its authorized employee representative to execute any and all other documents regarding the medical treatment of my child.

I understand that health information may need to be shared with the UNH and/or camp staff on a "need to know" basis. UNH staff will make every effort to reach the provided emergency contacts in the event of a medical or mental health issue.

In most cases, parental notification will occur before providing treatment, especially in non-emergency situations. If UNH staff determines that my child’s medical or mental health requirements fundamentally alter the program and cannot be appropriately managed by program staff, I understand that my child may be asked to leave the program, and as the parent/guardian, I agree to follow the recommendations of UNH staff.

In the State of New Hampshire, a minor cannot refuse medical treatment on their own and camp staff cannot make the decision to refuse treatment on the minor's behalf.

If the minor's parent/legal guardian cannot be reached to provide such refusal in consultation with emergency medical staff, the minor will most likely be transported to a medical facility for further care. All associated costs are the responsibility of the parent/guardian.

4-H/SELT event participants may be photographed and recorded for use in 4-H/SELT promotional and educational materials which may include use on web pages or social media.

I authorize 4-H/SELT to record the above-named person’s image and/or voice for use by the University of New Hampshire, its affiliates (including but not limited to the UNH Cooperative Extension, UNH Foundation, and a 4-H Foundation of New Hampshire), Southeast Land Trust of NH and/or its assignees in research, educational and promotional programs.

I understand and agree that the audio, video, film, and/or print images may be edited, duplicated, distributed, reproduced, broadcast, and/or reformatted in any form and manner without payment of fees, in perpetuity.