Maine 4-H State Dairy Show Registration Form

Name:(Required)

First Last

Email:(Required)

Phone:(Required)

What day do you plan to arrive?(Required)

How many animals do you intend to bring?(Required)

Limits: Seniors 5, Intermediates 4, Juniors 3

Do you intend to participate in the 4-H Fitting Contest?(Required)

Yes (be sure to bring an unclipped heifer to use in the contest)

No

Unknown- I would like someone to contact me to provide additional information

Do you intend to participate in the 4-H Grilled Cheese/Milkshake Contest?(Required)

Yes

No

Unknown- I would like someone to contact me to provide additional information

Emergency Contact:(Required)

Emergency Contact Phone:(Required)

UNIVERSITY OF MAINE SYSTEM RELEASE AND ASSUMPTION OF RISK

I acknowledge, declare, and agree as follows:

1. That I have voluntarily agreed to participate in the Maine 4-H State Dairy Show from July 19, 2024, to July 21, 2024, and in consideration of being permitted to participate, do voluntarily execute this "Release and Assumption of Risk" on behalf of myself, my heirs and next-of-kin, my personal representatives and my estate.

2. That I have been fully informed of the nature, scope, and demands of this activity, and I understand that participating may include activities that could be dangerous to me and others and which could cause property damage, bodily injury, and/or death. *See below for specific risks and dangers of the activity

3. That the University of Maine System and its University of Maine Cooperative Extension, (hereinafter referred to as the "University") has informed me that there may be dangers and hazards inherent to participants because of the activities involved and that I personally recognize and appreciate that such dangers and hazards exist. I accept and assume full responsibility for all harm and injury, of every nature, including death, which may occur to me or which I may suffer or cause to others, and for all damages or loss to any real or personal property owned by me or damaged by me, while I am participating and during all travel and transportation, and, in furtherance thereof, I agree to indemnify, hold harmless and release the University, its Trustees, faculty, employees, volunteers, and agents, from and against any and all claims, demands, actions or causes of action, on account of damage or loss to my real or personal property, my personal injury or death, or the personal injury, death or damage to real or personal property of others caused by me, which may occur or result directly or indirectly from my participation in the activity and not as a direct result of any negligent act of the University, its Trustees, faculty, employees, volunteers or agents.

4. I declare that I am able to physically withstand and cope with the indicated rigors of this activity with or without reasonable accommodation. If accommodation is needed, I will contact Sadee Mehuren.

5. This "Release and Assumption of Risk" shall be construed and interpreted pursuant to the laws of the State of Maine, and if any portion thereof is held invalid, void, unenforceable, or illegal, the remainder shall continue in full force and effect.

* Such dangers, hazards and risks of this activity may include, but are not limited to, injuries inflicted by the following:

Exposure to elements such as sever weather, heat, cold, sun, and biting insects.

Falls from all-terrain vehicles, bicycles, skateboards, scooters, or other personal transportation devices.

Fall hazards due to varied terrain.

Direct contact with livestock.

Potential exposure to COVID-19 while in a small outdoor group setting.

Use of cooking equipment including a griddle, knives, etc.

Electronic Signature of Participant(Required)

Please type first and last name.

I understand that checking this box constitutes a legal signature confirming that I acknowledge and agree to the above Terms of Acceptance.

I (child participant) understand that attendance in the Maine 4-H State Dairy show is not without risk to myself, members of my family, my guests who may attend, or my animal. I declare that I completely understand the "Assumption of Risk” by having read it, or having it read to me, Assented and agreed to on this day.

Electronic Signature of Parent or Guardian(Required)

Please type first and last name.

I, as Parent/Guardian, understand that checking this box constitutes a legal signature confirming that I acknowledge and agree to the above Terms of Acceptance.

I, the parent or legal guardian of my child, agree in consideration of my child being permitted to participate in the Maine 4-H State Dairy Show, to be bound by the terms of this Release and Assumption of Risk; and hereby indemnify, hold harmless and release the University, its Trustees, faculty, employees, volunteers and agents, in the same manner and with the same force and effect as set forth in section 3 above with regard to my child participating in the Program.

Cooperative Extension: 4-H

Maine 4-H State Dairy Show Registration Form

Animal Information (Optional)