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Name(Required)

First Last

Age(Required)

Age 14 - 19 years old, or enrolled in 9th grade or higher for the school year beginning in September.

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone(Required)

Email(Required)

Which Pathway Interests You?(Required)

a. Youth Board Member: Join a board, committee, or advisory council as a youth representative;

b. Policy Leader: Provide input to a policy initiative in your community, the state, or nation;

c. Public Service Leader: Complete a community service project;

d. I don't know yet.

Please check all that apply.

What civic issues or community topics interest you?

Please write a brief explanation (100 to 500 words) about why you are interested in this program.(Required)

Required Forms

Being an Effective Youth Representative²

Program Requirements

YOUth Have a Voice! is a 4-H Youth in Governance and Civic Engagement Program. This program aims to empower you to become a well-informed citizen who provides larger service and better living for your community, country, and the world. You will learn about civic affairs, build decision-making skills and develop a sense of understanding and confidence in relating and connecting to other people. An essential part of the program is for you to engage with organizations, communities, and civic/democratic processes and share voice, influence, and decision-making authority with adults. To participate in this program, you agree to:

Attend meetings on a regular basis. Find out the dates and enter them into your calendar.
- Policy Leader: meetings with policy officials (estimated one to three per program)
- Youth Board Member: Board Meetings where you are a representative (estimated three to seven per program)
- Public Service Leader: meetings with any partners for planning and collaboration, all events related to the project (estimated 3-7 per program)
Attend all 4-H program meetings and learning sessions. There will be at least two in-person sessions and also monthly virtual (Zoom) sessions from late August to April
Regularly meet, check in, or productively correspond with your mentor. This should occur at least once per month. Correspondence could be through email or phone calls.
Stay up to date on important issues. Read materials ahead of time and be prepared with questions, concerns, or suggestions. Seek input from other young people – your constituents.
Relax and be yourself. You are serving with a governing body, and you should show who you really are. Think of the other people in the group as your peers.
Appreciate adult allies. Recognize that adults are trying their best, even if things aren’t going well. Resist the temptation to judge or criticize.

Participant Electronic Signature(Required)

Please type your first and last name.

Date(Required)

MM slash DD slash YYYY

Electronic Signature of Parent or Guardian (required if applicant is under age 18)

Please type your first and last name.

Date

MM slash DD slash YYYY

University of Maine System and 4-H Photo Release Agreement

TERMS OF ACCEPTANCE

I hereby grant and authorize the University of Maine System, acting through the University of Maine, (hereinafter UMS) and the 4-H Program (defined as 4-H Afterschool, National 4-H Council, 4-H Cooperative Extension System, USDA/CSREES, Maine 4-H Program, 4-H clubs and programs, etc.) its employees and agents to make use of, license or assign the use of, my image, appearance, likeness, voice and/or photograph, and other reproductions of any of these, in still photographs, videotapes, publications, audio, sound recordings, web sites, electronic and other media and/or motion pictures, (hereinafter all of which are included in the term “Material”) obtained during the current 4-H year (October-September) at 4-H-sponsored events, and to do so with or without mention of my name.

I understand and agree that I am to receive no compensation of any kind, monetary or otherwise, on account of or arising from the production, publication, recording, rebroadcasting, or other use of such Material.

UMS shall have complete ownership of the Material produced or published and shall have the exclusive right and license to make such use of that Material as it wishes, including, but not limited to the right of performance, display, reproduction and distribution in all media, and the right to create, perform, display and distribute derivative works of the Material.

I agree to indemnify and hold UMS, the University, its employees and agents, harmless from and against any and all claims, damages, lawsuits, judgments, and expenses, including reasonable attorneys’ fees that UMS may become liable to pay or defend arising out of or caused by any matter or material furnished or spoken by me in connection with my appearance.

I hereby release UMS, its employees and agents from all expenses, claims and liabilities incurred by me arising out of or in connection with my appearance and/or the use of the Material, except to the extent that those expenses, claims or liabilities are the direct result of the negligent acts or omissions of UMS, the University, its employees or agents.

This agreement shall be governed and construed according to the laws of the State of Maine.

NOTE: If under 18, must be signed by parent or guardian on last checkbox below.

SIGNATURE

I, the undersigned for this photo release form, warrant the truthfulness of the information provided in this application.

Participant Electronic Signature(Required)

Please type your 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.(Required)

I Agree

I do not agree and do not want my photo taken

Electronic Signature of Parent or Guardian (required if applicant is under age 18)

Please type your 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 Agree

I do not agree and do not want my child/ward's photo taken

University of Maine Release and Assumption of Risk

I Parent/Guardian of the child completing this form acknowledge, declare and agree as follows:

That I have voluntarily agreed to participate in the YOUth Have a Voice!: Youth in Governance and Civic Engagement for the 2023 to 2024 program year, or subsequent dates if the event is rescheduled, and in consideration of my child being permitted to participate in the Program, 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.
That I have been fully informed of the nature, scope and demands of this activity, and I understand that participating may include activities which 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 Volunteer Activity

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.
I declare that my child is able to physically withstand and cope with the indicated rigors of the Program with or without a reasonable accommodation. In complying with the letter and spirit of applicable laws and pursuing its own goals of diversity, the University of Maine does not discriminate on the grounds of race, color, religion, sex, sexual orientation, including transgender status and gender expression, national origin, citizenship status, age, disability, genetic information or veteran status in employment, education, and all other programs and activities. The following person has been designated to handle inquiries regarding nondiscrimination policies: Director, Office of Equal Opportunity, 101 North Stevens Hall, 207.581.1226.
The University provides reasonable accommodations to qualified individuals with disabilities upon request. Any person with a disability who needs accommodations for this program should contact Andrew Hudacs to discuss their needs at least 14 days in advance.
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 reminder shall continue in full force and effect.

I DECLARE THAT I COMPLETELY UNDERSTAND AND HAVE FULLY INFORMED MYSELF OF THE TERMS AND CONDITIONS OF THIS "RELEASE AND ASSUMPTION OF RISK" BY HAVING READ IT, OR HAVING IT READ TO ME, BEFORE SIGNING AND I INTEND TO BE FULLY BOUND THEREBY.

* 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 severe weather, heat, cold, sun, and biting insects.
Fall hazards due to varied terrain
Utilizing tools (ex. stove, cutting cardboard/materials, glue gun, hammer, exposure to hot surfaces, etc.) in enrichment workshops.
Exposure to insects
Exposure to online and internet exposure (ex. workshops held via Zoom may be recorded or screen shot, sharing via social media, etc)

Electronic Signature of Parent or Guardian (required if applicant is under age 18)

I, the parent or legal guardian of my child, agree in consideration of my child being permitted to participate in the Program, 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.

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.

Participant Electronic Signature(Required)

Agree(Required)

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

I declare that I completely understand and have fully informed myself of the terms and conditions of this "Release and Assumption of Risk" by having read it, or having it read to me, before signing and I intend to be fully bound thereby.

Application Form: YOUth Have a Voice: Youth in Governance and Civic Engagement Program

Required Forms

Being an Effective Youth Representative2

Program Requirements

University of Maine System and 4-H Photo Release Agreement

TERMS OF ACCEPTANCE

SIGNATURE

University of Maine Release and Assumption of Risk

Being an Effective Youth Representative²