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.

University of Maine Release and Assumption of Risk

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

1. That I have voluntarily agreed to participate in this activity NAME OF EVENT/ACTIVITY,EVENT DATES, 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 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

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 a reasonable accommodation. If an accommodation is needed, I will contact NAME OF CONTACT to discuss their needs at least 14 days in advance.

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.

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:

• Recreational Activities
• Youth handling animals
• Disregarding direction from instructors or event organizers
• Weather Hazards
• Food Safety
• Overnight camping risks
• Inability of chaperone to adhere to responsibilities and expectations

Personal Judgement

• Assumption of Risk Consent

  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.
• Parent/Guardian Electronic Signature*
  Please type your first and last name
• Assumption of Risk Youth Consent

  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.

  I understand that checking this box constitutes a legal signature confirming that I acknowledge and agree to the above Terms of Acceptance.
• Youth Participant Electronic Signature*
  Please type your first and last name

• Participant Responsibilities and Expectations

  • Come with an open mind to experiential learning
  • Be respectful and participate fully in the program
  • Follow all schedule times including curfew and wake-up hours; to be where assigned, when assigned.
  • Uphold the highest standards of behavior, manners and language.
  • Refrain from using alcoholic beverages, non-prescribed or illegal drugs, tobacco products, or fireworks.
  • Respect the rights of others at all times and make every attempt to include all participants in all activities.
  • Leave the facilities in the same condition or better than I found them when I arrived.
  • Support and follow all leadership and direction received from coordinators, chaperones and any other adult authority.
  • Abide by all UMaine and State/Federal safety guidelines (this may include some restrictions due to COVID-19)
  • Respect the personal space and property of others in all settings including during overnight programs.
  • Seek assistance and support from adult chaperones on behalf of myself or others should a situation arise that warrants adult intervention or makes me feel uncomfortable
• Youth Participant Electronic Signature*
  Please type your first and last name to acknowledge you have read and agree to all responsibilities and expectations.
• Parent/Guardian Electronic Signature*
  Please type your first and last name; understand that typing your name constitutes a legal signature confirming that you acknowledge and agree to the above statement.
• If you need a reasonable accommodation, or if you have any questions/comments, please enter them here:
  If you need a reasonable accommodation, please contact Carla Scocchi, 4-H Staff by submitting this form or at carla.scocchi@maine.edu 207-667-8212 by June 15, 2022. If requests are received after this date, we may not have sufficient time to make necessary arrangements.

• Press submit to complete registration. You will receive an email confirmation.