Registration for 4-H Jamboree

Thank you for registering for the 2021 Jamboree with 4-H in Hancock County! Go back to the event page for workshop and activity information.

4-H Jamboree

Your Name*
First Last
Email*
Phone
Best way to contact you.
- Phone call
- Text
- Email
- Facebook
Address*
This is the address where the kit(s) will be delivered. Please note that we can only deliver to Washington and Hancock County residents. If you live in neighboring counties (Waldo, Penobscot), please allow for additional time for us to ship your activity kits.

Street Address Address Line 2 City State ZIP Code
Youth Participants*
*Press the + sign to add another youth* Note: As a way to document those we are reaching, we are seeking Gender and Race/Ethnicity information on an optional basis. It is important that we ensure equal opportunity to all who might benefit from our programs.
First and Last Name Age Gender Race/Ethnicity Enrolled in 4-H
Are you interested in Backyard Camping?
Keep the spirit of June Jamboree alive by camping in your backyard any day from June 5th - July 11th!
- Yes
- No
Would you like supplies for s'mores?
- Yes, definitely! I loooove chocolate marshmallow goodness.
- No, I'll get my own.
- Yuck. S'mores?? No, thank you.
Activity Kit Registration
Check the kit(s) that your household is interested in receiving. Activity descriptions can be found on the webpage above this form.
- Introduction to 4-H
- Outdoor Survival
- Build a Boat
- Ellsworth's STEAM Reading List
- Grow a Garden
- Discover Birding
- Nature Journalling
- Blue Hill Hertiage Trust Scavenger Hunt
- Frenchman Bay Conservancy Scavenger Hunt
- Geocaching Around the County (smart phone required)
- Photo Scavenger Hunt Challenge
Are you interested in registering for in-person workshops?*
- Yes
- No
Which workshops are you interested in registering for?
Workshops are limited in size and registration will occur on a first-come, first-serve basis. If a workshop fills up, your name will be put on a waiting list and we'll let you know if a spot opens up.
- Tomato in a Bucket, June 5th
- Intro to Orienteering, June 12th
- Painting with Felt, June 26th
- Build a Wind Vane, July 11th
Please type in the name(s) of all of the participants who will be attending the workshop, "Tomato in a Bucket."
Include the names of a parent/guardian if they will be accompanying the participant. Please only one adult per participant.
Please type in the name(s) of all of the participants who will be attending the workshop, "Intro to Orienteering."
Include the names of a parent/guardian if they will be accompanying the participant.
Please type in the name(s) of all of the participants who will be attending the workshop, "Painting with Felt.".
Include the names of a parent/guardian if they will be accompanying the participant.
Please type in the name(s) of all of the participants who will be attending the workshop, "Build a Weather Vane.".
Include the names of a parent/guardian if they will be accompanying the participant.
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 Joyce Fortier, 4-H Support Staff by submitting this form or at joyce.fortier@maine.edu 207-667-8212 by June 1st, 2021. If requests are received after this date, we may not have sufficient time to make necessary arrangements.
Required Forms
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.
Youth Participant Electronic Signature*
Please type your first and last name
Photo Release
Leave this box unchecked if you do NOT want your photo taken.
- I 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
Photo Release Consent
Leave this box unchecked if you do NOT want your child's photo taken.
- 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.
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, Hancock Jamboree from June 5th - July 11th, 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
1. 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.
2. 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 Joyce Fortier (joyce.fortier@maine.edu) to discuss their needs at least 14 days in advance.
1. 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
- Disregarding direction from instructors or event organizers
- Weather Hazards
- Food Safety
- Parent/Guardian Electronic Signature*
  Please type your first and last name
- 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.
- Youth Participant 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.
- Participant Responsibilities and Expectations
  - Come with an open mind to experiential learning
  - Be respectful and participate fully in the program
  - Adult supervision at home is expected for all project-related activities
  - Obtain the necessary equipment and supplies (materials/parts lists will be provided only if stated, some workshops will require you to gather your own materials in advance)
  - Perform tasks necessary to complete the project or workshop
  - Keep records as directed by program leaders
  - Report and present on the outcome of the project when appropriate
  - Take on a leadership role in an area of your interest when appropriate
  - Abide by all UMaine and State/Federal safety guidelines (this may include some restrictions due to COVID-19)
  - Some activities will require a small financial investment and time commitment from parents/guardians for their child to begin this project.
- 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.

The University of Maine is an EEO/AA employer and does not discriminate on the grounds of race, color, religion, sex, sexual orientation, transgender status, gender expression,

First and Last Name	Age	Gender	Race/Ethnicity	Enrolled in 4-H

4-H Jamboree

Required Forms

University of Maine System and 4-H Photo Release Agreement

TERMS OF ACCEPTANCE

SIGNATURE

University of Maine Release and Assumption of Risk

Participant Responsibilities and Expectations