Ocean Xplorers Registration

Location: Belfast Free Library (106 High St, Belfast, ME 04915)
Time: 3:30pm to 5:00pm

Registration must be completed for each program session. Registration for each session will opened following the completion of the previous month’s program.

Snacks will be provided for participants. Please list any dietary restrictions in the registration form below.

For more information or a reasonable accommodation, please contact Sadee Mehuren at sadee.mehuren@maine.edu or 207.342.5971 or visit the Belfast Free Library.

Ocean Xplorers Registration

  • Please enter the cell phone number on which you would like to receive text reminders for the program.
    Please note, registration for next month's session will open following the completion of the previous program.

  • Emergency Contact Information

  • Demographic Information (Optional)

  • Release 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 below.

    SIGNATURE

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

  • I understand that this constitutes a legal signature confirming that I acknowledge and agree to the above Terms of Acceptance.
  • I understand that this 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 allow my child in the STEAM Team Ocean Xplorers 4-H program hosted in partnership with the Belfast Free Library 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.
    2. That I have been fully informed of the nature, scope and demands of the Program, and understand that the Program may include activities which could be dangerous to my child and other participants and which could cause property damage, bodily injury and/or death. * See below for specific risks and dangers of the Program
    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 my child as a result of participating in the Program because of the activities and travel involved, and that I personally recognize and appreciate that such dangers and hazards exist for my child. I accept and assume full responsibility for all harm and injury, of every nature, including death, which may occur to my child or which s/he may suffer or cause to others, and for all damages or loss to any personal property owned by me or damaged by my child or my animal while my child is participating in the Program 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 personal property, my child’s injury or death, or the bodily injury, death or damage to personal property of others caused by my child or animal , which may occur or result directly or indirectly from my child’s participation in the Program 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 Nita Frederick at nita.frederick@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 reminder shall continue in full force and effect.

      2. I declare that I completely understand and have fully informed myself of the terms and conditions of the 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.

      Explosure to live animals including fish and other marine life.

      Utilizing tools (scissors, paint, and other craft supplies) in workshops.

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