Fill Out a Valid Oklahoma 4 H Youth Enrollment Form

IMPORTANT: FIELDS MARKED WITH * ARE REQUIRED – DO NOT SKIP! FAMILY INFORMATION

*E-Mail: _____________________________________________ *Last Name: ______________________________

*Mailing Address: _______________________________________________________________________________

*City:________________________________, OKLAHOMA *Zip Code: ___________________________________

Preferred Name (if different than first name):_________________________________________________________

Work Phone/Extension: _______________________________

PARENT 2 INFORMATION

First & Last Name: __________________________________ Cell Phone: ________________________________

Work Phone/Extension: _______________________________

SECONDARY HOUSEHOLD INFORMATION

Does Email/Mail need to be sent to a Second Household? ฀ Yes ฀ No

Mailing Address: ________________________________________________________________________________

City:________________________________, OKLAHOMA Zip Code: _____________________________________

Second Household E-Mail: ________________________________________________________________________

EMERGENCY CONTACT

If Emergency Contact for this member is different than the parent 1 information above, please complete the information below.

*Emergency Contact Name: ___________________________________ *Phone Number: _____________________

Cell Phone Number: _________________________________ E-Mail: ______________________________________

*Emergency Contact Relationship (Mom, Dad, Aunt, etc.): _______________________________________________

VOLUNTEER - * Are you a certified 4-H Volunteer? (Teen Leader-13 and up) ฀ Yes ฀ No

Oklahoma 4-H Youth Development

Oklahoma 4-H Youth Development

Our signature indicates that:

We have read this entire enrollment package and agree to help this member in the projects in which he/she has enrolled.

TRANSFERRING MEMBERSHIP FROM ANOTHER STATE OR COUNTY:

If you are new to this county and were enrolled in 4-H in another county in Oklahoma or another state, please provide the information below and we will transfer your membership to this county. If you have never been enrolled as a 4-H member before or there was a lapse in membership of a year or more, this information is not needed.

Oklahoma County transferring enrollment from: __________________________________________________

OR

State and county transferring enrollment from: ___________________________________________________

Oklahoma 4-H Youth Development

CODE OF CONDUCT - Rules and Disciplinary Procedures

Rules Participants and Parents Need to Know:

I.In seeking uniformity in the conduct expected at each county, district, state, national, and international 4-H event, the following guidelines have been developed.

Each participant has a reasonable expectation to enjoy a positive program experience. Therefore, the misbehavior of one participant, or a group of participants, will not be permitted to impact negatively on the program experience of others. Most programs are short in duration, so prompt action is required when problems occur.

 Realizi g these guideli es are ot all i lusi e , the E te sio “er i e reser es the right to ake adjust e ts to poli ies.

All rules and regulations governing an activity, event or facility use will be discussed with educators, certified volunteers, parents and 4-H'ers prior to or at the beginning of each event.

All 4-H'ers are under the supervision of any Extension staff or certified volunteer assigned to the event.

If the 4-H'er is found in violation of the Code of Conduct and disciplinary action is required his/her parent/guardian will be notified immediately and the 4-H'er may be suspended from participation in district, state, national and international 4-H activities and/or membership revoked. As deemed necessary, the appropriate County, District or State 4-H Office will be notified of disciplinary action.

If in the event any the misconduct is deemed in violation of a law, the appropriate law enforcement agency will be notified.

Participants dismissed from a program for disciplinary reasons will not receive a refund on any fees paid to attend.

If a 4-H'er wishes to appeal the disciplinary action he/she must appeal in writing through their County Extension Office. Appeals must be filed within 30 days following notification of punishment. As necessary, the State 4-H Leader shall appoint an appeal board, no sooner than 30 days following the date of notification of the disciplinary action.

Participants are responsible for securing their belongings. Neither Oklahoma State University, nor ext. staff or certified

volunteer, is responsible for lost or stolen items. Leave excess money and valuables at home. Valuables brought to the program are at participants’ risk and can only be used at free or other authorized times.

II. The following actions will be considered a serious breach in conduct. This is not an all-inclusive list of conduct violations.

Assault or Personal Harm – Inflicting physical or emotional harm on self or others.

Prohibit the possession, distribution, sale or use of illegal drugs/substances, alcoholic beverages; any form of tobacco or vapor products, fireworks; and/or weapons (does not limit the use of approved sporting arms when and where authorized).

Sexual Misconduct - Coed visitation in the residence halls is permitted in designated common areas only not in sleeping rooms.

No boys will be allo ed i girls’ roo s or ill girls e allo ed i o s' roo s, either as i di iduals or groups. It is re og ized that circumstances may arise for justifiable exceptions to this rule. However, in every case, permission for exceptions must be secured from chaperone in advance.

Theft, Misuse or Abuse of Public or Personal Property - Any damages caused by neglect or misuse will be charged to the responsible party. Replacement cost will be charged to anyone who removes or damages property. Any individual found tampering with any fire equipment (i.e. fire extinguishers, fire alarms, smoke detectors, etc.) will be dismissed from the Program immediately. Participants may not interfere with any security system or tamper with locks in participant rooms and other areas. All furniture must remain unchanged and kept in place.

Search of Property - If a question regarding any of the above is raised, 4-H member consents to a search of his/her room and/or personal property. Failure to comply will result in violation of the Code of Conduct.

III.The following actions will be considered a breach in conduct. This is not an all-inclusive list of conduct violations.

Breaking curfew and/or disturbing the peace - Participants will abide by nightly curfews and remain in there until morning.

Violating the Dress Code

Use of Abusive and Offensive Language

Bullying and Harassment – Physical, emotional or electronic harassment/harm against self, fellow participants or staff.

Vandalism and Pranks will not be permitted.

Unexcused Absence from the activities of the event - Participants are to remain on the event site and attend all workshops, classes, and planned social or recreational activities for the duration of the program unless program activities require otherwise. If a participant needs to leave campus or event site for some reason, supervising ext. staff or certified volunteer must have prior written approval from the parent or guardian, and agree to grant specific permission.

Unauthorized use of Vehicles during the event - Participants are not allowed to drive or ride in personal vehicles during the dates of the program unless they receive specific permission to do so from their supervising extension staff or certified volunteer. While we understand that some participants will drive to the event, our rule is that participants should not be driving during the event. Participants may be asked to turn their car keys in to the supervising staff or certified volunteer for the duration of the program.

Misuse of Technology - Participants must never misuse internet, social media, cell phone or any new technological devices. Accessing or sending unauthorized or inappropriate content is strictly prohibited.

Oklahoma 4-H Youth Development

Informed Consent, Voluntary Waiver, Release of Liability & Assumption of Risks

I, the undersigned, wish for my Child (hereafter Child ) to participate in the above referenced youth program (hereafter Program ) on the date(s) and location(s) indicated above and, in consideration for my Child’s

participation, I hereby agree as follows:

I acknowledge, understand and appreciate that as part of my Child’s participation in the Program there are dangers, hazards and inherent risks to which my Child may be exposed, including the risk of serious physical injury, temporary or permanent disability, and death, as well as economic and property loss. I further realize that participating in the youth program may involve risks and dangers, both known and unknown, and have elected to allow my Child to take part in the Program. Therefore I, on behalf of my Child, voluntarily accept and assume all risk of injury, loss of life or damage to property arising out of training, preparing, participating, and traveling to or from the Program.

I, on behalf of my Child, hereby release Oklahoma 4-H, Oklahoma State University, its Board of Regents, Administration, Faculty, Staff, Student Leaders, the Program Staff, and all other officers, directors, employees, volunteers and agents (hereafter OSU ) from any and all liability as to any right of action that may accrue to my heirs or representatives for any injury to my Child or loss that my Child may suffer while training, preparing, participating and/or traveling to or from the above indicted event. This agreement is binding on my heirs and assigns.

In the event of an accident or serious illness, I hereby authorize representatives of OSU to obtain medical treatment for my Child on my behalf. I hereby hold harmless and agree to indemnify OSU from any claims, causes of action, damages and/or liabilities, arising out of or resulting from said medical treatment. I further agree to accept full responsibility for any and all expenses, including medical expenses that may derive from any injuries to my Child that may occur during his/her participation in the Program.

This RELEASE shall be governed by and construed under the laws of Oklahoma. I agree that any legal action or proceeding relating to this RELEASE, or arising out of any injury, death, damage or loss as a result of my Child’s participation in any part of the Program, shall be brought only in Payne County, Oklahoma.

This RELEASE contains the entire agreement between the parties to this agreement and the terms of this RELEASE are contractual and are not all inclusive. The information I have provided is disclosed accurately and truthfully. I have been given ample opportunity to read this document and I understand and agree to all of its terms and conditions. I understand that I am giving up substantial rights (including my right to sue), and acknowledge that I am signing this document freely and voluntarily, and intend by my signature to provide a complete and unconditional release of all liability to the greatest extent allowed by law. My signature on this document is intended to bind not only myself and my Child but also the successors, heirs, representatives, administrators, and assigns of myself and my Child.