Alabama 4-H Youth & Parent Consent Form printable pdf download

Alabama 4-H Youth & Parent Consent Form

892 4-H Road, Columbiana, AL 35051

Tel (205) 669-4241, Fax (205) 669-1364

Publicity Release

 I authorize Alabama 4-H or its assignees to record or photograph my image and/or voice and that of my child (if under 19) for use in

research, educational and promotional programs and hereby convey all rights in such recording, photo, video or other media rights,

including but not limited to Alabama 4-H or its assignee. I also recognize that these audio, video and image recordings are the property

of Alabama 4-H

 No, I do not authorize use of my – or my child’s – individual image or voice.

Alabama 4-H Youth Code of Conduct

• I will attend all sessions of planned programs and will exhibit good character and behavior, such as trustworthiness, responsibility,

respect, caring, citizenship and fairness.

• I recognize that boys are not allowed in girls’ rooms and girls are not allowed in boys’ rooms except in rare cases when directly

supervised by adult chaperones.

• I will be responsive to the reasonable requests of leaders and comply with the need for personal safety.

• I will dress appropriately, use appropriate language, and value the rights of others.

• I will not use alcohol, drugs, or tobacco nor remain in the presence of anyone using them.

• I will not behave recklessly, engage in sexual misconduct, assault, threaten or harm another person nor abuse public or private

property.

• When I have access to computers at ACES facilities, I will use the computer for educational purposes and will not access

inappropriate web sites.

• I recognize that these guidelines are not “all inclusive” and that the Alabama Cooperative Extension System may make adjustments to

these policies.

CAMPER: I have read the Alabama 4-H Youth Code of Conduct and agree to live up to the expectations. I realize my failure to do so

could result in a loss of privileges during the event and/or in the future and may result in my being sent home at the expense of my

parent(s) or guardian(s).

Camper Signature ____________________________ Date___________________

Authorized Release of Camper

Please list any individual other than the custodial parent(s) or legal guardian(s) that are authorized to pick up your child at the end of

their camping session or in the case of an illness or injury:

Name: _________________________________________ Phone: _____________________________________________

Please note: Campers will only be released to those listed above. A valid photo ID (i.e. driver’s license, passport) must be presented before the child

will be released.

I have read and understand the Publicity Release and the Alabama 4-H Youth Code of Conduct.

Parent/Guardian Signature ___________________________________________ Date _________________

Alabama 4-H Youth & Parent Consent Form

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