Registration Form 19 th Annual Teen Involvement Conference January 20-22, 2012 fb.com/4htic

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1 Registration Form 19 th Annual Teen Involvement Conference January 20-22, 2012 fb.com/4htic Registration Fee: Early Bird: Application postmarked by December 11, 2011 Registration Fee - $ Deadline: Application postmarked between December 12, 2011 and January 7, 2012: Registration Fee - $ Late Registration: Application postmarked after January 7, 2012 or handed to the check-in table at the conference: Registration Fee - $ No refunds of fees after January 13, 2012 Conference Information: The Teen Involvement Conference is open to all California State 4-H members aged years old. Members must be 13 and not older than 19 by January 1, Ages must be verified by the local club leader with a signature located on this application form. All members must agree to the 4-H Code of Conduct and any rules set forth anytime during the conference by planning staff or chaperons. Chaperon Information: For every 8 youth attending, one Chaperon is required or the youth will not be able to attend. If there are male youth attending the conference it is required that there is a male chaperon from the youth s county. To be a chaperon at TIC you must be an enrolled 4-H leader and over the age of 21 or follow your county chaperone guidelines. NO ONE CAN LEAVE EARLY FROM TIC WITHOUT PRIOR PERMISSION!!! *TIC REGISTRATION IS ON A FIRST COME, FIRST SERVE BASIS, SO GET YOUR APPLICATIONS IN AS SOON AS POSSIBLE.* Applications are required to have the following: signed application, signed code of conduct, signed medical release form, signed dress code sheet, and registration fee in the form of a CHECK or MONEY ORDER made out to the South Section Leaders Council. Please mail completed application and registration fee package to: Matthew Jones 874 Ronald St. Brawley CA (760)

2 TIC Application Name: Age: Mailing Address: City: Zip Code: County: Phone #: Address: Member s Signature: Parent s Signature: Local Club Leader s Signature: Phone # County Staff Signature: Phone # Workshop Selection Please select a first and second choice for each workshop. Every effort will be made to accommodate the first choice of each participant. Attendance to workshops is a conference requirement, and selection is on a first come first serve basis. Workshop A 1 st Choice Workshop B 1 st Choice Workshop C 1 st Choice Workshop D 1 st Choice 2 nd Choice 2 nd Choice 2 nd Choice 2 nd Choice Please Attach, Completed: ~Code of Conduct ~Medical Release o youth for participants o adult for chaperones only This is a leadership conference. All the delegates will be expected to participate in the workshops and to attend all general workshops. During these workshops no one will be allowed to stay in their cabins. If the delegate becomes ill they will be staying with the nurse in the medical cabin. Please mail completed application and registration fee package to: Matthew Jones 874 Ronald St. Brawley CA (760) Items Needed for Success on the Island

3 Personal Items: Sleeping Bag Pillow Towel Washcloth Toothbrush/paste Soap/Shampoo Warm Clothes (enough for 2 days) Pajamas Extra socks Shoes (sandals/flip flops discouraged) Jacket Hat/Beanie (optional) Mittens/Gloves/Scarf (optional) Flash Light Your Enthusiasm!!!! Items to Share: (each delegate is asked to bring these items to share) 1 Snack Item for the community snack table (may bring more if you wish) Items for Community Service Project (see page 6 of registration packet) County Participation: (each county is asked to bring these items to participate in the opening ceremonies) County Flag and Flag Stand Poster Advertising County At least one flat of water (more would be appreciated!) Please come ready to talk about your county on Saturday afternoon. You may bring photos, fliers, or specific items that represent your county. Be creative! This presentation may be done as a group or you may choose 1 or 2 delegates to speak. You will have 3 to 5 minutes to make your county shine!

4 The South Section Teen Council is Proud to Present Taking Life Head On! Presented by: Yo Pal Hal Elrod Hal Elrod has been known as Yo Pal Hal since hosting his first radio show at age 15. He became a national record-breaking sales rep for a 200 million dollar marketing company at 19, but his real triumph came at age 20 when he was hit head on by a drunk driver and found dead at the scene Defying the logic of doctors, he lived, and despite the temptations to be a victim, he worked his way back to become a bestselling author, award-winning keynote, youth, and college motivational speaker, international life & business coach, hall of fame business achiever, ultra-marathon runner, survivor of a near-fatal car accident, and most importantly proud husband and father. Hal has appeared on dozens of TV and radio shows across the country, and his story was featured in the alltime bestselling Chicken Soup for the Soul book series. His bestselling book is Taking Life Head On! (The Hal Elrod Story) and he is the Creator of the not-soobvious secret guaranteed to change your entire life (before 8:00 A.M.) known as The Miracle Morning. Workshop Sessions Session A Session B Session C Session D 11:00 A.M. 1:10 P.M. 2:10 P.M. 3:30 P.M. Powering the Powering the Eat that Frog Eat that Frog Island Island Island Beaches Island Beaches Team Building Team Building Automotons: Automotons: The Secret of Life The Secret of Life Simple Machines Simple Machines Workshop Workshop Mapping Citizenship Mapping Citizenship Start an Island Start an Island Success Success Revolution! Revolution! Finding Hidden Treasure Finding Hidden Treasure

5 Island Beaches Gayle Champlin During your visit to Leadership Island stop and play in the sand. Create a beautiful sand art bottle, keychain or necklace. This session is learning to relax with crafts. You will also be able to take this knowledge back to your club or county. Mapping Citizenship Success Tory Grainger This session will share with participants the different adventures to becoming aware of being a good citizen while searching for treasure. Interactive discussion and presentation of conferences and trips such as California focus, National Conference, National Congress, and possibly International Frontiers. Start an Island Revolution! (Revolution of Responsibility) Dayle Morris and Savanna Stanley Ventura County All Stars Have a problem in your county that needs fixing but you don t know what to do? Come get some ideas on how to get others in your community involved in making a difference. Powering the Island (Geothermal Energy) Ernie Higgins General Manager of Calenergy Operating Company What is Geothermal Energy? How do they use it to make electricity? Learn how the science of Geothermal Energy powers our planet using our planet, and how California is on the cutting edge of this renewable energy source. Cardboard Automaton: Simple Machines Workshop Jessica Choi - California 4-H Technology Leadership Team The cardboard automaton is a hands-on, inquiry-based workshop that is low cost and environmentally friendly. This workshop is a fusion of art, as well as science, engineering, and technology (SET). Using shoe boxes that would otherwise be thrown away and common household items, such as straws and skewers, this workshop is perfect for underprivileged and individual groups and organizations. Finding Hidden Treasure John Trammell - California 4-H Technology Leadership Team Learn to use GPS technology to find hidden containers with GPS coordinates. Find out about this fast growing hobby called Geocaching! Team Building Making A List And Checking It Twice San Bernardino All-Stars Come learn to work as a team and how to teach others to do the same. But how do you know if you are succeeding? This session will also enable delegates and leaders to make a physical checklist to know if their team is running the correct way. In this session, they will be doing different activities to test their team. These activities are quick and easy letting the delegates take them back into their counties and clubs Eat That Frog Tony Burkhardt, South Section Teen Council Advisor Riverside County 4-H Volunteer Leader The secret to getting more things in less time. Bring pen, paper and a healthy appetite! The Secret Of Life Tony Burkhardt, South Section Tee Council Adviser So what is the secret of life? How do I find this buried treasure? Let s go and see if X marks the spot!

6 Community Service Project Honoring Our Troops To honor and thank our troops for the sacrifices they make for our country, we will be collecting items to ship to troops currently deployed in either Iraq or Afghanistan. These items will be shared by all troops n the area. Items you may contribute are: FoodItems Individually Wrapped Candies (Twizzlers, Tootsie Rolls, Tootsie Pops, Skittles, Life Savers, etc) NO CHOCOLATE chocolate can melt Small Packages (snack size) of nuts, seeds, pretzels, cookies, chips (Pringles in a can are best), Cracker Jacks, corn nuts, fruit snacks, and fruit leather Trail Mix, energy bars, protein bars, breakfast and granola bars, nut bars, Instant oatmeal, Kraft Easy Mac, Ramen Noodles, and Cup-a-Noodles Powdered presweetened drink mixes (Gatorade, Crystal Light, Kool-Aid), ground or instant coffee, tea bags, hot chocolate, cider mix, sweeteners, Coffee Mate, and condiment packets. Canned meat (NO PORK!), stews, chili, ravioli, soups, fruit, beef jerky, non-refrigerated microwavable meals Personal Items Hotel/Travel size gel deodorant, shampoo, lotion, toothpaste, mouthwash, toothbrushes, dental floss, and Brush-Ups Disposable razors, eye drops, nose drops, unscented baby wipes, wet wipes, small bottles of hand sanitizer, Mach 3 Turbo Razor Blades Small Kleenex packages, Q-Tips (large packages are fine), anti-fungal creams, Band Aides, Foot powder, and sunscreen DVD s, CD s, batteries (AAA and AA), pens, pencils, blank greeting cards and stationery, stickers, disposable cameras, AT&T phone cards, comic books, puzzle books, and paper-back novels Ziploc Bags (all sizes) to make care packages Hand written notes, cards, and letters of encouragement. We will be making these at TIC! Quilts Of Valor We are also making and sending quilts to the Quilts of Valor Project. If your county would like to participate by making a quilt to donate, go to The quilts need to meet certain requirements. This site will give you all of the requirements for the quilts. The finished quilts will be given to wounded soldiers as they enter the hospital and will remain with them for the entire time they are recuperating. Then the quilt will go home with the soldier to become a permanent part of his/her home. It is a reminder of those of us who care. It would be awesome if we could send several quilts to this project!!!

7 University of California Division of Agriculture and Natural Resources 4-H Youth Development Program Youth Medical Release Form This Medical Release Form is authorized for all 4-H Youth Development meetings and activities during the dates specified below: First Name Last Name Club/Unit Name County and State to Dates (From / To) While my child is attending or traveling to or from this 4-H function, I HEREBY AUTHORIZE THE ADULT 4-H VOLUNTEER LEADER OR 4-H STAFF MEMBER, or in his/her absence or disability, any adult accompanying or assisting him/her, TO CONSENT TO THE FOLLOWING MEDICAL TREATMENT FOR SAID MINOR: Any x-ray examination, anesthetic, medical or surgical diagnosis or treatment, and hospital care which is deemed advisable by, and is to be rendered under the general or special supervision of any physician and/or surgeon licensed under the provisions of the Medical Practices Act, California Business and Professions Code Section 2000 et seq.; or any x-ray examination, anesthetic, dental or surgical diagnosis or treatment, and hospital care to be rendered by a dentist licensed under the provisions of the Dental Practices Act, California Business and Professions Code Section 1600 et seq. This authorization is given pursuant to the provisions of Section 25.8 of the Civil Code of California. This authorization shall remain effective until my child completes his/her activities in this program unless sooner revoked in writing. I understand that as a parent/guardian, I will be responsible for the cost of any service or treatment provided not covered by the 4-H Accident/Sickness Insurance Program sponsored by UC Cooperative Extension. Emergency Contact Information Name Relationship to Youth Identified Above ( ) Emergency Day Phone (with area code) ( ) Emergency Night Phone (with area code) Mailing Address City State Zip Authorization and Consent and Release I hereby certify that my child is in good health and can travel to and participate in all functions of the 4-H Youth Development Program as described above. I understand is it my responsibility to keep the information on this form updated (including Health History and parent/guardian status) by contacting the State 4-H Office. Signature of Parent/Guardian Date Non-Consent I do not desire to sign this authorization and understand that this will prohibit my child from receiving any non-life threatening medical attention in the event of illness or accident. Signature of Parent/Guardian Date University policy and the State of California Information Practices Act of 1977 require the following information be provided when collecting personal information from you: The information entered on this form is collected under authority of the Smith-Lever Act. Submission of the medical data is voluntary. However, a signature is required on one or the other of the two signature lines above. Failure to provide the medical information and authorization may result in our inability to provide necessary medical treatment. You have the right to review University records containing personal information about you/your child, with certain exceptions as set forth in policy and statute. Copies of University policies pertaining to the collection, use, or release of personal data are available for your examination from the local UCCE County Director, 4-H Youth Development Advisor, 4-H Program Representative, or the State 4-H Director at the California 4-H Youth Development Program, University of California, DANR Building, One Hopkins Road, Davis, CA , (530) Only your own/your child's records are open to your review. Any known or foreseeable intergovernmental transfer that may be made of the information is as follows: None.

8 University of California Division of Agriculture and Natural Resources 4-H Youth Development Program Health History Information / / First Name Last Name County Date of Birth Subject to: Yes No Now Have or Have Had Yes No Colds Heart Trouble Sore Throat Asthma Fainting Spells Lung Trouble Bronchitis Sinus Trouble Convulsions Hernia (rupture) Cramps Appendicitis Allergies Has appendix been removed? Wear corrective lenses? Do you walk in your sleep? Is hearing good? Date of last Tetanus Vaccination: Please check over-the-counter medications that may be administered: Tylenol Ibuprofen Cough Syrup Decongestant Dramamine Antacid Polysporin Hydrocortisone Other: Please identify allergies including allergies to food, medications, and drug reactions: Please list any disability accommodations you will need in order to participate in this program or activity. Please list all current medications: Name of Medication Dosage Times Taken Please include any additional remarks and special instructions to better assist emergency service personnel. Please explain yes answers on this page. The University of California prohibits discrimination or harassment of any person on the basis of race, color, national origin, religion, sex, gender identity, pregnancy (including childbirth, and medical conditions related to pregnancy or childbirth), physical or mental disability, medical condition (cancer-related or genetic characteristics), ancestry, marital status, age, sexual orientation, citizenship, or service in the uniformed services (as defined by the Uniformed Services Employment and Reemployment Rights Act of 1994: service in the uniformed services includes membership, application for membership, performance of service, application for service, or obligation for service in the uniformed services) in any of its programs or activities. University policy also prohibits reprisal or retaliation against any person in any of its programs or activities for making a complaint of discrimination or sexual harassment or for using or participating in the investigation or resolution process of any such complaint. University policy is intended to be consistent with the provisions of applicable State and Federal laws. Inquiries regarding the University s nondiscrimination policies may be directed to the Affirmative Action/Equal Opportunity Director, University of California, Agriculture and Natural Resources, 1111 Franklin Street, 6th Floor, Oakland, CA 94607, (510) H 1109 (Rev 9/2008)

9 University of California Division of Agriculture and Natural Resources 4-H Youth Development Program Adult Medical Release Form This Medical Release Form is authorized for all 4-H Youth Development meetings and activities during the dates specified below: First Name Last Name Club/Unit Name County and State to Dates (From / To) While I am attending or traveling to or from this 4-H function, I HEREBY AUTHORIZE THE ADULT 4-H LEADER OR 4-H STAFF MEMBER, or in his/her absence or disability, any adult accompanying or assisting him/her, TO CONSENT TO THE FOLLOWING MEDICAL TREATMENT FOR ME SHOULD I BE UNABLE TO MAKE A DECISION: Any x-ray examination, anesthetic, medical or surgical diagnosis or treatment, and hospital care which is deemed advisable by, and is to be rendered under the general or special supervision of any physician and/or surgeon licensed under the provisions of the Medical Practices Act, California Business and Professions Code Section 2000 et seq.; or any x-ray examination, anesthetic, dental or surgical diagnosis or treatment, and hospital care to be rendered by a dentist licensed under the provisions of the Dental Practices Act, California Business and Professions Code Section 1600 et seq. This authorization is given pursuant to the provisions of Section 25.8 of the Civil Code of California. This authorization shall remain effective until I complete my activities in this program unless sooner revoked in writing. I understand that I will be responsible for the cost of any service or treatment provided not covered by the 4-H Accident/Sickness Insurance Program sponsored by UC Cooperative Extension. Emergency Contact Information Name Relationship to Adult Identified Above ( ) Emergency Day Phone (with area code) ( ) Emergency Night Phone (with area code) Mailing Address City State Zip Authorization and Consent and Release I hereby certify that I am in good health and can travel to and participate in all functions of the 4-H Youth Development Program as described above. I understand is it my responsibility to keep the information on this form updated (including Health History) by contacting the State 4-H Office. Signature Date Non-Consent I do not desire to sign this authorization and understand that this will prohibit me from receiving any non-life threatening medical attention in the event of illness or accident. Signature Date University policy and the State of California Information Practices Act of 1977 require the following information be provided when collecting personal information from you: The information entered on this form is collected under authority of the Smith-Lever Act. Submission of the medical data is voluntary. However, a signature is required on one or the other of the two signature lines above. Failure to provide the medical information and authorization may result in our inability to provide necessary medical treatment. You have the right to review University records containing personal information about you, with certain exceptions as set forth in policy and statute. Copies of University policies pertaining to the collection, use, or release of personal data are available for your examination from the local UCCE County Director, 4-H Youth Development Advisor, 4-H Program Representative or the State 4-H Director of the California 4-H Youth Development Program, University of California, DANR Building, One Hopkins Road, Davis, CA , (530) Only your own records are open to your review. Any known or foreseeable intergovernmental transfer that may be made of the information is as follows: None.

10 University of California Division of Agriculture and Natural Resources 4-H Youth Development Program Health History Information / / First Name Last Name County Date of Birth Subject to: Yes No Now Have or Have Had Yes No Colds Heart Trouble Sore Throat Asthma Fainting Spells Lung Trouble Bronchitis Sinus Trouble Convulsions Hernia (rupture) Cramps Appendicitis Allergies Has appendix been removed? Wear corrective lenses? Do you walk in your sleep? Is hearing good? Date of last Tetanus Vaccination: Please identify allergies including allergies to food, medications, and drug reactions: Please list any disability accommodations you will need in order to participate in this program or activity. Please list all current medications: Name of Medication Dosage Times Taken Please include any additional remarks and special instructions to better assist emergency service personnel. Please explain yes answers on this page. The University of California prohibits discrimination or harassment of any person on the basis of race, color, national origin, religion, sex, gender identity, pregnancy (including childbirth, and medical conditions related to pregnancy or childbirth), physical or mental disability, medical condition (cancer-related or genetic characteristics), ancestry, marital status, age, sexual orientation, citizenship, or service in the uniformed services (as defined by the Uniformed Services Employment and Reemployment Rights Act of 1994: service in the uniformed services includes membership, application for membership, performance of service, application for service, or obligation for service in the uniformed services) in any of its programs or activities. University policy also prohibits reprisal or retaliation against any person in any of its programs or activities for making a complaint of discrimination or sexual harassment or for using or participating in the investigation or resolution process of any such complaint. University policy is intended to be consistent with the provisions of applicable State and Federal laws. Inquiries regarding the University s nondiscrimination policies may be directed to the Affirmative Action/Equal Opportunity Director, University of California, Agriculture and Natural Resources, 1111 Franklin Street, 6th Floor, Oakland, CA 94607, (510) H 1110 (Rev 9/2008)

11 California 4-H Youth Development Program 4-H Member Code of Conduct University of California Cooperative Extension The following behavior guidelines and expectations are designed to make everyone s experience at 4 -H events satisfying to all attending. This means that all participants, members, adult volunteers, and 4-H YDP staff, shall adhere to the core values of the University of California 4-H Youth Development Program, respect the individual rights, safety, and property of others. Youth are expected to demonstrate the character traits of trustworthiness, respect, responsibility, fairness, caring and citizenship. While attending all 4-H meetings, projects, programs, and events as a 4-H member I will: 1. Be courteous and respect others. 2. Obey all rules established by the California 4-H YDP, the local club/group and all local, state and federal laws. 3. Respect the authority of adult volunteers, youth leaders, 4-H YDP staff, and others in leadership roles. 4. Use appropriate language and wear acceptable clothing at 4-H activities and events. 5. Show kindness to others and give assistance when needed. 6. Be honest and honor commitments. 7. Not use tobacco products, alcohol or drugs (except those prescribed by a doctor). 8. Not carry a weapon or threaten another person with a weapon, bodily force or language. 9. Accept responsibility for personal choices. 10. Acknowledge that searches of personal property may take place when there is reasonable suspicion of violations of law or University policy in accordance with 4-H YDP policy. 11. Not display overly affectionate or sexual behavior. While attending overnight events as a 4-H member, I will: 1. Be in my room when attending overnight events by the established hours. 2. Not leave the grounds unless permission is secured from the adult in charge and I am accompanied by two adults. 3. Not be in the sleeping areas of members of the opposite gender nor will I invite non 4-H participants to the sleeping areas. 4. Will be responsible for any damage caused by my actions. 5. Will comply with other rules of the event. PENALTIES FOR INFRACTIONS Infractions of the 4-H Code of Conduct must be reported promptly by anyone observing them to the adult in charge of the delegation/project and to the person in charge of the event who will bear final responsibility for disciplinary action. The parent/guardian and the County 4-H Office will be notified of action taken. Penalties may include any or all of the following: Notification of parents and appropriate staff members. Sending the participant home Barring the participant from future 4-H events Assessing the participant the cost of damages and repairs for damage or destruction of property Releasing the participant to the nearest law enforcement agency and/or the proper authorities Termination of 4-H membership I have read the Code of Conduct and agree to abide by its rules. I understand that infraction of this Code will result in any or all of the penalties listed above. County: Signature of Member: Date: Signature of Parent/Guardian: Date: Revised 4/17/2009

12 California 4-H Youth Development Program Code of Conduct/Responsibilities and Rights The following guidelines are to assist 4-H Volunteers in understanding what behavior is expected while performing within the course and scope of a 4-H Volunteer. 4-H Volunteers are considered Agents of the University of California and must abide by all UC policies. Appointments of 4-H Volunteers may be renewed on an annual basis through County Offices. To be appointed as a 4-H Volunteer, an adult must: 1. Be at least 18 years of age. 2. Complete a New Adult Volunteer Application Form. 3. Complete the 4-H Volunteer screening process including a Live Scan or BID-7 Applicant Finger Print Form. 4. Attend 4-H Volunteer orientation meeting(s) offered by the County 4-H Youth Development Staff. 5. Participate in required Volunteer trainings and activities. CODE OF CONDUCT Upon receiving a 4-H Volunteer Appointment Card signed by the County Director, all 4-H Volunteers shall act in ways that promote positive youth development and are not in conflict with its policies and procedures. The following are prohibited when acting on behalf of the 4-H program: 1. Possession or use of alcohol, tobacco, and/or illegal drugs (or be under the influence thereof) when involved in a 4-H event or activity. 2. Use of abusive, obscene, and discriminatory language at any 4-H activity or event. 3. Direct personal attack or harassment (visual, verbal, or physical) on another person. 4. Behavior that is illegal, unsafe, or contrary to the highest standards of ethics. 5. Be the subject of a criminal investigation or prosecution for a misdemeanor or felony offense. RESPONSIBILITIES 1. Participate in and support, when practicable, local Volunteer Management Organizations and/or Leaders Councils. 2. Recognize the responsibilities of the 4-H Youth Development Program Staff in setting program standards, priorities, and direction. 3. Be committed to the core values, educational goals, and standards of the 4-H Youth Development Program as established at various organizational levels. 4. Respect and safeguard the individual rights, competencies, safety, and property of program participants. 5. Prohibit discrimination of any policies, procedures, or practices on the basis of race, color, national origin, religion, sex, gender identity, pregnancy, physical or mental disability, medical condition (cancer-related or genetic characteristics), ancestry, marital status, age, sexual orientation, citizenship, or status as a covered veteran. 6. When transporting 4-H members or 4-H Volunteers, possess a valid driver s license, carry proof of automobile liability insurance, and ensure all passengers use seat belts. 7. Provide receipts for any money collected in the name of 4-H. 8. Adhere to and help enforce the program policies and procedures referred to in the 4-H Policy Handbook. RIGHTS 1. To be respected by program administrators and staff for the contribution 4-H Volunteers make to the program. 2. To have access to current program materials, training, and curriculum to support program delivery. 3. To actively participate in communications and meetings concerning the administration and delivery of the program. 4. To be informed of any administrative action that could result in disciplinary actions or expulsion from the program. 5. To make written complaints concerning Cooperative Extension programs, policies, or personnel as described in the 4-H Policy Handbook, Section To be immune from liability when reporting suspected child abuse, unless it can be proven that a false report was filed and the 4-H Volunteer knew it was false. PENALTIES FOR INFRACTIONS Infractions of the Code of Conduct or the 4-H Volunteer Responsibilities and Rights must be reported by anyone observing them to the 4-H Youth Development Staff and/or Cooperative Extension County Director. Penalties include: 1. Discussion of inappropriate actions with the 4-H Volunteer, and clarification of policy when appropriate. 2. Releasing the adult to the appropriate law enforcement agency, if appropriate. 3. Written notice of termination of 4-H Volunteer status, and removal from the 4-H Youth Development Program. 4. Volunteer status suspension while charges are under investigation. By my signature on the 4-H New Adult Volunteer Application Form, I acknowledge receipt of this document and acknowledge that I have read and agree to abide by the guidelines in this document. I understand that my appointment as a 4-H Volunteer is contingent upon my agreement to this document. Failure to comply with these guidelines may result in termination as a 4-H Volunteer. Photograph and Information Release I give to The Regents of the University of California, National 4-H Council, National 4-H Headquarters (USDA), Cooperative Extension and units, its nominees, agents, and assigns, unlimited permission to copyright and use, publish, and republish for purposes of advertising, public relations, trade, or any other lawful use, information about me and reproduction of my likeness (photographic or otherwise) and my voice, whether or not related to any affiliation with 4-H, with or without my name. I hereby waive any right that I (and minor) may have to inspect or approve the copy and/or finished product or products that may be used in connection therewith or the use to which it may be applied. By signature on the 4-H New Adult Volunteer Application Form, I consent and agree to the foregoing terms and provisions. Volunteer Signature

13 Conference Dress Code During your stay at the Teen Involvement Conference we want you to have the best experience possible. The planning committee has developed the following dress code to assure that no one will feel offended or uncomfortable during his or her stay. If you choose to dress inappropriately, you will be asked to change, or be required to wear a conference-issued shirt. By planning ahead and packing appropriately, you will save yourself the inconvenience of having to change and you will be contributing to a pleasant conference atmosphere. Please be advised that the following dress code will be enforced for all individuals attending the conference, including chaperones. 1. Clothing: All clothing shall be neat, clean, and acceptable in repair and appearance and shall be worn within the bounds of decency and good taste as appropriate for 4-H events. 2. Articles of clothing which display profanity, products, or slogans which promote tobacco, alcohol, drugs, sex or are in any other way distracting, are prohibited. 3. Excessive accessories such as hanging chains and hanging suspenders are not allowed. This is for safety reasons 4. Excessively baggy or tight clothing, and clothing which advertises gang symbols or affiliation is prohibited. 5. Items of clothing which expose bare midriffs, bare chests, undergarments, or that are transparent (see-through) are prohibited. Tank tops with straps wider then one inch are permitted. Please be advised that spaghetti straps, shirts which expose a bare back, halter tops, and tube tops are prohibited. 6. Swimming (For all water recreation): - Swim suits for men: swim trunks only (No shorts, cut-off pants, or Speedos). - Swimsuits for women: One-piece suits recommended, however, two-piece suits are allowed as long as they are modestly cut. No string, thong or crochet suits will be allowed. Swimsuits may only be worn while in the swimming pool area. Youth Signature: Parent Signature: Date: Date: