2025 Tinker Academy MINI Registration

Youth Information

Parent/Guardian Information

Camp Information

Form #1: Youth Health History & Treatment Authorization Form

Please download, complete, and print a copy of the health form. Bring it with you on the first day of camp.

Download at https://ucdavis.app.box.com/s/zno25x1fg9e8dxus3x1spb75uzal2lnn 

Form #2: Parent/Guardian Consent for Surveys and Evaluations

The California 4-H Youth Development Program offers a high-quality experience for young people based on the latest research on positive youth development. Information from the 4-H enrollment system, surveys, focus groups, and film recordings will be used to help us better understand young people and improve the Drone Camp and California 4-H.

Participation in surveys and focus groups is voluntary and your child may participate in 4-H even if they do not participate in the research and program evaluation process linked to the surveys and focus groups. Additionally, participants may decide to withdraw from the research and evaluation at any time and this will not affect their participation in 4-H. If you provide permission, information about your child from the 4-H enrollment system, surveys, focus groups, and film recordings may be used for research and program evaluation. There is no direct benefit to the participant; the information gained from the research may be used to help improve the program.

All data will be stored on a secure encrypted server with restricted access. Names and other identifying information will be removed from all files. Your child’s participation will be kept confidential and will not be identified in any publication or in any data files shared with other researchers. If you decide to withdraw your child from the research all data will be withdrawn from the research database.

If you have questions, please contact the State 4-H Office at ca4h@ucanr.edu or (530) 750-1334. For questions about your rights while taking part in this study call the Institution Review Board at (916) 703-9167 or write to IRB Administration,
CTSC Building, Suite 1400, Room 1429, 2921 Stockton Blvd., Sacramento, CA 95817. Information to help you understand research is on-line at: https://research.ucdavis.edu/policiescompliance/irb-admin/for-research-participants/ 

Form #3: Waiver of Liability, Assumption of Risk, and Indemnity Agreement

Waiver: In return for being permitted to participate in in-person and virtual (online) California 4-H Youth Development Activities and Projects, including associated use of the premises, facilities, staff, equipment, transportation, websites, online applications, digital resources, and services of the University, I, for myself, my heirs, personal representatives, and assigns, do hereby release, waive, discharge, and promise not to sue The Regents of the University of California, its directors, officers, employees, and agents (“The University”), from liability from any and all claims, including the negligence of the University, resulting in personal injury (including emotional injury or death), accidents or illnesses, and property loss, in connection with my participation in California 4-H Youth Development Activities and Projects.

Identification and Acknowledgment of Risks
Participation in in-person California 4-H Youth Development Activities and Projects carries with it certain inherent risks that cannot be eliminated regardless of the care taken to avoid injury. The specific risks vary from one activity to another, but the risks range from 1) minor injuries such as scratches, bruises, and sprains, to 2) major injuries such as eye injury, joint or bone injuries, heart attacks, and concussions, to 3) catastrophic injuries such as paralysis and death.

I am of aware of and understand the risks and potential hazards connection with participating in virtual (online) California 4-H Youth Development Activities and Projects, including, but not limited to, the risk of data mining, phishing, viruses, malware, data breach of online information, cyberbullying, exploitation, victimization, cyberstalking, online grooming, cyber predators, image replication, and/or exposure to disturbing sounds or visuals, and I hereby elect to voluntarily participate in virtual California 4-H Youth Development Activities and Projects, and engage in the activities knowing that they may be hazardous to me and my property.

Video and Audio Recordings: I understand that virtual California 4-H Youth Development Activities and Projects may be recorded for use by the instructor and other participants (particularly those who are not able to attend live). I agree that if I participate with a computer or mobile device camera engaged (or utilize a profile image), I hereby consent to have my video or image recorded. If I am unwilling to have my profile or video image&nbs

Enrollment Acknowledgement

By signing and dating this Enrollment Acknowledgement, parent/guardian certify they have read, understand, and agree to the following:

4-H Member Code of Conduct

4-H Parent, Guardian, and Adult Participant Code of Conduct

Photograph and Information Release

Animal Liability Release

Vaccinations Notice

They understand and give their informed consent to exceptions to the 4-H policy on youth member supervision, when, due to emergency or unforeseen events, it may be impractical or impossible for a minimum of two 4-H adult volunteers and/or personnel to be present with youth.

Youth participant certifies that they have read, understand, and agree to the following:

4-H Member Code of Conduct

4-H Dress Guidelines- All clothing shall be neat, clean, acceptable in repair and appearance. Articles of clothing that display profanity, products or slogans that promote tobacco, alcohol, drugs and sex are prohibited.

Photo and Media Release

I understand the photograph(s) or video or audio recording(s) taken of me or my child by agents, employees or representatives of The Regents of the University of California, Sonoma County Office of Education, and/or Santa Rosa Junior College (hereinafter called “the Organizers”) shall be used in connection with the Organizer's dissmenation of information by its public service and academic programs to the general public.

I hereby irrevocably authorize the Organizers to copy, exhibit, publish or distribute any and all such images and audio of me or my child or wherein I or my child appear, including composite or artistic forms and media, for purposes of publicizing Organizer's educational programs (including Tinker Academy) or for any other lawful purpose. In addition, I waive any right to inspect or approve the finished product, including written copy, wherein my or my child's likeness appears. I hereby hold harmless and release and forever discharge the Organizers from all claims, demands and causes of action which I, my heirs, representatives executors, administrators or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization.

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