As legal guardian for
I give permission for said youth to participate in the following approved
activity, as indicated below. Please check each activity and sub part(s), if any, in which the youth may
I understand that the program involves a measure of risk. Activities involved in this program include high ropes training such as, but not limited, to the following: wall climbing, suspended ropes course, and on ground outdoor team building activities, etc. Youth will participate in skills based upon their cooperation, interest, physical and mental ability, and skill acquisition level.
I understand that the program includes but is not limited to the following activities: grooming, tacking,
riding, and higher-level skill for trotting, etc. Youth will participate in skills based upon their cooperation,
interest and skill acquisition level. Permission for this activity is valid for the summer program beginning
in May and running through mid-August.
I understand that the program activities include choosing a project area of interest and completing the
project for county-wide judging and participation in the Van Wert county fair. Project areas vary
depending on youth’s interests and may include livestock projects such as rabbits, chickens, turkeys,
horses, etc. Youth involved in 4-H attend project meetings on and off campus, and work with the Van Wert
County 4-H program level and state level if invited from a superior project judging.
By signing this authorization, I release The Marsh Foundation, the Van Wert YMCA, and their agents and
employees for all liability for injuries, loss, or damage occasioned by participating in the course. The Marsh
Foundation staff will seek emergency medical care for the above listed youth, if deemed necessary.
I understand that I may revoke my permission, in writing, at any time for all or any of the above activities.
1229 Lincoln Highway,(P.O. Box 150)Van Wert, Ohio 45891