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NORTH DAKOTA 4-H SHOOTING SPORTS <br /> PROGRAM INFORMED CONSENT <br /> <br />I <br />for <br /> <br />of <br /> <br />am parent / legal guardian of and responsible <br />who is enrolled in the Shooting Sports Program <br /> <br /> County, North Dakota. I am aware, understand and accept the program <br />and its continuing curriculum. <br /> <br />My child is enrolled in the following Discipline of the 4-H Shooting Sports Program. <br /> <br />( ) Pistol (BB, Pellet, .22 & .38 cal.) <br />( ) Black Powder (.32, .36, .44, .45 & .50 cai). <br />( ) Rifle (BB, Pellet, .22 & .223 cai) <br />( ) Shotgun (.410,, 28, 20, 16 & 12 gauge) <br />( ) Archery ( Curve, Recurve & Compound ) <br /> <br />As an enrollee in this discipline, I am aware of the'sporting equipment involved, <br />circumstances of its use and consequences of its misuse. I am aware of the fact; that, there is <br />a potential physical danger to my child if precautions, safety and training are not provided and <br />followed. With respect to this potential danger; those volUnteers that are coaching and <br />providing the instructional training will deem it. necessary to instruct and discipline from time <br />to time for the best interests of all involved. The foremost concern is safety with skill <br />attainment and enjoyment second. <br /> <br />I am also aware and understand that my child from time to time will be touched, moved and <br />held in a manner to assist positioning, balance, comfort and provide continuity in curriculum <br />training for the discipline being taught. <br /> <br />I am also aware that even though my child enrolls in the 4-H Group Accident Policy this may <br />not be adequate insurance coverage. I understand I may provide added coverage for accident <br />and liability at my own expense. <br /> <br />I therefore am aware of the program, instruction and training being taught, requirements of <br />the shooting discipline, the risks involved and potential dangers if safety is not followed. <br /> <br />Parent I Legal Guardian 4-H Shooting Sports Enrollee <br /> <br />4-H Club Leader Instructor / or / County Extension Agent <br /> <br />(Must be completed, signed and returned to the local County Extension Office before youth <br />will be allowed to participate in 4-H Shooting Sports Program/Event.) <br /> J:~4H Youth'~°roject Areas'Outdoor Skills~SConsent Form.wpd <br /> <br /> <br />