TEXAS 4-H YOUTH DEVELOPMENT PROGRAM

Transcription

1 TEXAS 4-H YOUTH DEVELOPMENT PROGRAM July 10, 2018 Dear Texas 4-H Congress Delegate: Congratulations on being one of the 330 delegates, press corps, lobbyists, Texas 4-H Council, Texas 4-H Technology Team members, or chaperones attending the 2018 Texas 4-H Congress in Austin on July Plans are in the final stages to make this one of the best Texas 4-H Congresses! To prepare you for your Texas 4-H Congress experience, carefully read this information. Important Things About Texas 4-H Congress: TEXAS 4-H CONGRESS FACT: Did you know that Texas 4-H Congress is one of only a few youth groups that have the opportunity to use the floors of the Senate and House of Representatives in the Texas State Capitol? This is because of the outstanding respect and care that the 4-H members show the facilities. Only you can help continue this tradition! BEHAVIOR AND ATTITUDE: Texas 4-H Congress is the premiere citizenship & leadership youth program that is conducted by the Texas 4-H Youth Development Program. We ask that you please remember that each of you is a reflection of the 4-H program s outstanding reputation. Throughout Texas 4-H Congress there will be many state lawmakers, administrators from the Texas A&M University System, donors, Texas 4-H Foundation members and others present. Please extend to them the highest level of behavior and attitude. Remember that first impressions are never forgotten. Any unruly or extreme behavior, attitude, or incidents will result in you being removed immediately and sent home from the event. AUTHORIZATION FOR MEDICAL: The Waiver and Health Forms must be completed and brought with you to Texas 4-H Congress. Both copies will be given to your chaperone once you arrive. Your district chaperone will retain one copy for their information, and one copy will be turned over to the Texas 4-H Congress staff for the files. DRESS CODE: Texas 4-H Congress is a professional dress event. A coat and tie for gentlemen and nice dress for ladies is required for the time spent in the Texas Capitol. Please refer to the Dress Guide handout for additional information on dress expectations. BILLS AND COMMITTEES: Each delegate registered for Texas 4-H Congress was asked to submit at least one bill for possible inclusion into the Texas 4-H Congress Bill Book. Since 4-H members serving on the press corps, as a lobbyist, Texas 4-H Council, or Technology Team cannot serve as sponsors of bills, you may be assigned to a bill that you did not submit and/or your bill may have been reassigned based on your committee assignment. Make sure that you immediately look to see if you are responsible for sponsoring a bill(s) in the committee process. The Texas 4-H Congress Bill Book is posted online for review at: texas4-h.tamu. edu/events/congress. ARRIVAL AND REGISTRATION: You should plan to arrive at the Sheraton Austin Hotel starting at 12:00 noon based upon the time of your scheduled capitol tour. You will need to find your district (ask at the Texas 4-H Congress registration desk located outside the Capitol Ballroom). Your district chaperones will be responsible for checking you in to ensure the presence of all delegates. They will distribute your registration and room access information. Please do not go to the front hotel desk and try to check in to a hotel room at any point. DELEGATE DROP-OFF AND PICK-UP: If you arrive via personal car with a parent, county agent, or chaperone to Texas 4-H Congress please DO NOT park and leave your car unattended in the valet parking/driveway of the hotel. The hotel has other guests who are not associated with Texas 4-H Congress that have to use the area as well. TOURS OF TEXAS CAPITOL: Tours of the Texas State Capitol will be held on Sunday, July 22, 2018 and Monday, July 23, If your district has scheduled a tour the schedule time is on our website. You are strongly encouraged to be present for your tour so please review the tour schedule and plan your arrival accordingly. Visit texas4-h.tamu.edu/events/congress to view the tour schedule. DELEGATE LODGING: All delegates, lobbyists, and press corp members will be housed three youth to a room that contains two large queen beds. Courtney Dodd, Ph.D William D Fitch, College Station, TX Tel , Fax cfdodd@ag.tamu.edu, Web: texas4-h.tamu.edu The members of Texas A&M AgriLife will provide equal opportunities in programs and activities, education, and employment to all persons regardless of race, color, sex, religion, national origin, age, disability, genetic information, veteran status, sexual orientation or gender identity and will strive to achieve full and equal employment opportunity throughout Texas A&M AgriLife.

2 SPENDING MONEY AND BREAKFAST: Participants are encouraged to bring some spending money for meals to and from Texas 4-H Congress as well as for breakfast and breaks during the event. The Sheraton Austin at the Capitol has a full-service restaurant for those delegates wishing to have a breakfast each day. Additionally, the hotel has arranged for a Breakfast Cart to be available on Monday, Tuesday, and Wednesday mornings in the lobby of the hotel. The cart will feature the following items: 12 oz. Coffee $3.00 Bottled Juice $3.00 Sausage & Egg Biscuit $4.00 Milk/Choc. Milk $3.00 Yogurt $3.00 Breakfast Taco $4.00 Soda/Water $3.00 Cookie $2.00 Delegates may wish to bring spending money for refreshments at the Texas 4-H Capitol during the allotted break times on Monday and Tuesday. Registration for Texas 4-H Congress includes the following meals: Sunday dinner, Monday lunch and dinner, and Tuesday lunch and dinner. MONDAY NIGHT THEME DINNER: The Texas 4-H Council has selected the theme of Jump Into Character A night of 4-H members dressing like their favorite movie, book, comic, hero, or TV character. The evening will include various games, contests, and interactive activities for the delegates. TUESDAY NIGHT CLOSING GALA: The Tuesday night closing event will be the final coat and tie affair of the 2018 Texas 4-H Congress. The Gala will celebrate the successes of Texas 4-H Congress with a video dance party afterwards. DISTRICT 1, 2, AND 3 DELEGATES - CHARTER BUS INFORMATION: Texas 4-H Congress Delegates from Districts 1, 2, and 3 had a registration fee that included transportation to and from Congress via chartered bus. You are not required to travel on the bus, but transportation fees will not be refunded if you do not. See Bus Schedule for more information. DISTRICT CHAPERONES: Each district will have two adult chaperones who are County Extension Agents. These chaperones have been hand selected by their District Administrator to supervise and be responsible for the district delegation at this event. If at any time a delegate needs assistance or help they can contact any district chaperone or a member of the Texas 4-H Congress Leadership Team. See district chaperone list below: DISTRICT CHAPERONES District District Chaperone Phone # 1 Thomas Cunningham thomas.cunningham@ag.tamu.edu 1 Amalia Mata asmata@ag.tamu.edu 2 Kendra Bilbrey kendra.bilbrey@ag.tamu.edu 2 Audra Graves audra.graves@ag.tamu.edu 3 Josh Kouns josh.kouns@ag.tamu.edu 3 Maranda Revell madavis@ag.tamu.edu 4 Jessica Kimbro jessica.kimbro@ag.tamu.edu 4 TBD 5 Grant Davis grant.davis@ag.tamu.edu 5 Kate Marshall kate.marshall@ag.tamu.edu 6 Cody Trimble Cody.Trimble@ag.tamu.edu 6 Kailey Scott kaileyroberts13@gmail.com 7 Justin Klinksiek Justin.Klinksiek@ag.tamu.edu 7 Laci Kennedy laci.kennedy@ag.tamu.edu 8 Cassie Ferguson fergiec102938@yahoo.com 8 Justin Hale justin.hale@ag.tamu.edu 9 Cameron Peters cameron_peters17@outlook.com 9 John Grange john.grange@agnet.tamu.edu 10 Mellanie Mickelson mlmickelson@ag.tamu.edu 10 Taylor Osbourn taylor.osbourn@ag.tamu.edu 11 Paige Melton paige.melton@ag.tamu.edu 11 Eric Taylor ec.taylor@ag.tamu.edu 12 Lilian Mezquida lmezquida@ag.tamu.edu 12 Marcel Valdez mj-valdez@tamu.edu If you have any questions, please contact your County Extension Agent. We look forward to seeing you in Austin and remember to check the Texas 4-H Congress website periodically for updates on Texas 4-H Congress.

3 District 1, 2 & 3 Bus Schedule STOP LOCATION AND ADDRESS Texas A&M AgriLife Research and Extension Center 6500 W. Amarillo Blvd Amarillo TX Texas A&M AgriLife Research and Extension Center 1102 E. FM 1294 Lubbock, TX Baylor County AgriLife Extension Office 500 N. Main Seymour, TX Sheraton Austin at the Capitol Stop for Lunch In Route at What-A-Burger in Brownwood, Texas (Estimated lunch time: 1:00 pm) TIME (Be present at location at least 30 minutes prior to departure time). Departure Time: 5:30 am Departure Time: 7:30 am Departure Time: 10:45 am Estimated Arrival 4:15 pm Return trip from Austin to Districts 1, 2, and 3 STOP LOCATION AND ADDRESS Sheraton Austin at the Capitol TIME (Be present at location at least 30 minutes prior to departure time). Departure Time: 7:00 am Baylor County AgriLife Extension Office 500 N. Main Seymour, TX Stop for Lunch In Route in Seymour after first drop off Texas A&M AgriLife Research and Extension Center 1102 E. FM 1294 Lubbock, TX Texas A&M AgriLife Research and Extension Center 6500 W. Amarillo Blvd Amarillo TX Arrival Time: 11:45 am Arrival Time: 4:30 pm Arrival Time: 6:30 pm

4 TEXAS 4-H CONGRESS DRESS GUIDE ADVISED DRESS/ATTIRE CHART Below is a chart that will assist all delegates in choosing their wardrobe choices for Texas 4-H Congress. Please remember this is a professional event and your attire should reflect your standing as a young professional! EVENT MALE DRESS/ATTIRE FEMALE DRESS/ATTIRE WHAT IS NOT ALLOWED Capitol Tours (Sunday Afternoon) Opening Session & Legislative Workshop (Sunday Evening) State Capitol (Monday & Tuesday) Congress Gala (Tuesday Night) PROFESSIONAL DRESS IS REQUIRED IN CAPITOL Theme Dinner (Monday Evening) Dance (Monday & Tuesday) Walking Shorts (no holes) Collared Polo/Button Up Shirt Blue Jeans / Casual Slacks Boots, Tennis Shoes, Loafers Slacks Collard Polo/Button Up Shirt Boots, Loafers, Dress Shoes Dress Shirt w/ Tie Dress Slacks/Pants Sports/Dress Coat Polished Boots/Shoes Dress Suit Walking Shorts (no holes) Collared Polo/Button Up Shirt Blue Jeans / Casual Slacks Boots, Tennis Shoes, Loafers DRESS CODE PHILOSOPHY The primary responsibility for the grooming and appearance of each participant rests with the parents, County Extension Agents, and participants. At the same time, it is the professional belief of the Texas 4-H Youth Development Program that proper dress contributes to good citizenship. It becomes the responsibility of the Texas 4-H Youth Development Program to ensure that each participants appearance does not jeopardize the individual s health and safety, nor that of others, and does not interfere, or create disruptions during Texas 4-H Congress. To ensure that the health standards, safety conditions, and the proper educational process is maintained, the following grooming guidelines will apply: 1. 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 displays profanity, products, or slogans which promote tobacco, alcohol, drugs, sex or are in any other way distracting, are prohibited. 3. Excessively baggy or tight clothing, and clothing which advertise gang symbols or affiliation is prohibited. 4. All youth must wear shoes. 5. Items of clothing which expose midriffs, bare chests, undergarments, or which are transparent (see-through) are prohibited. Tank tops with straps wider than two-inches are permitted. Please be advised that spaghetti straps, shirts that expose a bareback, halter tops, and tube tops are prohibited. 6. No hats or caps are allowed in either the hotel or capitol at any time and may not be worn from the hotel to the capitol. Casual/Nice Blue Jeans Close-toed Shoes or Boots Favorite Sports Team T-Shirt or Jersey Walking Shorts (no holes) Collared Polo / Casual Blouse Blue Jeans / Casual Slacks Boots, Tennis Shoes, Loafers Casual Slacks / Skirt Nice/Dress Blouse Boots, Dress Shoes, Flats Dress Slacks or Dress Dress Blouse Business Suit/Coat Dress Shoes Walking Shorts (no holes) Collared Polo / Casual Blouse Blue Jeans / Casual Slacks Boots, Tennis Shoes, Loafers DRESS CODE VIOLATIONS Basketball/Work Out Attire T-Shirt, Tank Tops, Sleeveless Any clothes with holes, Yoga Pants, Short Shorts Blue Jeans / Shorts/ Yoga Pants T-Shirts Flip Flops / Sandals Polo Style / T-Shirt Tops Shorts (any kind) Blue Jeans / Denim Capri s Anything with holes/ Yoga Pants Dirty Shoes / Flip Flops / Sandals Basketball/Work Out Attire/Yoga Pants, T-Shirt, Tank Top Any clothes with holes Short Shorts Basketball/Work Out Attire/Yoga Pants, T-Shirt, Tank Top Any clothes with holes Short Shorts Flip Flops / Sandals

5 COPY TEXAS 4-H CONGRESS Program Name CAMP & ENRICHMENT PROGRAM WAIVER, INDEMNIFICATION, AND MEDICAL TREATMENT AUTHORIZATION FORM 1. EXCULPATORY CLAUSE. In consideration for receiving permission for my/my child s participation in any and all activities of Texas 4-H (herein referred to as camp ), which is sponsored by Texas A&M AgriLife Extension Service and Texas 4-H Youth Development Program, (herein referred to as sponsor ), I hereby release, waive, discharge, covenant not to sue, and agree to hold harmless for any and all purposes sponsor, The Texas A&M University System, the Board of Regents for The Texas A&M University System, Texas A&M AgriLife Extension Service, Texas 4-H and Youth Development Program, Texas 4-H Youth Development Foundation, Texas A&M University, and their members, officers, servants, agents, volunteers, or employees (herein referred to as RELEASEES or INDEMNITEES) from any and all liabilities, claims, demands, injuries (including death), or damages, including court costs and attorney s fees and expenses, that may be sustained by me/my child while participating in such activity, while traveling to and from the activity, or while on the premises owned or leased by RELEASEES, including injuries sustained as a result of the sole, joint, or concurrent negligence, negligence per se, statutory fault, or strict liability of RELEASEES. I understand this waiver does not apply to injuries caused by intentional or grossly negligent conduct. 2. INDEMNITY CLAUSE. I am fully aware that there are inherent risks to my child, myself and others involved with this activity, including but not limited to all events and activities, and I choose to voluntarily participate/allow my child to participate in said activity with full knowledge that the activity may be hazardous to me, my child and my property, and to the person and property of others. I acknowledge there may be physically strenuous activities. I know of no medical reason why I/my child should not participate. I agree to indemnify and hold harmless INDEMNITEES from any and all liabilities, claims, demands, injuries (including death), or damages, including court costs and attorney s fees and expenses, which may occur to myself, my child, other participants, and thirdpersons as a result of my/my child s participation in said activity, including injuries sustained as a result of the sole, joint, or concurrent negligence, negligence per se, statutory fault, or strict liability of INDEMNITEES. 3. NO INSURANCE. I understand that RELEASEES may or may not maintain any insurance policy covering any circumstance arising from my/my child s participation in this activity or any event related to that participation. As such, I am aware that I should review my personal insurance coverage. Organization may not carry general liability insurance to cover claims arising from this activity so it seeks a waiver of claims as additional consideration for the right to participate so organization, can (a) provide the activity at the lowest possible cost to participants; and (b) provide access to a greater number of participants by expending limited resources on program materials rather than on liability insurance. 4. BINDS HEIRS. It is my express intent that this agreement shall bind the members of my family and spouse, if I am alive, and my heirs, assigns and personal representatives, if I am deceased, and shall be governed by the laws of the State of Texas. 5. MEDICAL AUTHORIZATION, INDEMNITY FOR MEDICAL EXPENSES, and WAIVER. I understand RELEASEES cannot be expected to control all of the risks articulated in this form and RELEASEES may need to respond to accidents and potential emergency situations. Therefore, I hereby give my consent for any medical treatment that may be required, as determined by a medical professional at the medical facility, during my/ my child s participation in this activity with the understanding that the cost of any such treatment will be my responsibility. I agree to indemnify and hold harmless INDEMNITEES for any costs incurred to treat me/

6 COPY 1 my child, even if an INDEMNITEE has signed hospital documentation promising to pay for the treatment due to my inability to sign the documentation. I further agree to release, waive, discharge, covenant not to sue, and agree to hold harmless for any and all purposes, RELEASEES from any and all liabilities, claims, demands, injuries (including death), or damages, including court costs and attorney s fees and expenses, that may be sustained by me/my child while receiving medical care or in deciding to seek medical care, including while traveling to and from a medical care facility, including injuries sustained as a result of the sole, joint, or concurrent negligence, negligence per se, statutory fault, or strict liability of RELEASEES. I understand this waiver does not apply to injuries caused by intentional or grossly negligent conduct. 6. VOLUNTARY SIGNATURE. In signing this agreement I acknowledge and represent that I have read it, understand it, and sign it voluntarily as my own free act and deed; sponsor has not made and I have not relied on any oral representations, statements, or inducements apart from the terms contained in this agreement. I execute this document for full, adequate and complete consideration fully intending to be bound by the same, now and in the future. I understand I can choose not to sign this document and free myself and my child from its terms and the associated risks of the activity by simply not participating in the activity and choosing some other activity available to me/my child that has a lower level of risk to myself and my child. I further understand this is a voluntary, extracurricular activity. While I understand alternative activities are available to me/my child that do not have the risks associated with this activity I still desire to voluntarily engage/ permit my child to engage in this activity. SIGNING THIS DOCUMENT INVOLVES THE WAIVER OF VALUABLE LEGAL RIGHTS. CONSULT YOUR ATTORNEY BEFORE SIGNING THIS DOCUMENT. SIGNED this day of, Participant Signature: Printed Name: Participant s Date of Birth: Parent or Legal Guardian Signature: (If participant is under 18 years old) Parent or Legal Guardian Printed Name: (If participant is under 18 years old) In case of emergency, contact at the following number If the participant has medical insurance, please indicate: Insurance Company: Policy Number: Name of Primary Policy Holder: Please list any special services your child may require:

7 COPY TEXAS 4-H CONGRESS Program Name CAMP & ENRICHMENT PROGRAM WAIVER, INDEMNIFICATION, AND MEDICAL TREATMENT AUTHORIZATION FORM 1. EXCULPATORY CLAUSE. In consideration for receiving permission for my/my child s participation in any and all activities of Texas 4-H (herein referred to as camp ), which is sponsored by Texas A&M AgriLife Extension Service and Texas 4-H Youth Development Program, (herein referred to as sponsor ), I hereby release, waive, discharge, covenant not to sue, and agree to hold harmless for any and all purposes sponsor, The Texas A&M University System, the Board of Regents for The Texas A&M University System, Texas A&M AgriLife Extension Service, Texas 4-H and Youth Development Program, Texas 4-H Youth Development Foundation, Texas A&M University, and their members, officers, servants, agents, volunteers, or employees (herein referred to as RELEASEES or INDEMNITEES) from any and all liabilities, claims, demands, injuries (including death), or damages, including court costs and attorney s fees and expenses, that may be sustained by me/my child while participating in such activity, while traveling to and from the activity, or while on the premises owned or leased by RELEASEES, including injuries sustained as a result of the sole, joint, or concurrent negligence, negligence per se, statutory fault, or strict liability of RELEASEES. I understand this waiver does not apply to injuries caused by intentional or grossly negligent conduct. 2. INDEMNITY CLAUSE. I am fully aware that there are inherent risks to my child, myself and others involved with this activity, including but not limited to all events and activities, and I choose to voluntarily participate/allow my child to participate in said activity with full knowledge that the activity may be hazardous to me, my child and my property, and to the person and property of others. I acknowledge there may be physically strenuous activities. I know of no medical reason why I/my child should not participate. I agree to indemnify and hold harmless INDEMNITEES from any and all liabilities, claims, demands, injuries (including death), or damages, including court costs and attorney s fees and expenses, which may occur to myself, my child, other participants, and thirdpersons as a result of my/my child s participation in said activity, including injuries sustained as a result of the sole, joint, or concurrent negligence, negligence per se, statutory fault, or strict liability of INDEMNITEES. 3. NO INSURANCE. I understand that RELEASEES may or may not maintain any insurance policy covering any circumstance arising from my/my child s participation in this activity or any event related to that participation. As such, I am aware that I should review my personal insurance coverage. Organization may not carry general liability insurance to cover claims arising from this activity so it seeks a waiver of claims as additional consideration for the right to participate so organization, can (a) provide the activity at the lowest possible cost to participants; and (b) provide access to a greater number of participants by expending limited resources on program materials rather than on liability insurance. 4. BINDS HEIRS. It is my express intent that this agreement shall bind the members of my family and spouse, if I am alive, and my heirs, assigns and personal representatives, if I am deceased, and shall be governed by the laws of the State of Texas. 5. MEDICAL AUTHORIZATION, INDEMNITY FOR MEDICAL EXPENSES, and WAIVER. I understand RELEASEES cannot be expected to control all of the risks articulated in this form and RELEASEES may need to respond to accidents and potential emergency situations. Therefore, I hereby give my consent for any medical treatment that may be required, as determined by a medical professional at the medical facility, during my/ my child s participation in this activity with the understanding that the cost of any such treatment will be my responsibility. I agree to indemnify and hold harmless INDEMNITEES for any costs incurred to treat me/

8 COPY 2 my child, even if an INDEMNITEE has signed hospital documentation promising to pay for the treatment due to my inability to sign the documentation. I further agree to release, waive, discharge, covenant not to sue, and agree to hold harmless for any and all purposes, RELEASEES from any and all liabilities, claims, demands, injuries (including death), or damages, including court costs and attorney s fees and expenses, that may be sustained by me/my child while receiving medical care or in deciding to seek medical care, including while traveling to and from a medical care facility, including injuries sustained as a result of the sole, joint, or concurrent negligence, negligence per se, statutory fault, or strict liability of RELEASEES. I understand this waiver does not apply to injuries caused by intentional or grossly negligent conduct. 6. VOLUNTARY SIGNATURE. In signing this agreement I acknowledge and represent that I have read it, understand it, and sign it voluntarily as my own free act and deed; sponsor has not made and I have not relied on any oral representations, statements, or inducements apart from the terms contained in this agreement. I execute this document for full, adequate and complete consideration fully intending to be bound by the same, now and in the future. I understand I can choose not to sign this document and free myself and my child from its terms and the associated risks of the activity by simply not participating in the activity and choosing some other activity available to me/my child that has a lower level of risk to myself and my child. I further understand this is a voluntary, extracurricular activity. While I understand alternative activities are available to me/my child that do not have the risks associated with this activity I still desire to voluntarily engage/ permit my child to engage in this activity. SIGNING THIS DOCUMENT INVOLVES THE WAIVER OF VALUABLE LEGAL RIGHTS. CONSULT YOUR ATTORNEY BEFORE SIGNING THIS DOCUMENT. SIGNED this day of, Participant Signature: Printed Name: Participant s Date of Birth: Parent or Legal Guardian Signature: (If participant is under 18 years old) Parent or Legal Guardian Printed Name: (If participant is under 18 years old) In case of emergency, contact at the following number If the participant has medical insurance, please indicate: Insurance Company: Policy Number: Name of Primary Policy Holder: Please list any special services your child may require:

9 COPY 1 Texas 4-H Youth Development Program HEALTH AND SAFETY STATEMENT Check one: Youth Adult County: Event: 2018 Texas 4-H Congress Event Dates: July 22-25, 2018 Section I. Participant Information First Name: Date of Birth: Age: Gender: Last Name: Name of Physician: Address: Physician s Number: City, State, Zip: Date of last physical exam: Home Phone: Section II. In the event of an Emergency, please contact: Name: Address: City, State, Zip: Home Phone: Work Phone: Cell Phone: Section III. Health History (Check the appropriate answer and explain any YES responses.) Have you had or do you currently have any heart problems (dates): Yes No Do you frequently suffer from pains in your chest: Yes No (NOTE: If you have any heart related problems you will need to have a physician s release.) Do you often feel faint or have spells of severe dizziness: Yes No Has a doctor ever told you that you might have high blood pressure: Yes No Are you a smoker: Yes No Do you have arthritis, joint, or back problems that can be aggravated by exercise: Yes No Have you had any operations or serious injuries (dates): Yes No Do you have any chronic recurring illness or communicable diseases: Yes No Are there any activities to be limited/discouraged by a physician s advice: Yes No Are you allergic to any medications, food or food ingredients, insects, or pollens: Yes No Do you have Epilepsy: Yes No Do you have Diabetes: Yes No Do you have any prescribed meal plan or dietary restrictions (explain) Yes No Any other health related information for 4-H personnel to be aware of: Yes No Section IV: Medications (ALL medications must be in ORIGINAL container with ORIGINAL LABEL.) Are there prescribed medications currently being taken (describe) Yes No Section V. Insurance Information Please provide a copy of your insurance card. Do you carry family medical/hospital insurance? Yes No Carrier: Policy Number: Section VI. Release of Participant (If minor) I/We do hereby authorize the release of said minor child to the following person/people at the conclusion: (please list all persons, including parents) Further, I/We require that said minor child NOT be released to the following person/people at the conclusion of the activity: Section VII. Health and Safety Statement Certification By signing below, I certify that my answers and statements are true and complete to the best of my knowledge and belief. I understand this information is confidential and is to be used only by the Texas 4-H Congress Staff for health and safety reasons. I hereby consent to the use of this information for such purposes. Signature of Participant: (Or guardian if participant is under the age of 18) Date:

10 COPY 2 Texas 4-H Youth Development Program HEALTH AND SAFETY STATEMENT Check one: Youth Adult County: Event: 2018 Texas 4-H Congress Event Dates: July 22-25, 2018 Section I. Participant Information First Name: Date of Birth: Age: Gender: Last Name: Name of Physician: Address: Physician s Number: City, State, Zip: Date of last physical exam: Home Phone: Section II. In the event of an Emergency, please contact: Name: Address: City, State, Zip: Home Phone: Work Phone: Cell Phone: Section III. Health History (Check the appropriate answer and explain any YES responses.) Have you had or do you currently have any heart problems (dates): Yes No Do you frequently suffer from pains in your chest: Yes No (NOTE: If you have any heart related problems you will need to have a physician s release.) Do you often feel faint or have spells of severe dizziness: Yes No Has a doctor ever told you that you might have high blood pressure: Yes No Are you a smoker: Yes No Do you have arthritis, joint, or back problems that can be aggravated by exercise: Yes No Have you had any operations or serious injuries (dates): Yes No Do you have any chronic recurring illness or communicable diseases: Yes No Are there any activities to be limited/discouraged by a physician s advice: Yes No Are you allergic to any medications, food or food ingredients, insects, or pollens: Yes No Do you have Epilepsy: Yes No Do you have Diabetes: Yes No Do you have any prescribed meal plan or dietary restrictions (explain) Yes No Any other health related information for 4-H personnel to be aware of: Yes No Section IV: Medications (ALL medications must be in ORIGINAL container with ORIGINAL LABEL.) Are there prescribed medications currently being taken (describe) Yes No Section V. Insurance Information Please provide a copy of your insurance card. Do you carry family medical/hospital insurance? Yes No Carrier: Policy Number: Section VI. Release of Participant (If minor) I/We do hereby authorize the release of said minor child to the following person/people at the conclusion: (please list all persons, including parents) Further, I/We require that said minor child NOT be released to the following person/people at the conclusion of the activity: Section VII. Health and Safety Statement Certification By signing below, I certify that my answers and statements are true and complete to the best of my knowledge and belief. I understand this information is confidential and is to be used only by the Texas 4-H Congress Staff for health and safety reasons. I hereby consent to the use of this information for such purposes. Signature of Participant: (Or guardian if participant is under the age of 18) Date:

11 Sunday, July 22, noon Unload Buses/Vehicles Front Drive 12:00 pm - 5:00pm Delegates Arrive at Hotel Capitol Ballroom (Delegates immediately should go to Ballroom area for luggage storage and to meet chaperone) 12:00 pm - 5:00 pm Texas State Capitol Tours As Arranged Texas Capitol 3:00 pm - 5:00 pm Check into Hotel Rooms Reception Area 5:00 pm Governor s Reception (Invitation Only) 16th Floor, #1601 6:00 pm Dinner Capitol Ballroom 6:45 pm Texas 4-H Congress Opening Session Capitol Ballroom Welcome Swearing in of Congress Officials 7:45 pm - 10:30 pm Legislative Workshops Capitol Ballroom Capitol View Terrace, Bickler, Barton, Bonnell 10:30 pm District Meetings 11:00 pm Leadership Team Meeting 16th Floor, # :00 pm Curfew Monday, July 23, TEXAS 4-H CONGRESS SCHEDULE 7:30 am - 9:00 am Breakfast Bar in Hotel Lobby Hotel Lobby 8:30 am Texas State Capitol Tours As Arranged Texas Capitol 9:00 am Walk to Capitol by Districts Capitol Ballroom 9:45 am - 10:15 am Opening Joint Session of Texas 4-H Congress House Chambers Senate House Gallery House of Representatives House Gallery Press Corp and Lobbyist House Gallery 10:30 am - 10:45 am House of Representatives Session House Chambers 10:30 am - 10:45 am Senate Session Senate Chambers 10:45 am - 11:15 am House & Senate Public Hearings Committee Rooms 11:15 am - 12 noon Lunch for House of Representatives Legislative Conference Center 11:15 am Senate Public Hearings (continue as needed) (Senate Committee Meetings immediately following hearings.) Education Senate Chambers Environment E1.012 Government, Finance, & Appropriations E2.036 Highways & Transportation E1.024 Judiciary E1.020 Public, Health & Welfare E :00 noon House of Representatives Public Hearings (continue as needed) (House Committee Meetings immediately following hearings.) Education House Chambers Environment E2.012 Government, Finance, & Appropriations E2.010 Highways & Transportation E2.016 Judiciary E2.028 Public, Health & Welfare E :15 pm Lunch for Senate, Press Corp & Lobbyist Legislative Conference Center 1:00 pm Senate Committees resume 2:00 pm Bills passed in committees submitted to E2.018 House & Senate Calendar Clerks

12 Monday, July 23, 2018, continued 2:00 pm - 2:45 pm Delegate Break to Prepare Calendars Texas Capitol 2:45 pm - 5:00 pm House of Representatives Session House Chambers Senate Session Senate Chambers 5:15 pm - 6:15 pm Lobbyist Reception (Invitation Only) Capitol View Terrace 6:30 pm - 8:30 pm Theme Dinner: Jump into Character Capitol Ballroom 8:30 pm - 10:30 pm Dance Capitol Ballroom 10:30 pm - 11:00 pm District Meetings Capitol Ballroom 11:00 pm Leadership Team Meeting 11:00 pm Curfew Capitol Ballroom Tuesday, July 24, :00 am - 8:00 am Breakfast Bar in Hotel Lobby Hotel Lobby 8:00 am Walk to Capitol by Districts Capitol Ballroom 9:00 am House of Representatives Session House Chambers Senate Session Senate Chambers 11:30 am - 12:15 pm Lunch for Senate Legislative Conference Center 12:30 pm - 1:15 pm Lunch for House of Representatives Legislative Conference Center 12:30 pm Senate Session Continues Senate Chambers 1:30 pm House of Representatives Session Continues House Chambers 3:00 pm House of Representatives & Senate End 3:00 pm - 3:30 pm Break 3:30 pm - 4:00 pm Closing Joint Session of Texas 4-H Congress House Chambers Senate (Gallery) House of Representatives (Chambers Floor) Press Corp and Lobbyists (Chambers Floor) 4:30 pm Return back to Sheraton Hotel 7:00 pm Congress Gala Banquet and Dance Capitol Ballroom Speaker: Kyle Willkom 11:00 pm District Meetings Capitol Ballroom 11:00 pm Leadership Team Meeting 16th Floor, # :30 pm Curfew Wednesday, July 25, :00 am - 8:00 am Breakfast Bar in Hotel Lobby Hotel Lobby 6:00 am - 10:00 am Departure of all delegates Hotel Lobby