Release and Permission Slip for Dog Obedience
Carroll County Extension Office
I give my permission for (Youth’s Name)_______________________________to participate in
the 2015 Carroll County 4-H Youth Development Program Dog Obedience classes and
activities.
I do hereby release, discharge and hold harmless the University of Maryland Extension, all
its employees, volunteers, and supporters thereof in connection with aforementioned
program, from any and all claims, demands, damages, actions, liability, or suits or law or in
equity, for personal injury, whether physical or mental, property damage, medical, dental
or hospital expenses or any other expenses of whatever kind, including death, which I (or
said child) may have had, now have, or may hereafter have, in any manner connected with,
arising from or growing out of my child’s participation in said program.
I the undersigned, acknowledge that I sign this Release knowingly and intelligently and
with full and complete knowledge of the purpose of said program and without any form of
duress and/or intimidation whatsoever on the part of the University of Maryland
Extension.
Parent/Guardian Signature___________________________________________________
Date________________________________________________
Cell Number/Contact Number During Training_________________________________________
*Medication/Medical Conditions ___________________________________________
The University of Maryland Extension programs are open to any person and will not discriminate against anyone because of
race, age, sex, color, sexual orientation, physical or mental disability, religion, ancestry, national origin, marital status, genetic
information, political affiliation, and gender identity or expression.