Gouverneur-St. Lawrence County Fair

4-H/FFA Overnight Request Form

Note: This completed form, along with a completed Health Form, should be turned into the Cooperative Extension Office or FFA teacher by July 18th, 2008

Name: ________________________________________________________

Address: __________________________________________________

__________________________________________________

Telephone Number: __________________ 4-H Club/FFA Chapter _______________________

I request permission to stay overnight on the fairgrounds for the following nights:

____Monday, august 4th ________Tuesday, august 5^th

____Wednesday, august 6^th ________Thursday, august 7^th

____Friday, august 8^th ________Saturday, august 9^th

Reason for request: _________________________________________________________________

_____________________________________________________________________________________

I will be spending the night(s) in the following building: ______________________________

I have read and agree to abide by the rules and regulations for spending the night on the fairgrounds on the reverse side.

____________________________________

Signature of Member

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I am aware of the above arrangements and give permission for my child to spend the designated evenings overnight on the fairgrounds with the adult I have designated being responsible for him/her. I understand that I can check which nights my child is signed up for by calling Cornell Cooperative Extension of St. Lawrence County office @ 379-9192, or appropriate FFA teacher. I realize that at no time will my child receive immediate supervision from the Cornell Cooperative Extension staff in St. Lawrence County.

___________________________________________________________

(Signature of Parent or Legal Guardian)

If you are unable to contact me for any reason, please contact:

_________________________________________ _______________________________

Name Telephone Number

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I agree to chaperone the above-mentioned youth and to assume responsibility for their actions. I have read the rules and regulations listed on the reverse side connected with this agreement.

______________________________________ ________________________________________

Signature of Designated Chaperone # 1 Dates Responsible for

______________________________________ ________________________________________

Signature of Designated Chaperone #1 Dates Responsible for

______________________________________ ________________________________________

Signature of Designated Chaperone #1 Dates Responsible for

RULES & REGULATIONS FOR 4-H/FFA MEMBER

1. All 4-H/FFA members spending the night on the fairgrounds under the age of 18 and without direct parental supervision must complete this form.

2. All 4-H/FFA members must be in their designated locations by 10:00 p.m.

3. Members will stay in this designated area until 6:00 a.m., unless they need to otherwise prepare to participate in a fair activity or show and have received permission from their designated chaperone.

4. No smoking, consumption of alcohol or other illegal drugs is permitted.

5. Members shall, at all times, act with a mature and morally responsible attitude, recognizing the basic rules of society and the common rights of others.

6. Violations of these responsibilities and guidelines may result in forfeit of awards, premiums, and privileges of further participation in the Gouverneur-St. Lawrence County Fair.

7. A completed Health Form must accompany this form. You can get a Health Form by calling the Extension Office @ 379-9192, stopping in at the Fair Office on East Barney Street in Gouverneur, or contacting your local FFA advisor.

8. If members wish to add additional nights to their request once the form has been handed in, a totally new form must be completed and signed by all parties.

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RULES & REGULATIONS FOR CHAPERONES

1. Designated chaperones must be over 18 years of age and be acceptable to the Cooperative Extension Staff, FFA teacher, Fair Board President, and the Youth Fair Superintendent.

2. Chaperones agree to enforce the Rules and Regulations for 4-H/FFA members and notify the Cooperative Extension staff, FFA Teacher, Youth Fair Superintendent or the Fair Board President of any violations.

3. Chaperones are responsible for their assigned member(s) from 10:00 p.m. – 6:00 a.m. each night they are designated to provide supervision.

4. No chaperone may be responsible for more than ten (10) members on any given night.