Texas A&M Beef Cattle Short Course
Special Youth Program
Youth Registration Fee - The cost of the Texas A&M Beef Cattle Short Course has been reduced to $80
for youth. Deadline for registration will be July 29. After July 29 the registration fee will be $100. Each youth
must be attending the Texas A&M Beef Cattle Short Course with a parent or other responsible supervising
adult. The participants will be expected to cover their own expenses for travel to the program, lodging and
extra food costs.
Registration Information – Please read carefully and print legibly.
Name _____________________________________________________________________
Gender (circle one): M or F
Age as of July 29, 2015 ________ (Participants must 13-18 years old and in junior high school or high
school this Fall of 2015 and accompanied by a supervising adult to participate)
Address, City, State, Zip
_____________________________________________________________________________
_____________________________________________________________________________
Home Phone _____________________________ Cell Phone ____________________________
Email ______________________________________________
Parent Name __________________________________________
Parent Cell Phone _____________________________________________
Supervising Adult Name __________________________________________
Supervising Adult Cell Phone _____________________________________________
Supervising Adult is which of the following (check one) Parent
________ Ag Teacher ______
Other Relation (Specify) ________________ Extension Agent _______
Volunteer _______
These Supervising Adults if unrelated must be over 21 years of age and have undergone a background
check at the county or school level.
Registration Deadline: July 29, 2015 Cost $80
Late Registration Fee: Cost $100
Payment
!
!
Check (Payable to “Beef Cattle Short Course”
Credit Card (Fill out information below)
Cardholder Name
Credit Card Type
Card Number
Exp. Date (MM/YY)
________________________________
________________________________
________________________________
________________________________
Questions: For registration questions, call Kay Sanders at 979-845-7694. For program or trade show
questions call Dr. Cleere’s office at 979-845-6931 and speak to Shelby Arnold or Stephanie Lastovica.
Texas A&M Beef Cattle Short Course
Special Youth Program Participant Authorization for
Medical Care and
Recognition and Assumption of Risk Agreement
This authorization covers ___________________________________________________ during
his/her travel to and participation in 2015 Special Youth Program. This activity covers the period August
3-4, 2015.
I, the undersigned parent/legal guardian of the above-mentioned participant, authorize said child's
participation in 2015 Special Youth Program August 3 and 4. It is my understanding that participation in
the activities that make up 2015 Special Youth Program is not without some inherent risk of injury, as
such, in consideration of my child's participation in 2015 Special Youth Program, I hereby release, waive,
discharge, and covenant not to sue the Texas Beef Council, Texas A&M AgriLife Extension, the Texas
A&M University System, the State of Texas, their officers, servants, agents, or employees from any and all
liability, claims, demands, action, and causes of action whatsoever arising out of or related to any loss,
damage, or injury, including death, that may be sustained by my child, whether caused by the negligence of
the releases, or otherwise while participating in such activity, or while in, on, or upon the premises where
the activity is being conducted.
I also understand that I should make sure my child is covered in the event of a serious accident.
I also give my permission for any emergency medical care or treatment by a physician, surgeon, hospital,
or medical care facility that may be required, and accept responsibility for the cost. In case of sudden
illness or accident to the above mentioned participant requiring immediate treatment or surgery while en
route to this activity, while there as a participant, and/or while returning from the event, I authorize Texas
A&M AgriLife Extension personnel, Texas A & M University personnel, and those serving as supervising
adults to take such action as seems appropriate to protect the health and physical well-being of the
participant.
This authority extends to any physician or surgeon selected by the chaperone(s) to perform medical or
surgical procedures necessary to preserve the life or well being of the above named participant. The
following information is provided as an aid to the chaperone(s) in dealing with the well being of the named
person.
Additionally, I, the undersigned, release the above-mentioned minor’s name and any photographs or video
to be used in promotion or advancement of the 2015 Special Youth Program as deemed necessary by
management.
Name of Primary Insurance Company:_______________________________________________
Policy Number of Primary Insurance:________________________________________________
Please list any medical issue or consideration that we should know about your child?
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
Date: _____________
Signature of Parent/Guardian: _____________________________________
Texas A&M Beef Cattle Short Course
Information Sheet
Age Classification - Participants must 13-18 years old and either in junior high school or high
school in the fall of 2015.
Supervising Adult – Each youth participant must be accompanied by a supervising adult. If
unrelated, the supervising adults must be over 21 years of age and have undergone a background
check at the county or school level. The supervising adult must be also registered for the Texas
A&M University Short Course and may attend any of the other sessions.
Behavior – Each participant is expected to attend all sessions that are part of the planned
program for all activities. You will dress appropriately for the occasion (no shorts, skirts,
spaghetti straps or strapless tops at any time). Participants should be courteous, clean, treat
others with respect and possess good manners. Tobacco products will not be allowed during
the program at anytime.
Proper Attire – On Monday participants will be performing hands-on activities in a livestock
pavilion and therefore must wear long pants and closed-toed shoes. On Tuesday in the meat
processing area you will need to wear warm clothes and closed-toed shoes, jewelry, watches,
gum and tobacco products will not be allowed in the facility.
Youth Registration Fee - The cost of the Texas A&M Beef Cattle Short Course has been
reduced to $80 for youth. Deadline for registration will be July 29. After July 29 the registration fee
will be $100. Each youth must be attending the Texas A&M Beef Cattle Short Course with a parent
or other responsible supervising adult. The participants will be expected to cover their own
expenses for travel to the program, lodging and extra food costs.
How to Register Mail form to:
Conference Services
Texas A&M Beef Cattle Short Course
1232 TAMU
College Station, TX 778431232
Fax Form to:
(979) 8452519, ATTN: Kay Sanders
Cancellation Requests Must be made in writing to Kay Sanders. Refunds of seminar registration fees will be
made if written notification is received no later than July 29, 2015. After July 29, 2015,
no refunds will be honored.
Questions
Registration Questions - Kay Sanders at 9798457694.
For Program Questions - Dr. Cleere's office at 9798456931 and speak to Shelby Arnold or
Stephanie Lastovica.