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Event Registration
2019 NPIC - Smithfield Youth Workshop
Tuesday, July 9
9 a.m. - 11:30 a.m.
2019 NPIC
Kalahari Resort, Wisconsin Dells, WI

Thank you for your interest in registering for the 2019 NPIC Youth Workshop! You must complete this form for EACH child participating in the Youth Workshop.

First Name of Participant *
Your answer
Last Name of Participant *
Your answer
Grade that the youth participant will be entering this fall: *
Parent or Legal Guardian Name *
Your answer
Parent or Legal Guardian Phone Number *
Your answer
Parent or Legal Guardian Email Address *
Your answer
Disclosure and Waiver
Please read carefully before signing.
I understand that a parent or legal guardian needs to attend the grilling portion of the session with the youth participant at approximately 10 a.m. *
Required
I, the above-named Parent/Guardian, am the parent or legal guardian of the above-named Child. I understand there are numerous inherent risks associated with participating in any cooking/grilling activity, including, but not limited to, using sharp knives, operating a hot stove or grill, and operating and handling other kitchen/grilling equipment and tools. I hereby give permission for my child to participate in all cooking/grilling activities, including those described above. I acknowledge and assume all risks involved in these cooking/grilling activities and for any damage, illness, or injury resulting from such risks. My child has no conditions or special needs that may limit or restrict his/her participation in the cooking/grilling lesson, except as disclosed by me in writing to Smithfield Foods. *
Required
I, on behalf of myself and my child, hereby release and waive, to the maximum extent permitted by law, any and all claims or prospective claims of liability by my child or by me on behalf of my child against Smithfield Foods, Inc. or any of its parents, subsidiaries, employees, officers, directors or agents, with respect to any injuries, illness, damage or death occurring to my child while he/she participates in any and all cooking/grilling activities. *
Required
I, the Parent/Guardian, assert that I have explained to my child the risks of the activity, his/her responsibilities for adhering to the rules and regulations, and that my child understands this agreement. *
Required
I, FOR MYSELF AND MY CHILD, HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT WE HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND HEREBY SIGN AND AGREE TO IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT. I UNDERSTAND THAT CLICKING/CHECKING HERE REPRESENTS MY SIGNATURE AND AGREEMENT TO THIS WAIVER/RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT. *
Required
Parent/Guardian Initials *
Your answer
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