2022 NPIC - Smithfield Youth Workshop
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2022 NPIC - Smithfield Youth Workshop
Tuesday, July 12, 2022
9 a.m. - 11:30 a.m.
2022 NPIC
Kalahari Resort, Wisconsin Dells, WI

Thank you for your interest in registering for the 2022 NPIC Youth Workshop! You must complete this form for EACH child participating in the Youth Workshop.
First Name of Participant *
Last Name of Participant *
Grade that the youth participant will be entering this fall: *
Parent or Legal Guardian Name *
Parent or Legal Guardian Phone Number *
Parent or Legal Guardian Email Address *
Disclosure and Waiver
Please read carefully before signing.
I, the above-named Parent/Guardian, am the parent or legal guardian of the above-named Child.  I understand that participation in the Youth Workshop includes food handling, eating, and interactions in close proximity to others giving rise to a possible exposure to and illness from infectious disease, including but not limited to COVID-19. I hereby give permission for my child to participate in all Youth Workshop activities, including those described above.  I acknowledge and assume all risks involved in participating in the Youth Workshop and for any damage, illness (including, without limitation, COVID-19), or injury resulting from such risks.  My child has no conditions, food allergies, or special needs that may limit or restrict his/her participation in the Youth Workshop, except as disclosed by me in writing to Smithfield Foods, Inc. *
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, or affiliates and their respective employees, officers, directors or agents, with respect to any injuries, illness (including, without limitation, COVID-19), damage or death occurring to my child arising from or related to his/her participation in the 2022 NPIC Youth Workshop, including without limitation, any and all food handling and eating 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
I, the Parent/Guardian, authorize Smithfield Foods, Inc. to take photographs and/or video footage of my child during the Youth Workshop and to use such photographs and/or video footage for marketing and promotional purposes, including, without limitation, on Smithfield’s social media channels, without further approvals and/or financial compensation. *
Required
Parent/Guardian Initials *
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