Blue Lake Rancheria Tribal Education Agency
4-H Agriculture Program

3.) Covid-19 Precautionary Behavior Standards & Assurances

The following are precautionary behavioral standards & assurances that comply with the Humboldt County approved re-opening plan for these activities. Participants shall adhere to these standards while participating in the Blue Lake Rancheria Tribal Education Agency’s 4-H Agriculture Program.

As a condition of participation in the 4-H Agriculture Program, I agree to the following Covid-19 precautionary behaviors. I will:

• Answer all the following questions at the beginning of each session:
  • Have you come into contact with anyone with a suspected or confirmed Covid-19 case in the last 14 days?
  • Have you or anyone you live with experienced any symptoms including cough, fever, difficulty breathing, or other signs of illness within the last 24 hours?
  • Have you taken any fever reducing medication in the last 24 hours?

• Exclude myself from activities if I have a temperature of 100.4F, or am experiencing any symptoms of illness, notifying the Program leaders by phone, text, or email that I will not be attending prior to the session’s start time; and
• Keep six (6) feet of separation between myself and others at all times while at the Blue Lake Rancheria Community Garden and participating in this program, and not engage in horseplay or any potential actions that could infringe upon the six (6) foot separation; and Wear a mask at all times while participating in this program and its activities, removing it briefly only to eat or drink. My mask will be in place prior to approaching the gathering area at the beginning of each session and will remain in place until I have left; and
• Wash my hands or use hand sanitizer before arriving at Blue Lake Rancheria Community Garden, or immediately following arrival at a provided sanitizing station, and will sanitize my hands before and after touching any pre-packaged food/snacks, water bottles, eating, and using the restroom facilities; and
• Sneeze or cough into my shoulder or elbow, not my hands, even when wearing a mask, nor will I cause bodily fluids to be disbursed (no spitting, kissing, licking, etc.); and
• Use precautionary actions, such as using a tissue when using the handle to flush the toilet, and wash my hands for 20 seconds using soap after using the restroom, using single use paper towels to dry my hands thoroughly; and
• Label my personal items (i.e. composition books and pencils), keep them separate from others personal items, and not touch or handle other persons’ personal items.

Blue Lake Rancheria Tribal Education Agency
4-H Agriculture Program

4.) Medical Release & Consent to Treat

Consent to Treat

In the event of illness or injury during my student’s participation in the 4H Agriculture Program, I do hereby consent to whatever X-ray examination, anesthetic, medical, surgical or dental diagnosis or treatment and hospital care that are considered necessary in the best judgement of the attending physicians or dentist and performed by or under the supervision of a member of the medical staff of the hospital or facility furnishing medical or dental services.

OR

5.) Image Release

This release form authorizes Blue Lake Rancheria Tribe the use of your child's name, city, and photo for electronic and print media advertising and promotional material. Any and all other information will be kept confidential.

I hereby expressly grant Blue Lake Rancheria and its employees, agents and assignees the right to photograph my child and and the use of their picture, silhouette and other reproductions of their physical likeness (as the same may appear in any still camera photography, social media, video and/or motion picture film/commercial), in and in connection with the exhibition theatrically, on television, or otherwise, of any motion pictures in which the same may be used or incorporated, and/also in the advertising/publicizing of any such motion picture/product, not limited to television, print reproduction or motion pictures. I further give my consent to said company the right to reproduce in any manner whatsoever any recordings made by said company of my voice and all instrumental, musical or other sound effects produced by me.  I enter into this agreement willingly and expect no compensation, either monetary or through gift of physical items and/or services.

OR