{ "document_id": 16665, "filename": "Parent_Guardian_Program_Authorization_and_Release.pdf", "engine": "paddleocr_vl", "source_run_id": 16776, "generated_at": "2026-11-05T04:27:55+00:00", "page_count": 1, "counts_by_type": { "figure": 2, "form_field": 11, "header": 1, "heading": 4, "list": 3, "list_item": 14, "text": 7, "title": 1 }, "timings": { "total_ms": 250, "structure_ms": 70, "text_layer_ms": 11, "build_ms": 4 }, "pages": [ { "document_id": 16665, "page": 1, "width": 612, "height": 792, "rotation": 0, "pipeline_version": "paddleocr-vl-1.6+paul-48", "width_pt": 612, "height_pt": 792, "engine": "paddleocr_vl", "source_run_id": 16776, "item_count": 43, "counts_by_type": { "figure": 2, "form_field": 11, "header": 1, "heading": 4, "list": 3, "list_item": 14, "text": 7, "title": 1 }, "build_ms": 4, "items": [ { "id": "p1.1", "order": 1, "type": "figure", "bbox": { "l": 25.44, "t": 761.04, "r": 141.6, "b": 699.6 }, "text": "", "attrs": { "role": "page_header", "block_label": "header_image" }, "reading_order": 0 }, { "id": "p1.2", "order": 2, "type": "header", "bbox": { "l": 186.24, "t": 756.72, "r": 533.04, "b": 698.4 }, "text": "KENTUCKY STATE UNIVERSITY\nCooperative Extension Program 4-H Youth Development", "attrs": { "block_label": "header" }, "level": 2, "reading_order": 1 }, { "id": "p1.3", "order": 3, "type": "title", "bbox": { "l": 186.48, "t": 714.96, "r": 529.92, "b": 698.88 }, "text": "PARENT/GUARDIAN AUTHORIZATION AND RELEASE", "attrs": { "block_label": "doc_title" }, "level": 2, "reading_order": 2 }, { "id": "p1.4", "order": 4, "type": "figure", "bbox": { "l": 27.1146, "t": 670.9904, "r": 593.7676, "b": 587.5322 }, "text": "", "attrs": { "source": "pdf_image" }, "reading_order": 3 }, { "id": "p1.5", "order": 5, "type": "text", "bbox": { "l": 37.68, "t": 665.76, "r": 207.84, "b": 654.96 }, "text": "TO BE COMPLETED BY PROGRAM STAFF:", "reading_order": 4 }, { "id": "p1.6", "order": 6, "type": "text", "bbox": { "l": 37.44, "t": 648.96, "r": 582, "b": 636 }, "text": "Program/Event Name: ___", "reading_order": 5 }, { "id": "p1.7", "order": 7, "type": "text", "bbox": { "l": 39.12, "t": 629.76, "r": 572.64, "b": 617.28 }, "text": "Date: _____ County/Location: _____", "reading_order": 6 }, { "id": "p1.8", "order": 8, "type": "text", "bbox": { "l": 39.84, "t": 611.28, "r": 585.36, "b": 598.56 }, "text": "Employee Name: ___ Program Area: ___", "reading_order": 7 }, { "id": "p1.9", "order": 9, "type": "heading", "bbox": { "l": 38.64, "t": 579.84, "r": 176.88, "b": 565.68 }, "text": "Participant Information", "attrs": { "block_label": "paragraph_title" }, "level": 3, "reading_order": 8 }, { "id": "p1.10", "order": 10, "type": "list", "bbox": { "l": 37.92, "t": 558, "r": 510.24, "b": 460.8 }, "text": "", "attrs": { "item_count": 5 }, "children": [ { "id": "p1.10.1", "order": 11, "type": "list_item", "bbox": { "l": 38.4, "t": 558, "r": 508.56, "b": 545.04 }, "text": "Participant Name: ___", "children": [ { "id": "p1.10.1.1", "order": 12, "type": "form_field", "bbox": { "l": 40.1089, "t": 557.5128, "r": 506.9693, "b": 545.5124 }, "text": "", "attrs": { "field_kind": "text", "label": "Participant Name: ___", "source": "blank_line", "label_source": "parent_text", "label_ref": "p1.10.1" }, "reading_order": 0 } ], "reading_order": 0 }, { "id": "p1.10.2", "order": 13, "type": "list_item", "bbox": { "l": 38.16, "t": 537.6, "r": 504.96, "b": 524.16 }, "text": "Date of Birth: ___", "children": [ { "id": "p1.10.2.1", "order": 14, "type": "form_field", "bbox": { "l": 40.1089, "t": 536.5121, "r": 502.5471, "b": 524.5117 }, "text": "", "attrs": { "field_kind": "text", "label": "Date of Birth: ___", "source": "blank_line", "label_source": "parent_text", "label_ref": "p1.10.2" }, "reading_order": 0 } ], "reading_order": 1 }, { "id": "p1.10.3", "order": 15, "type": "list_item", "bbox": { "l": 38.16, "t": 516.72, "r": 507.6, "b": 503.04 }, "text": "Parent/Guardian Name: ___", "children": [ { "id": "p1.10.3.1", "order": 16, "type": "form_field", "bbox": { "l": 40.1089, "t": 515.5114, "r": 505.7081, "b": 503.511 }, "text": "", "attrs": { "field_kind": "text", "label": "Parent/Guardian Name: ___", "source": "blank_line", "label_source": "parent_text", "label_ref": "p1.10.3" }, "reading_order": 0 } ], "reading_order": 2 }, { "id": "p1.10.4", "order": 17, "type": "list_item", "bbox": { "l": 37.92, "t": 495.36, "r": 509.76, "b": 481.68 }, "text": "Phone Number: ___", "children": [ { "id": "p1.10.4.1", "order": 18, "type": "form_field", "bbox": { "l": 40.1089, "t": 494.5107, "r": 508.4129, "b": 482.5103 }, "text": "", "attrs": { "field_kind": "text", "label": "Phone Number: ___", "source": "blank_line", "label_source": "parent_text", "label_ref": "p1.10.4" }, "reading_order": 0 } ], "reading_order": 3 }, { "id": "p1.10.5", "order": 19, "type": "list_item", "bbox": { "l": 38.16, "t": 474.72, "r": 510.24, "b": 460.8 }, "text": "Email: ___", "children": [ { "id": "p1.10.5.1", "order": 20, "type": "form_field", "bbox": { "l": 40.1089, "t": 473.51, "r": 508.9889, "b": 461.5096 }, "text": "", "attrs": { "field_kind": "text", "label": "Email: ___", "source": "blank_line", "label_source": "parent_text", "label_ref": "p1.10.5" }, "reading_order": 0 } ], "reading_order": 4 } ], "reading_order": 9 }, { "id": "p1.11", "order": 21, "type": "heading", "bbox": { "l": 38.16, "t": 440.16, "r": 208.8, "b": 426.24 }, "text": "PHOTO AND MEDIA RELEASE", "attrs": { "block_label": "paragraph_title" }, "level": 3, "reading_order": 10 }, { "id": "p1.12", "order": 22, "type": "text", "bbox": { "l": 37.68, "t": 421.2, "r": 548.16, "b": 374.88 }, "text": "I hereby authorize Kentucky State University and its representatives to photograph, video record, and/or otherwise capture the likeness of my child for use in educational, promotional, and program-related materials, including print and digital formats.", "reading_order": 11 }, { "id": "p1.13", "order": 23, "type": "heading", "bbox": { "l": 38.88, "t": 371.04, "r": 129.12, "b": 359.04 }, "text": "I understand that:", "level": 3, "reading_order": 12 }, { "id": "p1.14", "order": 24, "type": "list", "bbox": { "l": 40.11172, "t": 357.07021, "r": 435.878912, "b": 242.07077700000002 }, "text": "", "attrs": { "item_count": 6 }, "children": [ { "id": "p1.14.1", "order": 25, "type": "list_item", "bbox": { "l": 60.5004, "t": 357.07021, "r": 181.212424, "b": 341.073677 }, "text": "Participation is voluntary", "marker": "•", "reading_order": 0 }, { "id": "p1.14.2", "order": 26, "type": "list_item", "bbox": { "l": 60.5004, "t": 340.56981, "r": 226.981949, "b": 324.573277 }, "text": "No compensation will be provided", "marker": "•", "reading_order": 1 }, { "id": "p1.14.3", "order": 27, "type": "list_item", "bbox": { "l": 60.5004, "t": 324.06951, "r": 435.878912, "b": 308.072977 }, "text": "These materials may be used by Kentucky State University without restriction", "marker": "-", "reading_order": 2 }, { "id": "p1.14.4", "order": 28, "type": "list_item", "bbox": { "l": 60.824411, "t": 291.236416, "r": 146.087253, "b": 275.23988299999996 }, "text": "I GIVE permission", "marker": "□", "children": [ { "id": "p1.14.4.1", "order": 29, "type": "form_field", "bbox": { "l": 60.82, "t": 291.24, "r": 72.82, "b": 279.24 }, "text": "", "attrs": { "field_kind": "checkbox", "label": "I GIVE permission", "source": "glyph_estimate", "bbox_estimated": true, "label_source": "parent_text", "label_ref": "p1.14.4", "text_offset": 0, "text_span": 0 }, "reading_order": 0 } ], "reading_order": 3 }, { "id": "p1.14.5", "order": 30, "type": "list_item", "bbox": { "l": 60.824411, "t": 276.83593599999995, "r": 188.056252, "b": 260.83940299999995 }, "text": "I DO NOT GIVE permission", "marker": "□", "children": [ { "id": "p1.14.5.1", "order": 31, "type": "form_field", "bbox": { "l": 60.82, "t": 276.84, "r": 72.82, "b": 264.84 }, "text": "", "attrs": { "field_kind": "checkbox", "label": "I DO NOT GIVE permission", "source": "glyph_estimate", "bbox_estimated": true, "label_source": "parent_text", "label_ref": "p1.14.5", "text_offset": 0, "text_span": 0 }, "reading_order": 0 } ], "reading_order": 4 }, { "id": "p1.14.6", "order": 32, "type": "list_item", "bbox": { "l": 40.11172, "t": 258.06731, "r": 215.756775, "b": 242.07077700000002 }, "text": "Parent/Guardian Initials: ___", "children": [ { "id": "p1.14.6.1", "order": 33, "type": "form_field", "bbox": { "l": 40.1117, "t": 254.7552, "r": 215.7573, "b": 242.7548 }, "text": "", "attrs": { "field_kind": "text", "label": "Parent/Guardian Initials: ___", "source": "blank_line", "label_source": "parent_text", "label_ref": "p1.14.6" }, "reading_order": 0 } ], "reading_order": 5 } ], "reading_order": 13 }, { "id": "p1.15", "order": 34, "type": "heading", "bbox": { "l": 37.2, "t": 215.76, "r": 387.84, "b": 201.12 }, "text": "FIELD TRIP/OFFSITE TRAVEL AUTHORIZATION IF APPLICABLE", "attrs": { "block_label": "paragraph_title" }, "level": 3, "reading_order": 14 }, { "id": "p1.16", "order": 35, "type": "text", "bbox": { "l": 37.2, "t": 196.08, "r": 546.72, "b": 165.84 }, "text": "I give permission for my child to participate in all program activities, including supervised field trips both on and off campus, and to travel with authorized program staff.", "reading_order": 15 }, { "id": "p1.17", "order": 36, "type": "list", "bbox": { "l": 37.92, "t": 147.12, "r": 217.2, "b": 100.08 }, "text": "", "attrs": { "item_count": 3 }, "children": [ { "id": "p1.17.1", "order": 37, "type": "list_item", "bbox": { "l": 39.12, "t": 147.12, "r": 148.08, "b": 134.16 }, "text": "I GIVE permission", "marker": "□", "children": [ { "id": "p1.17.1.1", "order": 38, "type": "form_field", "bbox": { "l": 39.12, "t": 147.12, "r": 51.12, "b": 135.12 }, "text": "", "attrs": { "field_kind": "checkbox", "label": "I GIVE permission", "source": "glyph_estimate", "bbox_estimated": true, "label_source": "parent_text", "label_ref": "p1.17.1", "text_offset": 0, "text_span": 0 }, "reading_order": 0 } ], "reading_order": 0 }, { "id": "p1.17.2", "order": 39, "type": "list_item", "bbox": { "l": 39.12, "t": 132.48, "r": 189.6, "b": 119.76 }, "text": "I DO NOT GIVE permission", "marker": "□", "children": [ { "id": "p1.17.2.1", "order": 40, "type": "form_field", "bbox": { "l": 39.12, "t": 132.48, "r": 51.12, "b": 120.48 }, "text": "", "attrs": { "field_kind": "checkbox", "label": "I DO NOT GIVE permission", "source": "glyph_estimate", "bbox_estimated": true, "label_source": "parent_text", "label_ref": "p1.17.2", "text_offset": 0, "text_span": 0 }, "reading_order": 0 } ], "reading_order": 1 }, { "id": "p1.17.3", "order": 41, "type": "list_item", "bbox": { "l": 37.92, "t": 113.28, "r": 217.2, "b": 100.08 }, "text": "Parent/Guardian Initials: ___", "children": [ { "id": "p1.17.3.1", "order": 42, "type": "form_field", "bbox": { "l": 40.0269, "t": 112.6338, "r": 215.6725, "b": 100.6334 }, "text": "", "attrs": { "field_kind": "text", "label": "Parent/Guardian Initials: ___", "source": "blank_line", "label_source": "parent_text", "label_ref": "p1.17.3" }, "reading_order": 0 } ], "reading_order": 2 } ], "reading_order": 16 }, { "id": "p1.18", "order": 43, "type": "text", "bbox": { "l": 552.72, "t": 60.48, "r": 560.64, "b": 49.92 }, "text": "1", "attrs": { "block_label": "number" }, "reading_order": 17 } ] } ] }