{
    "document_id": 16666,
    "page": 1,
    "width_pt": 612,
    "height_pt": 792,
    "rotation": 0,
    "pipeline_version": "paddleocr-vl-1.6+paul-48",
    "engine": "paddleocr_vl",
    "source_run_id": 16778,
    "item_count": 47,
    "counts_by_type": {
        "figure": 1,
        "form_field": 16,
        "header": 1,
        "heading": 6,
        "list": 3,
        "list_item": 14,
        "text": 5,
        "title": 1
    },
    "build_ms": 3,
    "items": [
        {
            "id": "p1.1",
            "order": 1,
            "type": "figure",
            "bbox": {
                "l": 34.8,
                "t": 760.8,
                "r": 151.68,
                "b": 699.84
            },
            "text": "",
            "attrs": {
                "role": "page_header",
                "block_label": "header_image"
            }
        },
        {
            "id": "p1.2",
            "order": 2,
            "type": "header",
            "bbox": {
                "l": 186.96,
                "t": 755.76,
                "r": 491.04,
                "b": 724.8
            },
            "text": "KENTUCKY STATE UNIVERSITY\nCooperative Extension Program 4-H Youth Development",
            "attrs": {
                "block_label": "header"
            },
            "level": 2
        },
        {
            "id": "p1.3",
            "order": 3,
            "type": "title",
            "bbox": {
                "l": 179.52,
                "t": 709.44,
                "r": 442.32,
                "b": 678.24
            },
            "text": "Medical Information and Authorization\nPARENT/GUARDIAN AUTHORIZATION AND RELEASE",
            "attrs": {
                "block_label": "doc_title"
            },
            "level": 2
        },
        {
            "id": "p1.4",
            "order": 4,
            "type": "heading",
            "bbox": {
                "l": 30.96,
                "t": 663.84,
                "r": 201.12,
                "b": 652.8
            },
            "text": "TO BE COMPLETED BY PROGRAM STAFF:",
            "attrs": {
                "block_label": "paragraph_title"
            },
            "level": 3
        },
        {
            "id": "p1.5",
            "order": 5,
            "type": "list",
            "bbox": {
                "l": 33.316149,
                "t": 643.478901,
                "r": 572.805929,
                "b": 613.7339020000001
            },
            "text": "",
            "attrs": {
                "item_count": 2
            },
            "children": [
                {
                    "id": "p1.5.1",
                    "order": 6,
                    "type": "list_item",
                    "bbox": {
                        "l": 33.316149,
                        "t": 643.478901,
                        "r": 572.805929,
                        "b": 632.4839020000001
                    },
                    "text": "Program/Event Name: ___",
                    "children": [
                        {
                            "id": "p1.5.1.1",
                            "order": 7,
                            "type": "form_field",
                            "bbox": {
                                "l": 33.3162,
                                "t": 643.4789,
                                "r": 572.806,
                                "b": 632.4839
                            },
                            "text": "",
                            "attrs": {
                                "field_kind": "text",
                                "label": "Program/Event Name: ___",
                                "source": "blank_line",
                                "label_source": "parent_text",
                                "label_ref": "p1.5.1"
                            }
                        }
                    ]
                },
                {
                    "id": "p1.5.2",
                    "order": 8,
                    "type": "list_item",
                    "bbox": {
                        "l": 33.316149,
                        "t": 624.7289020000001,
                        "r": 572.560458,
                        "b": 613.7339020000001
                    },
                    "text": "Date(s):___"
                }
            ]
        },
        {
            "id": "p1.6",
            "order": 9,
            "type": "text",
            "bbox": {
                "l": 32.88,
                "t": 625.92,
                "r": 573.12,
                "b": 613.44
            },
            "text": "County/Location: ___",
            "children": [
                {
                    "id": "p1.6.1",
                    "order": 10,
                    "type": "form_field",
                    "bbox": {
                        "l": 33.3162,
                        "t": 624.7289,
                        "r": 572.5605,
                        "b": 613.7339
                    },
                    "text": "",
                    "attrs": {
                        "field_kind": "text",
                        "label": "County/Location: ___",
                        "source": "blank_line",
                        "label_source": "parent_text",
                        "label_ref": "p1.6"
                    }
                }
            ]
        },
        {
            "id": "p1.7",
            "order": 11,
            "type": "text",
            "bbox": {
                "l": 34.08,
                "t": 607.2,
                "r": 578.64,
                "b": 593.76
            },
            "text": "Employee Name: _____ Program Area: _____",
            "children": [
                {
                    "id": "p1.7.1",
                    "order": 12,
                    "type": "form_field",
                    "bbox": {
                        "l": 33.3162,
                        "t": 605.9789,
                        "r": 576.5977,
                        "b": 594.9839
                    },
                    "text": "",
                    "attrs": {
                        "field_kind": "text",
                        "label": "Employee Name: _____ Program Area: _____",
                        "source": "blank_line",
                        "label_source": "parent_text",
                        "label_ref": "p1.7"
                    }
                }
            ]
        },
        {
            "id": "p1.8",
            "order": 13,
            "type": "heading",
            "bbox": {
                "l": 31.68,
                "t": 556.32,
                "r": 414.48,
                "b": 542.16
            },
            "text": "SECTION 1. PARTICIPANT & EMERGENCY CONTACT INFORMATION",
            "attrs": {
                "block_label": "paragraph_title"
            },
            "level": 3
        },
        {
            "id": "p1.9",
            "order": 14,
            "type": "heading",
            "bbox": {
                "l": 31.92,
                "t": 525.84,
                "r": 161.76,
                "b": 512.64
            },
            "text": "Participant information",
            "attrs": {
                "block_label": "paragraph_title"
            },
            "level": 3
        },
        {
            "id": "p1.10",
            "order": 15,
            "type": "text",
            "bbox": {
                "l": 31.44,
                "t": 506.64,
                "r": 388.8,
                "b": 493.92
            },
            "text": "Participant Name: ___",
            "children": [
                {
                    "id": "p1.10.1",
                    "order": 16,
                    "type": "form_field",
                    "bbox": {
                        "l": 34.0269,
                        "t": 506.4885,
                        "r": 387.4218,
                        "b": 494.4885
                    },
                    "text": "",
                    "attrs": {
                        "field_kind": "text",
                        "label": "Participant Name: ___",
                        "source": "blank_line",
                        "label_source": "parent_text",
                        "label_ref": "p1.10"
                    }
                }
            ]
        },
        {
            "id": "p1.11",
            "order": 17,
            "type": "text",
            "bbox": {
                "l": 32.4,
                "t": 491.04,
                "r": 291.36,
                "b": 477.84
            },
            "text": "Date of Birth: ___ / ___ / ___ Gender: □ M □ F",
            "children": [
                {
                    "id": "p1.11.1",
                    "order": 18,
                    "type": "form_field",
                    "bbox": {
                        "l": 34.0269,
                        "t": 490.5885,
                        "r": 289.0823,
                        "b": 477.9885
                    },
                    "text": "",
                    "attrs": {
                        "field_kind": "text",
                        "label": "Date of Birth: ___ / ___ / ___ Gender: □ M □ F",
                        "source": "blank_line",
                        "label_source": "parent_text",
                        "label_ref": "p1.11"
                    }
                }
            ]
        },
        {
            "id": "p1.12",
            "order": 19,
            "type": "heading",
            "bbox": {
                "l": 31.68,
                "t": 450.48,
                "r": 180.96,
                "b": 437.76
            },
            "text": "Parent/Guardian Information",
            "attrs": {
                "block_label": "paragraph_title"
            },
            "level": 3
        },
        {
            "id": "p1.13",
            "order": 20,
            "type": "list",
            "bbox": {
                "l": 31.44,
                "t": 430.32,
                "r": 469.68,
                "b": 338.88
            },
            "text": "",
            "attrs": {
                "item_count": 5
            },
            "children": [
                {
                    "id": "p1.13.1",
                    "order": 21,
                    "type": "list_item",
                    "bbox": {
                        "l": 31.68,
                        "t": 430.32,
                        "r": 393.12,
                        "b": 417.36
                    },
                    "text": "Parent/Guardian Name: ___",
                    "children": [
                        {
                            "id": "p1.13.1.1",
                            "order": 22,
                            "type": "form_field",
                            "bbox": {
                                "l": 34.0269,
                                "t": 430.1985,
                                "r": 392.0489,
                                "b": 418.1985
                            },
                            "text": "",
                            "attrs": {
                                "field_kind": "text",
                                "label": "Parent/Guardian Name: ___",
                                "source": "blank_line",
                                "label_source": "parent_text",
                                "label_ref": "p1.13.1"
                            }
                        }
                    ]
                },
                {
                    "id": "p1.13.2",
                    "order": 23,
                    "type": "list_item",
                    "bbox": {
                        "l": 31.44,
                        "t": 411.6,
                        "r": 469.68,
                        "b": 398.4
                    },
                    "text": "Primary Phone: _____ Secondary Phone: _____",
                    "children": [
                        {
                            "id": "p1.13.2.1",
                            "order": 24,
                            "type": "form_field",
                            "bbox": {
                                "l": 34.0269,
                                "t": 410.6985,
                                "r": 468.1521,
                                "b": 398.6985
                            },
                            "text": "",
                            "attrs": {
                                "field_kind": "text",
                                "label": "Primary Phone: _____ Secondary Phone: _____",
                                "source": "blank_line",
                                "label_source": "parent_text",
                                "label_ref": "p1.13.2"
                            }
                        }
                    ]
                },
                {
                    "id": "p1.13.3",
                    "order": 25,
                    "type": "list_item",
                    "bbox": {
                        "l": 31.68,
                        "t": 391.68,
                        "r": 396.96,
                        "b": 378.72
                    },
                    "text": "Email: ___",
                    "children": [
                        {
                            "id": "p1.13.3.1",
                            "order": 26,
                            "type": "form_field",
                            "bbox": {
                                "l": 34.0269,
                                "t": 391.1985,
                                "r": 395.3232,
                                "b": 379.1985
                            },
                            "text": "",
                            "attrs": {
                                "field_kind": "text",
                                "label": "Email: ___",
                                "source": "blank_line",
                                "label_source": "parent_text",
                                "label_ref": "p1.13.3"
                            }
                        }
                    ]
                },
                {
                    "id": "p1.13.4",
                    "order": 27,
                    "type": "list_item",
                    "bbox": {
                        "l": 31.68,
                        "t": 372.24,
                        "r": 393.6,
                        "b": 358.8
                    },
                    "text": "Home Address: ___",
                    "children": [
                        {
                            "id": "p1.13.4.1",
                            "order": 28,
                            "type": "form_field",
                            "bbox": {
                                "l": 34.0269,
                                "t": 371.6985,
                                "r": 391.8396,
                                "b": 359.6985
                            },
                            "text": "",
                            "attrs": {
                                "field_kind": "text",
                                "label": "Home Address: ___",
                                "source": "blank_line",
                                "label_source": "parent_text",
                                "label_ref": "p1.13.4"
                            }
                        }
                    ]
                },
                {
                    "id": "p1.13.5",
                    "order": 29,
                    "type": "list_item",
                    "bbox": {
                        "l": 32.16,
                        "t": 352.32,
                        "r": 386.16,
                        "b": 338.88
                    },
                    "text": "City: _____ State: _____ Zip: _____",
                    "children": [
                        {
                            "id": "p1.13.5.1",
                            "order": 30,
                            "type": "form_field",
                            "bbox": {
                                "l": 34.0269,
                                "t": 352.1985,
                                "r": 384.3242,
                                "b": 340.1985
                            },
                            "text": "",
                            "attrs": {
                                "field_kind": "text",
                                "label": "City: _____ State: _____ Zip: _____",
                                "source": "blank_line",
                                "label_source": "parent_text",
                                "label_ref": "p1.13.5"
                            }
                        }
                    ]
                }
            ]
        },
        {
            "id": "p1.14",
            "order": 31,
            "type": "heading",
            "bbox": {
                "l": 35.52,
                "t": 295.44,
                "r": 231.6,
                "b": 282.48
            },
            "text": "ADDITIONAL EMERGENCY CONTACT",
            "attrs": {
                "block_label": "paragraph_title"
            },
            "level": 3
        },
        {
            "id": "p1.15",
            "order": 32,
            "type": "heading",
            "bbox": {
                "l": 35.04,
                "t": 254.88,
                "r": 349.92,
                "b": 240.96
            },
            "text": "Primary Emergency Contact (if different from parent/guardian)",
            "attrs": {
                "block_label": "paragraph_title"
            },
            "level": 3
        },
        {
            "id": "p1.16",
            "order": 33,
            "type": "list",
            "bbox": {
                "l": 35.04,
                "t": 234,
                "r": 426.48,
                "b": 104.4
            },
            "text": "",
            "attrs": {
                "item_count": 7
            },
            "children": [
                {
                    "id": "p1.16.1",
                    "order": 34,
                    "type": "list_item",
                    "bbox": {
                        "l": 35.28,
                        "t": 234,
                        "r": 324.48,
                        "b": 221.52
                    },
                    "text": "Name: ___",
                    "children": [
                        {
                            "id": "p1.16.1.1",
                            "order": 35,
                            "type": "form_field",
                            "bbox": {
                                "l": 37.0679,
                                "t": 234.1292,
                                "r": 323.0524,
                                "b": 222.1292
                            },
                            "text": "",
                            "attrs": {
                                "field_kind": "text",
                                "label": "Name: ___",
                                "source": "blank_line",
                                "label_source": "parent_text",
                                "label_ref": "p1.16.1"
                            }
                        }
                    ]
                },
                {
                    "id": "p1.16.2",
                    "order": 36,
                    "type": "list_item",
                    "bbox": {
                        "l": 35.28,
                        "t": 215.52,
                        "r": 426.24,
                        "b": 201.84
                    },
                    "text": "Phone: ___ Alternate Phone: ___",
                    "children": [
                        {
                            "id": "p1.16.2.1",
                            "order": 37,
                            "type": "form_field",
                            "bbox": {
                                "l": 37.0679,
                                "t": 214.6292,
                                "r": 425.063,
                                "b": 202.6292
                            },
                            "text": "",
                            "attrs": {
                                "field_kind": "text",
                                "label": "Phone: ___ Alternate Phone: ___",
                                "source": "blank_line",
                                "label_source": "parent_text",
                                "label_ref": "p1.16.2"
                            }
                        }
                    ]
                },
                {
                    "id": "p1.16.3",
                    "order": 38,
                    "type": "list_item",
                    "bbox": {
                        "l": 35.52,
                        "t": 195.6,
                        "r": 319.92,
                        "b": 182.4
                    },
                    "text": "Relationship: ___",
                    "children": [
                        {
                            "id": "p1.16.3.1",
                            "order": 39,
                            "type": "form_field",
                            "bbox": {
                                "l": 37.0679,
                                "t": 195.1292,
                                "r": 318.2363,
                                "b": 183.1292
                            },
                            "text": "",
                            "attrs": {
                                "field_kind": "text",
                                "label": "Relationship: ___",
                                "source": "blank_line",
                                "label_source": "parent_text",
                                "label_ref": "p1.16.3"
                            }
                        }
                    ]
                },
                {
                    "id": "p1.16.4",
                    "order": 40,
                    "type": "list_item",
                    "bbox": {
                        "l": 35.28,
                        "t": 176.64,
                        "r": 215.04,
                        "b": 163.92
                    },
                    "text": "SECONDARY EMERGENCY CONTACT"
                },
                {
                    "id": "p1.16.5",
                    "order": 41,
                    "type": "list_item",
                    "bbox": {
                        "l": 35.04,
                        "t": 156.48,
                        "r": 324.72,
                        "b": 144
                    },
                    "text": "Name: ___",
                    "children": [
                        {
                            "id": "p1.16.5.1",
                            "order": 42,
                            "type": "form_field",
                            "bbox": {
                                "l": 37.0679,
                                "t": 156.1292,
                                "r": 323.0524,
                                "b": 144.1292
                            },
                            "text": "",
                            "attrs": {
                                "field_kind": "text",
                                "label": "Name: ___",
                                "source": "blank_line",
                                "label_source": "parent_text",
                                "label_ref": "p1.16.5"
                            }
                        }
                    ]
                },
                {
                    "id": "p1.16.6",
                    "order": 43,
                    "type": "list_item",
                    "bbox": {
                        "l": 35.28,
                        "t": 137.52,
                        "r": 426.48,
                        "b": 124.32
                    },
                    "text": "Phone: _____ Alternate Phone: _____",
                    "children": [
                        {
                            "id": "p1.16.6.1",
                            "order": 44,
                            "type": "form_field",
                            "bbox": {
                                "l": 37.0679,
                                "t": 136.6292,
                                "r": 425.062,
                                "b": 124.6292
                            },
                            "text": "",
                            "attrs": {
                                "field_kind": "text",
                                "label": "Phone: _____ Alternate Phone: _____",
                                "source": "blank_line",
                                "label_source": "parent_text",
                                "label_ref": "p1.16.6"
                            }
                        }
                    ]
                },
                {
                    "id": "p1.16.7",
                    "order": 45,
                    "type": "list_item",
                    "bbox": {
                        "l": 35.52,
                        "t": 117.84,
                        "r": 319.92,
                        "b": 104.4
                    },
                    "text": "Relationship: ___",
                    "children": [
                        {
                            "id": "p1.16.7.1",
                            "order": 46,
                            "type": "form_field",
                            "bbox": {
                                "l": 37.0679,
                                "t": 117.1292,
                                "r": 318.2304,
                                "b": 105.1292
                            },
                            "text": "",
                            "attrs": {
                                "field_kind": "text",
                                "label": "Relationship: ___",
                                "source": "blank_line",
                                "label_source": "parent_text",
                                "label_ref": "p1.16.7"
                            }
                        }
                    ]
                }
            ]
        },
        {
            "id": "p1.17",
            "order": 47,
            "type": "text",
            "bbox": {
                "l": 549.6,
                "t": 60.48,
                "r": 557.52,
                "b": 49.92
            },
            "text": "1",
            "attrs": {
                "block_label": "number"
            }
        }
    ],
    "excluded_furniture": {
        "first": [],
        "last": []
    }
}