{ "document_id": 16667, "page": 2, "width_pt": 612, "height_pt": 792, "rotation": 0, "pipeline_version": "paddleocr-vl-1.6+paul-48", "engine": "paddleocr_vl", "source_run_id": 16777, "item_count": 23, "counts_by_type": { "figure": 1, "footer": 1, "form_field": 4, "header": 1, "heading": 4, "list": 1, "list_item": 4, "text": 7 }, "build_ms": 1, "items": [ { "id": "p2.1", "order": 1, "type": "figure", "bbox": { "l": 41.28, "t": 774.72, "r": 155.28, "b": 713.28 }, "text": "", "attrs": { "role": "page_header", "block_label": "header_image" } }, { "id": "p2.2", "order": 2, "type": "header", "bbox": { "l": 171.84, "t": 769.92, "r": 475.68, "b": 738 }, "text": "KENTUCKY STATE UNIVERSITY\nCooperative Extension Program 4-H Youth Development", "attrs": { "block_label": "header" }, "level": 2 }, { "id": "p2.3", "order": 3, "type": "text", "bbox": { "l": 36.24, "t": 684, "r": 405.36, "b": 671.04 }, "text": "NAME OF CAMP/PROGRAM:___", "children": [ { "id": "p2.3.1", "order": 4, "type": "form_field", "bbox": { "l": 38.0444, "t": 683.3947, "r": 404.4853, "b": 671.4022 }, "text": "", "attrs": { "field_kind": "text", "label": "NAME OF CAMP/PROGRAM:___", "source": "blank_line", "label_source": "parent_text", "label_ref": "p2.3" } } ] }, { "id": "p2.4", "order": 5, "type": "text", "bbox": { "l": 36.24, "t": 665.28, "r": 338.88, "b": 652.56 }, "text": "PARTICIPANT NAME:___", "children": [ { "id": "p2.4.1", "order": 6, "type": "form_field", "bbox": { "l": 38.0444, "t": 664.8896, "r": 337.6669, "b": 652.8896 }, "text": "", "attrs": { "field_kind": "text", "label": "PARTICIPANT NAME:___", "source": "blank_line", "label_source": "parent_text", "label_ref": "p2.4" } } ] }, { "id": "p2.5", "order": 7, "type": "heading", "bbox": { "l": 35.28, "t": 631.68, "r": 150.96, "b": 619.92 }, "text": "5. PROPERTY DAMAGE", "attrs": { "block_label": "paragraph_title" }, "level": 3 }, { "id": "p2.6", "order": 8, "type": "text", "bbox": { "l": 34.8, "t": 616.8, "r": 556.56, "b": 589.68 }, "text": "I agree to be financially responsible for damages to Kentucky State University property caused by negligent, reckless, or intentional acts of my child." }, { "id": "p2.7", "order": 9, "type": "heading", "bbox": { "l": 35.28, "t": 569.28, "r": 138.24, "b": 557.28 }, "text": "6. GOVERNING LAW", "attrs": { "block_label": "paragraph_title" }, "level": 3 }, { "id": "p2.8", "order": 10, "type": "text", "bbox": { "l": 34.56, "t": 554.16, "r": 529.68, "b": 527.28 }, "text": "I understand that any legal claim arising from participation in the program shall be governed by the laws of the Commonwealth of Kentucky." }, { "id": "p2.9", "order": 11, "type": "heading", "bbox": { "l": 36.24, "t": 489.36, "r": 142.56, "b": 476.88 }, "text": "ACKNOWLEDGMENT", "attrs": { "block_label": "paragraph_title" }, "level": 3 }, { "id": "p2.10", "order": 12, "type": "heading", "bbox": { "l": 55.68, "t": 466.32, "r": 121.92, "b": 454.32 }, "text": "I certify that:", "level": 3 }, { "id": "p2.11", "order": 13, "type": "list", "bbox": { "l": 76.668777, "t": 450.891229, "r": 422.826466, "b": 397.146232 }, "text": "", "attrs": { "item_count": 4 }, "children": [ { "id": "p2.11.1", "order": 14, "type": "list_item", "bbox": { "l": 76.668777, "t": 450.891229, "r": 351.366585, "b": 439.89623 }, "text": "I am the parent/legal guardian of the participant listed above;", "marker": "•" }, { "id": "p2.11.2", "order": 15, "type": "list_item", "bbox": { "l": 76.668777, "t": 436.64123, "r": 203.412291, "b": 425.646231 }, "text": "I am at least 18 years of age;", "marker": "-" }, { "id": "p2.11.3", "order": 16, "type": "list_item", "bbox": { "l": 76.668777, "t": 422.39123, "r": 422.826466, "b": 411.396231 }, "text": "I have read and understand this Residential Summer Camp Release of Liability;", "marker": "•" }, { "id": "p2.11.4", "order": 17, "type": "list_item", "bbox": { "l": 76.668777, "t": 408.141231, "r": 232.121812, "b": 397.146232 }, "text": "and I voluntarily agree to its terms.", "marker": "•" } ] }, { "id": "p2.12", "order": 18, "type": "text", "bbox": { "l": 40.32, "t": 335.52, "r": 349.68, "b": 322.32 }, "text": "Parent/Guardian Signature ___", "children": [ { "id": "p2.12.1", "order": 19, "type": "form_field", "bbox": { "l": 41.8442, "t": 334.95, "r": 348.0436, "b": 322.95 }, "text": "", "attrs": { "field_kind": "text", "label": "Parent/Guardian Signature ___", "source": "blank_line", "label_source": "parent_text", "label_ref": "p2.12" } } ] }, { "id": "p2.13", "order": 20, "type": "text", "bbox": { "l": 41.52, "t": 295.92, "r": 165.6, "b": 283.92 }, "text": "Date _____", "children": [ { "id": "p2.13.1", "order": 21, "type": "form_field", "bbox": { "l": 43.0861, "t": 296.0019, "r": 164.3008, "b": 284.0019 }, "text": "", "attrs": { "field_kind": "text", "label": "Date _____", "source": "blank_line", "label_source": "parent_text", "label_ref": "p2.13" } } ] }, { "id": "p2.14", "order": 22, "type": "text", "bbox": { "l": 549.36, "t": 60.48, "r": 557.76, "b": 49.92 }, "text": "2", "attrs": { "block_label": "number" } }, { "id": "p2.15", "order": 23, "type": "footer", "bbox": { "l": 188.4, "t": 47.28, "r": 452.64, "b": 35.76 }, "text": "Kentucky State University is an equal opportunity provider.", "attrs": { "block_label": "footer" } } ], "excluded_furniture": { "first": [], "last": [] } }