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                "text": "KENTUCKY STATE UNIVERSITY\nCooperative Extension Program 4-H Youth Development",
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                "type": "TITLE",
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                "text": "PARENT/GUARDIAN AUTHORIZATION AND RELEASE",
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                "text": "TO BE COMPLETED BY PROGRAM STAFF:",
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                "type": "TEXT",
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                "text": "Date: _____ County/Location: _____",
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                "type": "TEXT",
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                "text": "Employee Name: ___ Program Area: ___",
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                "page": 1,
                "type": "TITLE",
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                "text": "Participant Information",
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                "page": 1,
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                "text": "Participant Name: ___",
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                "page": 1,
                "type": "TEXT",
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                "text": "Date of Birth: ___",
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            {
                "page": 1,
                "type": "TEXT",
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            {
                "page": 1,
                "type": "TEXT",
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                "text": "Phone Number: ___",
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                "page": 1,
                "type": "TEXT",
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                "type": "TITLE",
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                "text": "PHOTO AND MEDIA RELEASE",
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                "page": 1,
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                "location": {
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                "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": 13
            },
            {
                "page": 1,
                "type": "LIST_ITEM",
                "location": {
                    "l": 38.88,
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                    "r": 129.12,
                    "b": 359.04
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                "text": "I understand that:",
                "list_id": "L1",
                "level": 0,
                "items": [
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                        "page": 1,
                        "type": "LIST_ITEM",
                        "location": {
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                        "text": "Participation is voluntary",
                        "marker": "•",
                        "list_id": "L1",
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                        "reading_order": 0
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                        "type": "LIST_ITEM",
                        "location": {
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                        "text": "No compensation will be provided",
                        "marker": "•",
                        "list_id": "L1",
                        "level": 1,
                        "reading_order": 1
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                    {
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                        "type": "LIST_ITEM",
                        "location": {
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                        "text": "These materials may be used by Kentucky State University without restriction",
                        "marker": "-",
                        "list_id": "L1",
                        "level": 1,
                        "reading_order": 2
                    }
                ],
                "reading_order": 14
            },
            {
                "page": 1,
                "type": "TEXT",
                "location": {
                    "l": 39.36,
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                    "r": 148.32,
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                "text": "☐ I GIVE permission",
                "reading_order": 15
            },
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                "page": 1,
                "type": "TEXT",
                "location": {
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                    "r": 190.56,
                    "b": 261.36
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                "text": "☐ I DO NOT GIVE permission",
                "reading_order": 16
            },
            {
                "page": 1,
                "type": "TEXT",
                "location": {
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                "text": "Parent/Guardian Initials: ___",
                "reading_order": 17
            },
            {
                "page": 1,
                "type": "TITLE",
                "location": {
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                "text": "FIELD TRIP/OFFSITE TRAVEL AUTHORIZATION IF APPLICABLE",
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                "level": 2
            },
            {
                "page": 1,
                "type": "TEXT",
                "location": {
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                "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": 19
            },
            {
                "page": 1,
                "type": "TEXT",
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                "text": "□ I GIVE permission",
                "reading_order": 20
            },
            {
                "page": 1,
                "type": "TEXT",
                "location": {
                    "l": 39.12,
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                    "b": 119.76
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                "text": "☐ I DO NOT GIVE permission",
                "reading_order": 21
            },
            {
                "page": 1,
                "type": "TEXT",
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                "text": "Parent/Guardian Initials: ___",
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            }
        ]
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