__________________________ will indemnify, hold harmless, and defend 
Name (or Parent)

Virginia Cooperative Extension and Virginia Polytechnic Institute and State University

and its employees and volunteers from all liability from loss, damage, or injury 

to__________________________ or property in any manner arising out of

               Name

__________________________'s participating as a  __________________________at

              Name                                    Role

_____________________________ including without limitation all consequential

              Location

damages, whether  or not resulting from the negligence of VPI&SU or its agents.

___________________________     ________________________       _______

              Name                  Signature                  Date

___________________________    _________________________      ________ 
    
Parents Name - If Minor              Signature                 Date