Progressive Agriculture Safety Days® Progressive Agriculture Foundation

5-Star Sponsors Bunge North America Crop Production Services Agrium, Inc. TransCanada Corp. CHS & CHS Foundation Enbridge 4-Star Sponsors Archer Daniels Midland Company John Deere Farm Credit Monsanto Company 3-Star Sponsor Toyota 2-Star Sponsors Bayer CropScience DTN/The Progressive Farmer Kubota Tractor Corporation BASF Canada 1-Star Sponsors Betaseed, Inc. Nationwide Foundation Westfield Industries/Ag Growth International Brandt Co. Flint Hills Resources FMC Iowa Farm Bureau Federation Rain and Hail Insurance Contributing Sponsors Alabama Power Foundation & Company MacDon Industries Ltd. Bridgestone Americas Trust Fund National Shooting Sports Foundation CSX Corporation Farmers Mutual Hail Insurance Company U.S. Custom Harvesters Inc. The Andersons Intrepid Potash Ken Cook Company Princess Auto (Canada) Viterra (Canada) Association of Equipment Manufacturers AKE Safety Equipment Union Pacific Railroad Company Deloitte & Touche, LLP Spectrum Technologies, Inc. Farmers National Company Krone North America, Inc. In-Kind Sponsors Canadian Agricultural Safety Association Asmark Institute Colle+McVoy Media Sponsors Penton Agriculture DTN/The Progressive Farmer Farm Journal Media The Western Producer (Canada) Carbon Media Group Hoard’s Dairyman Meister Media Worldwide Country Folks & Lee Publications High Plains Journal Progressive Dairyman Ontario Farmer (Canada) Farm Business Communications (Canada) Le Terre de Chez Nous (Canada)

Dear Safety Day Participant,

May 4, 2016

We are looking forward to having you at our Progressive Agriculture Safety Day on Tuesday, June 14, 2016, held in the 4-H Youth Building at the Darke County Fairgrounds in Greenville, OH. Please plan to arrive by 9:00 a.m and come to the registration table inside the north door – we will have signs and attendants to help direct you to the right area. Please dress lightly if particularly warm as we will be providing you with a safety day T-Shirt. Also please make sure to wear closed toe shoes for everyone’s safety. A lunch consisting of a sandwich, chips, fruit, cookie & drink will be provided. You may bring a sack lunch if you prefer. We have an exciting day planned for you! There are many activities to teach you how to stay safe. Staying safe is a serious subject, but we’ve made learning how to stay safe fun. You will be in a group of approximately 20 children your age. On page 3, you will find a schedule of the Progressive Agriculture Safety Day activities. Parents, please be at the fairgrounds to pick up your child(ren) at 2:00 p.m. After the event, we hope you will take time to discuss what they learned and to look through the items in their take-home bag. If your child is bringing his/her grandparent (or other adult), please remind them to bring their lawn chair. See you on June 14th! In the meantime, if you have questions, please call me at 937-467-3095. See you soon. Sincerely, Morgan Aultman, Coordinator Progressive Agriculture Safety Day www.progressiveag.org Page 1

Darke County Chapter Farm Safety For Just Kids

Darke County Chapter Farm Safety For Just Kids

PROGRESSIVE AG SAFETY DAY, JUNE 14, 2016 There will be 100 children divided into 5 groups. They will rotate through the Safety Sessions listed below:

9:00 – 9:20 – Registration

9:20 – 9:40 – Welcome & Opening Remarks 9:45 - 10:00 – Citizen’s CPR – Darke County Red Cross 10:05 – 10:20 – Chemical Look-a-Likes – Nathan Cross (GV CPS) 10:25 - 10:40 – ATV Safety – Brad Wilcox/GV Fire Dept 10:45 – 11:00 – Fire Safety – Smokehouse – Rossburg Fire Dept 11:05 – 11:20 – Water Safety – Hannah Barga/Versailles YMCA 11:20 -12:15 – Lunch, kids make Thank You Cards & visit the fun stations, adults go to session in the Gazebo Adult Session – Hearing Safety/Awareness – Jordan Francis 12:20 – 12:50 – Group Session– Drug Safety – Clinton Randall/Early Bird 12:50 – 1:00 – Stretch, Move to other session 1:00 – 1:50 – Group Session Part 2 Grain Entrapment Trailer

Sam Custer/Dee Jepsen/ OSU Extention Office 1:50 – 2:00 – Take Group Picture 2:00 – Kid’s assemble at their tables with the Group Leaders. Draw for Door prizes. Kid’s await pick-up. When parent arrives, collect Goodie Bags and certificates and youth are dismissed. Page 2

Please read --- Registration Information! The Darke County Chapter of Farm Safety For Just Kids will be hosting their 12th annual Progressive Ag Safety Day on Tuesday, June 14, at the Darke County Fairgrounds in Greenville for kids ages 6-13. Please call/email Rhonda at 937-417-7412 or [email protected] to request a registration packet, and send completed application and consent forms along with $3/child to: (checks made out to Darke County Farm Safety for Just Kids) Rhonda Kress 7972 Graw Rd. Arcanum, OH 45304 (Only copies of the application and consent forms need to be sent – pg. 4,5 – for kids -Parents and/or grandparents are welcome (free to attend) and will need to fill out the consent form on pg. 6) There will be a special session at noon for the adults with special door prizes. Registration is limited to the first 100 kids.

T-Shirt Sizing (#5000B) - Youth T-Shirt 5.3 oz

Small (6-8) Medium (10-12) Large (14-16)

(#5000) - Adult T-Shirt 5.3 oz.

Small Medium Large X-Large 2X-Large 3X-Large 4X-Large

Width in Inches

Length in Inches

16 17 18*

20 22 24

18* 20 22 24 26 28 30

28 29 30 31 32 33 34

* This is correct the only difference between the Youth Large and Adult Small is their length.

Page 3

Code 16-633

Progressive Agriculture Safety Day™ Application

Darke Co. Fairgrounds Youth Building June 14, 2016 9AM – 2PM Ages 6-13 Our 12th Safety Day presented by Darke County Chapter Farm Safety For Just Kids Registration fee -$3/child (Adults are free) Name of Participant (one child/form) ____________________________________________________________

Participant’s age ________________

Grade in school_________

Participant is:

□ Boy

□ Girl

If needed, my child has permission to take: Tylenol _______Other__________________ Allergies?__________________Special needs/disabilities?______________________________________________ If possible, I would like my child to be placed in a group with ___________________________________________ Name of Adult who would like to also attend with child (needs consent form) _______________________________ The following person has permission to pick up my child at 2 PM _________________________________________

Please circle your child’s t-shirt size: (See pg. 3)

YOUTH – S (6-8) M(10-12) or ADULT Sizes S, M, L, XL

Lunch Menu – Grilled Hot dogs, Chips, Fruit, Cookie & Drink – you may send a sack lunch if needed. A parent or guardian must sign the Release & Consent form in order for their child(ren) to participate in the Progressive Agriculture Safety Day. (pg. 4 & 5) If a parent, grandparent or other adult is attending the Safety Day with the child, please fill out the attached Adult Release & Consent Form (only needed if adult accompanies-pg. 6). Each Participant will receive lunch, snacks, guest speakers, a Safety Day t-shirt, safety material, and goodie bag. Applications will be accepted until June 10, After June 6, please call to see if registration is full (937-417-7412) Please send the registration and consent forms plus $3 (checks made out to Darke County Farm Safety for Just Kids) for each child to:

Rhonda Kress 7972 Graw Rd. Arcanum, OH 45304

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Code 16-633

Progressive Agriculture Safety Day®

2016 Release and Consent Form II 1) I give my permission for the child listed below to attend the Progressive Agriculture Safety Day ®. I understand that one of the purposes of the Progressive Agriculture Safety Day® is to teach participants to stay safe around farm sites, equipment, and animals among other topics. During the Safety Day, safety barriers will be in place, safety rules will be enforced, and participants will be closely supervised by Safety Day instructors and group leaders. However, I acknowledge that there is the possibility of accidents. I release the coordinators, instructors, volunteers, sponsors, the Progressive Agriculture Foundation, and the Progressive Agriculture Safety Day ® program from all claims, in the event of injury to my child, unless the injury is the result of gross negligence or willful misconduct on the part of these parties. 2) First aid will be available at the Safety Day and medical and/or hospital care will be provided in case of serious illness or injury. I understand that if serious illness or injury occurs the emergency contact(s) listed below will be notified. If it is impossible to reach the emergency contact(s), I give permission for emergency treatment as recommended by the attending physician. 3) I give my permission for photographs, audio, and video to be taken of my child while engaged in Safety Day activities and for these images to be used to promote safety in the media, social media, on websites, and in promotional materials. 4) I understand that my child might be asked to complete a written knowledge survey before and after the Safety Day to help evaluate the effectiveness of the Progressive Agriculture Safety Day ® program. Participation is voluntary, and my child may choose not to participate. I give permission for my child to participate in these evaluations. 6/12/2015

I have read and agree to the above information. [Note: If you do not give permission for all or part of items 2, 3, or 4 simply mark through and initial the statement(s) that you do not agree to. However, if you do not agree to item 1, your child cannot attend the Safety Day.]

Parent/Guardian Signature___________________________________________ Date ____________________ Printed Name of Parent/Guardian ______________________________________________________________ Name of Participant________________________________________________________________________ Participant’s age ________________

Grade in school_________

Participant is: □ Boy

□ Girl

Address __________________________________________________________________________________ City _________________________________ State/Province ___________ Postal Code __________________ Phone Number ________________________ Email Address ______________________________________ Does this participant: □ Live on a farm or ranch □ Work on a farm or ranch □ Visit a farm or ranch □ N/A Emergency Contact 1 ___________________________ Emergency Phone Number(s) ________________________ Emergency Contact 2 ___________________________ Emergency Phone Number __________________________

Page 5

Code 16-633

Progressive Agriculture Safety Day™ 2016 Release and Consent Form for Parents & Grandparents (or Other Adult attending with child) 1)

I release the coordinators, instructors, volunteers, sponsors, the Progressive Agriculture Foundation, and the Progressive Agriculture Safety Day™ program from all claims, in the event of injury, unless the injury is the result of gross negligence or willful misconduct on the part of these parties. I understand that one of the purposes of the Progressive Agriculture Safety Day™ is to teach me how to stay safe around farm sites, farm equipment, and farm animals. During the safety day, safety barriers will be in place, safety rules will be enforced, and all participants will be closely supervised by safety day instructors and leaders. However, I acknowledge that there is the possibility of accidents.

2)

First aid will be available at the safety day and medical and/or hospital care will be provided in case of serious illness or injury. I understand that if serious illness or injury occurs, the alternate emergency contact provided below will be contacted. If it is impossible to reach the alternate emergency contact provided below, I give permission for emergency treatment as recommended by the attending physician.

3)

I give my permission for photographs, audio, and video to be taken while I am engaged in safety day activities and for these images to be used in the media, on the Progressive Agriculture Safety Day™ Website, and in promotional materials related to farm safety.

4)

I understand that I may be asked to complete a written knowledge test before and after the safety day to help evaluate the effectiveness of the Progressive Agriculture Safety Day™ program. Participation is voluntary, and I may choose not to participate. Please print the following:

Adult’s Name _____________________________________________________________________ Adult’s Address ____________________________________________________________________ City ______________________________________ State ______________ Zip _________________ Phone Number __________________Emergency Contact __________________________________ I am:

□ Male □ Female

Age ________ (nurse needs this in case of medical emergency)

Signature_________________________________________________________________________ Child/Participant’s Name __________________________________________________________________ Page 6