Exhibitor Name *
Youth First Name
Youth Last Name
Parent/Guardian Name *
Guardian First Name
Guardian Last Name
Phone * Email *
Exhibitor's Date of Birth *
Date Format: MM slash DD slash YYYY
4-H Age Division * Age Division: PeeWee (younger than 9 as of 9/30/21) Age Division: Junior (9-11 as of 9/30/21) Age Division: Intermediate (12-13 as of 9/30/21) Age Division: Senior (14-18 as of 9/30/21) Exhibitor Shirt Size * Shirt Size: Youth Medium Shirt Size: Youth Large Shirt Size: Adult Small Shirt Size: Adult Medium Shirt Size: Adult Large Shirt Size: Adult Extra Large Shirt Size: Adult XXL Species? * Species: Beef Species: Sheep Species: Goats Species: Hogs
The educational clinics and the showmanship contests for all four species will run at the same time. Please select which specie you plan to participate with for the day.
Clinic, Jackpot or Both? * Both the clinic and the showmanship contest. Clinic only. Showmanship contest only.
You may choose to participate in one or both of the day's events. Please let us know what you are planning to do so we can plan classes accordingly. The price is a flat fee – only participating in one event will not decrease price.
* Participant Food Allergies/Dietary Restrictions
Please let us know if the exhibitor has any severe food allergies or dietary restrictions. Lunch will be provided for registered participants. Those participants with severe food allergies and dietary restrictions will be provided with an alternate lunch if needed.
COVID-19 Waiver *
Due to the outbreak of the novel Coronavirus (COVID-19), Culpeper Agriculture Enterprise, Inc. (CAE) and HOMETOWN SHOWDOWN are taking reasonable steps to protect you, our exhibitors/vendors, our community and our staff. CAE and HOMETOWN SHOWDOWN will be following the Center of Disease Control (CDC) and the Virginia Department of Health (VDH) Guidelines for social distancing practices and sanitation. We ask our exhibitors/vendors to be honest about their health conditions. If you have any of the following symptoms or other symptoms of COVID-19, then you will not be authorized to participate in events.
Symptoms of COVID-19 include but are not limited to:
• Dry Cough
• Difficulty Breathing
I agree to the following statement:
I, nor members of my household, nor anyone I am in close personal contact with, have experienced any of the symptoms listed above within the last 14 days.
CAE and HOMETOWN SHOWDOWN are following these enhanced procedures to prevent the spread of the Coronavirus (Covid-19):
• Operating at 50% Capacity of Buildings and areas used
• Social Distancing Plans must be observed
• Cleaning will occur regularly in bathrooms and regularly touched surfaces
By signing below, I hereby release and agree to hold CAE and all individuals and entities associated with HOMETOWN SHOWDOWN harmless from and waive on behalf of myself, my heirs, and any personal representatives any and all causes of action, claims, demands, damages, costs, expenses, and compensation for damages or loss to myself and/or property that may be caused by any act, or failure to act of the CAE or HOMETOWN SHOWDOWN, or that may otherwise arise in any way in connection with attendance by me or persons claiming through me at any event or function of CAE and/or HOMETOWN SHOWDOWN. I agree to release CAE and HOMETOWN SHOWDOWN from any and all liability for exposure or harm due to the Coronavirus (COVID-19). By signing below, exhibitors and their families release the CAE and HOMETOWN SHOWDOWN and all committee members and volunteers from any and all responsibility for loss, damages, or accidents including, among other things, exposure to the COVID-19 virus.
Accident Waiver and Release of Liability *
I hereby grant permission to the rights of images/video taken on my property/of my property/or my image, likeness and sound of my voice as recorded on audio or video tape without payment or any other consideration. I understand that images/videos/recordings may be edited, copied, exhibited, published or distributed and waive the right to inspect or approve the finished product wherein my likeness/property appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of any image or recording of me or my property . I also understand that this material may be used in diverse settings within an unrestricted geographic area.
Photographic, audio or video recordings may be used for the following purposes, including but not limited to:
Presentations | Social Media | Website | Displays | Informational Documents/Brochures/Banners
By electronically signing this release I understand this permission signifies that photographic or video recordings of me or my property may be electronically displayed via the Internet or in a public setting.
I understand I will NOT be consulted about the use of the photographs/videos/recordings for any purpose.
There is no time limit on the validity of this release nor is there any geographic limitation on where these materials may be distributed. I understand all material collected of me or my property falls subject to this agreement. If a Photo/video release is terminated none of the prior acquired material will be deleted, it will remain in effect for eternity.
This release applies to photographic, audio or video recordings.
This release applies to any video/image/audio/or other media gifted to CFC by signee.
By electronically consenting to this form I acknowledge that I have completely read and fully understand the above release and agree to be bound thereby. I hereby release any and all claims against any person or organization utilizing this material for any purposes.
Registration Fee *
Exhibitor registration includes the clinic, lunch and entry for the showmanship jackpot. No refunds will be issued; no exceptions. If you choose to only participate in one of the activities (clinic or show), registration price remains the same. Payment must be received at the time of entry for your registration to be processed. You will be redirected to a PayPal page for payment. You may either pay via PayPal or using a credit or debit card. Payment is secure.