Register - BCSOFoundation

Camp

Participant's Name*

D.O.B.*

Gender*

Age*

Name of School*

Current Grade*

Home Address*

City*

Zip*

(1) Parent Name*

(1) Parent Phone*

(2) Parent Name

(2) Parent Phone

Select child’s shirt size:*

Shirts must be picked up the morning of camp. Camp Shirts are REQUIRED to be worn to attend the camp. This is also used as a safety measure during the camp to determine campers present. Therefore, please allow for an extra 30 minutes to drop off your child the first morning of which ever camp your child is attending. They will receive two shirts and can change at camp.

**Read Baldwin County Shining Star Camp Rules & Responsibilities** * I agree that I have read and understand all of the Baldwin County Sheriff Office's "Shining Star Camp Rules and Responsibilities" and I will comply accordingly.

Authorization to Transport * By allowing your child to participate in the Baldwin County Sheriff’s Office Shining Star Camp you are giving the Baldwin County Sheriff’s Office permission to transport your child via bus to any facility or event deemed part of the camp activities. Please note proper pick up times and locations for each day and they are subject to change.

Release for Video and Image Authorization * By allowing your child to participate in the Baldwin County Sheriff’s Office Shining Star Camp you are giving the Baldwin County Sheriff’s Office exclusive rights to all images &/or video captured of your child while participating in Camp activities. The Baldwin County Sheriff’s Office has the right to print, publish and/or share any images &/or video of your child.

Medical Information / Authorization Form
Emergency Contacts / Check out list (besides parents)

Emergency Contact Name (1)*

Relationship (1)*

Phone (1)*

Emergency Contact Name (2)*

Relationship (2)*

Phone (2)*

* Is the child allergic to horses?

YES

Immunizations

DPT Series

Booster

Tetanus

Polio OPY (Sabin)

Other health problems not listed that prevents physical activity:

Any medications currently being taken? If yes, specify:

* * * Please take notice that the Baldwin County Sheriff’s Office Shining Star Camp is staffed by volunteer staff members from our agency. We are not able to assign staff members to each individual camper to meet one-on-one supervision needs. Therefore, any camper that possesses any prospective behavioral issues or requires closely monitored one-on-one supervision must be accompanied by that applicants guardian at all times. The guardian must also pass a criminal background check to accompany the camper and must be present at all times to care for the camper. One-on-one supervision needs or behavioral issues must be disclosed to the camp director upon submission of the application. Failure to do so may result in refusal of admittance. * * *

* Please type in your initials that you have read and understand the statements above with regards to behavioral and supervision needs and will comply accordingly.

HEALTH INSURANCE

Health Insurance

Policy No.

Group No.

*I acknowledge the health history on this form is correct so far as I know, the child described herein has permission to engage in all program activities, except as noted by me and/or recommended by our physician.

WAIVER OF LIABILITY
In consideration of my child’s participation in this activity, I hereby release and discharge the Baldwin County Sheriff’s Office, Baldwin County Public School’s employees, staff and any city or county employee or any selected volunteer, presenter, or any individual Deputy Sheriff/ or Police Officer from any and all liability arising from accident, injury or illness that (he/she) may suffer as a result of participation in this program. I understand that I do not have to sign this waiver, but by not doing so my child will not be able to participate in the program.

*I accept the waiver liability stated.

* Email (Required for registration receipt delivery and notifications.)

Addt’l. Email (Not Required. Addt’l. email will also recieve notifications with regards to camp.)

* Submitted By: (Full Name)

Shining Star Online Registration