Name of Attendee
*
First Name
Last Name
Date of Birth
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Month
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Day
Year
Date
Phone Number
*
Please enter a valid phone number.
Emergency Contact
*
First Name
Last Name
ER Contact Phone Number
*
Please enter a valid phone number.
School Currently Attending
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Shirt Size
*
Please Select Reality Check Class You Will Be Attending
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Please Select
You DO NOT have to attend the school where the class is being held. All programs will be from 8:00 a.m. until 4:00 p.m.
Waiver & Release
I understand this course is to familiarize students with various skills and that there will be some hands on instruction. I agree for my child to participate in the program. My child does not have any physical constraints that would prohibit his/her participation in the program. I hereby release Sheriff Tony Mancuso, the Calcasieu Parish Sheriff’s Office, Calcasieu Parish Regional Training Academy, any/all staff and instructors, agents and assigns, for responsibility and/or liability for any damages that occur during the training or for injuries or damages that may result from their attempting to utilize said training in the future.
Signature of Attendee
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Clear
Signature of Parent or Guardian
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