I the legal parent/guardian, is aware that the applicant will be facing many physical and mental challenges on a daily basis. These challenges are an integral part of the MS ChalleNGe Academy. These challenges are designed to build self- esteem, to create a climate of accomplishment, and to encourage and develop team cohesiveness. No applicant will be successful without the support and active participation of their parents or guardian. I therefore agree and contract to support the efforts of the MS ChalleNGe Academy by supporting my applicant in his or her efforts to succeed. I will demonstrate this support by providing praise and encouragement in times of success, and reassurance and motivation during times of frustration. I am committed to the maximum extent possible, to ensure my child remains in the MS ChalleNGe Academy until completion of the twenty-two-week residential phase and one year Post Residential Phase, that follows upon graduation of this program.
As parent or legal guardian, I hereby grant my permission for the physical screening evaluation and I further understand this exam does not prevent injury or sudden death during the applicant's participation in the MS Youth ChalleNGe Academy.
I willingly and knowingly assume all liability for any and all bodily injury or property damage incurred by the participant at the MS ChalleNGe Academy. No fraternization or relationships beyond platonic are allowed for the duration of the program.
We the parent(s)/Guardian do consent to his/her participation in the Mississippi National Guard Youth ChalleNGe Academy to be conducted at Camp Shelby, Mississippi. The opportunity to participate in the YCA is by invitation and is purely voluntary on our behalf.
I/We authorize the participant to visit with the Mentor during the residential portion of the program. This includes all activities involving the mentor. I also give permissions for the Mississippi Youth ChalleNGe Academy staff to discuss behavior issues with mentors upon successfully passing the required criminal background check.
I/We further agree that, if necessary, due to medical, disciplinary, or other reasons, the Director or Deputy may elect to return him/her to their home of record address by commercial or private carrier, for which I/we may be responsible for payment.
I/we consent to the applicant being photographed and/or videotaped while in residence at the Academy and to have such photographs and/or video posted on the official Mississippi ChalleNGe Academy website, for official, non- commercial purposes only.
I/we consent to the above-named applicant being transported as a passenger in certain National Guard and/or air vehicles while in residence at the Academy. Whereas my/our son/daughter/ward will accept such transportation entirely upon his/her own initiative, risk and responsibility, now I/we therefore in consideration of the permission extended to the above named applicant by the United States and the State of Mississippi through their officers and agents for myself/ourselves, our heirs, released and forever discharge the Government of the United States and the Government of the State of Mississippi and employees acting officially, from any and all claims, demands, actions, or cause of action, on account of any injury or illness to the above named applicant or personal property which may occur from any cause during said transportation, as well as all ground operations incident thereto.
I/we understand that I/we are responsible for the above named applicant’s medical care and any incurred medical cost, DO HEREBY consent in advance to whatever emergency, X-Ray examinations, anesthesia, diagnostic procedure, medical and/or surgical treatment is considered necessary in the best judgment of the attending physician in the event of illness or injury occurring to the above named applicant during his/her attendance at the MS National Guard Youth ChalleNGe Academy to be conducted at the MS Youth Challenge Academy. In the event of any major illness or injury, reasonable efforts will be made to immediately notify me/us. Further consent is granted for psychological/educational assessments and evaluations and the completion of questionnaires and interviews.
Eligible applicants must meet the requirement listed below:
- 16-18 years of age at time of entry into the program.
- Not received a secondary school diploma or certificate.
- A citizen or legal resident of the United States unemployed or under-employed
- Not currently on parole or probation for other than Juvenile status offenses, not awaiting sentencing, and not under indictment, accused, or convicted of a felony
- Free from use of illegal drugs or substances
- Possess Medical/Medicaid Insurance
- Physically and mentally capable to participate in the program in which enrolled with reasonable accommodation for physical and other disabilities.
I/We consent to the program nurse as well as unlicensed YCA cadre/staff to administer both prescription and over-the-counter (OTC) medications to my/our child. I understand prescription medications will be administered per directions
on the label, and OTC medications will be administered per instructions on the packaging.
As parent/legal guardian of the above-named applicant, I have read this entire application and all its attachments. I approve of his/her participation in the MS ChalleNGe Academy. It is my choice that he/she participates, free of any compulsion or necessity to do so. He/she is in good health. On behalf of him/her, myself, and my heirs and assigns, I am signing this Application and Release; fully aware that I am releasing the MS ChalleNGe Academy, all contracted agents, employees and volunteers, from any and all liability arising out of his/her participation. I also certify to the best of my knowledge, the applicant meet the eligibility criteria required to attend the MS Youth ChalleNGe Academy.