Hinds County Warriors Summer Camp Registration Form

Hinds County Warriors Summer Camp Registration Form
Please complete one application per child. Please ensure the form is filled out Completely. Enrollment is limited, and applications will be considered on a first-come, first-served basis.

To secure your child's placement, kindly register by May 1, 2024.
Child's First & Last Name *
Child's Gender*
Male or Female
Grade entering fall of 2024*
What grade will your child be in August of 2024?
School Name*
T-Shirt Size:*
Parent/Guardian First & Last Name*
Phone Number*
Address*

Street Address

Street Address Line 2

CityStateState / Province

Postal / Zip Code
PostalZip Code*
Email address*
example@example.com
Please list any medical concerns that you believe we should be aware of. *
Ex: Diabetes, Asthma, Allergies, etc.
Medical Release and Liability Waiver
Child's First & Last Name*
Parent/Guardians First & Last Name*
In case of emergency, do you want the program directors to seek medical*

YesNo
I hereby give permission for (child’s name) *to receive treatment at a local medical center or any hospital and/or doctor the program directors deem appropriate.
Insurance Company*
Policy Number*
Parent/Guardian Signature*

Clear
Date*

MonthDayYear
Date
Liability Waiver: I am aware that participation in the Hinds County Warriors Summer Camp has some inherent risks and injury can occur. On rare occasions these injuries can be serious. In consideration of my child being allowed to participate in the Hinds County Warriors Summer program, I, the parent/guardian, assume the risk of all injury and agree not to sue the Hinds County Warriors, Hinds County Sheriff's Office, program directors, or volunteers for any and all injuries caused by or resulting from participating in the Hinds County Warriors Summer Program. By signing this waiver, I also authorize the use of pictures of the above-named participant to be posted on the Hinds County Sheriff's Office website and all social media platforms.
ParentGuardian Signature*

Clear
Date*

MonthDayYear
Date
Please give the name and number of an emergency contact person in the event that a parent/guardian cannot be reached:
Emergency Contact Name*
Emergency Contact Phone Number*
Relation to Child*
We use Remind to stay in touch with parents throughout the summer. Text Code hew2024 to receive updates from us!
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