Hoosier Boys State - Application

First Name*

Last Name*

Birthdate*

Email*

Please do not use a school email address

Phone Number*

Please enter a valid phone number.

Address*

Shirt Size*

Name of High School you're attending (Homeschooled may enter Homeschool)*

HS Counselor/Advisor Name:*

HS Counselor/Advisor Email:*

example@example.com

HS Counselor/Advisor Phone Number:*

Please enter a valid phone number.

County that you attend school in*

Are you interested in participating in the color guard?*

YesNo

Are you interested in participating in the HBS Concert Band?*

YesNo

What instrument do you play?*

Will you bring your instrument with you?*

YesNo

Hoosier Boys State takes place in Angola, Indiana. Is transportation a potential problem for you?*

YesNo, I have a reliable mode of transportation

Do you need housing Friday night at Trine University after the Closing Assembly*

YesNo, I will be leaving Friday Night

Parent First and Last Name*

Parent Phone Number Number*

Please enter a valid phone number.

Parent's Email (must be different from applicant email)*

example@example.com

The Hoosier Boys State program has an insurance program that provides benefits for medical expenses not covered by other family insurance. For us to determine benefits, we will file a claim with your family insurance company. The Legion insurance policy will pay eligible expenses not paid by your coverage. Please answer all questions. Failure to provide complete information will delay payment of allowable benefits.

Insurance Company:*

Group #:*

Policy Number:*

Policy Holder:*

Relationship to HBS Citizen:*

Please check all that apply:

Do you have allergies (describe):

Current Medication (dosage, frequency, if refrigeration required):

Other conditions (please describe):

*Medication will be turned into HBS Staff for security but will be available to students as needed*

The undersigned parent and/or guardian of the applicant noted above does hereby authorize any Health Center or Hospital and its doctors and nurses to treat and/or prescribe medications to the above-named minor while enrolled or participating in any activity with Hoosier Boys' State or Trine University.

Do you agree to the terms & conditions stated above.*

I agree to the terms & conditions stated above.

Print Parents Name*

I understand all the images and video clips taken throughout the week will be used exclusively for the Hoosier Boys State promotional purposes. Images and video clips will not be sold or used by any third-party vendors. I give Hoosier Boys State permission to film and reproduce the image of the above-stated attendee.

Media release waiver*

Yes, Hoosier Boys State may use photos and video of me for promotional purposes.Opt out of the release of contact information to American Legion/National Guard/Trine University for marketing purposes

Are there any special accommodations (i.e. dietary, housing, special needs) staff needs to be aware of?

Are there any medical concerns or accommodations that staff need to be made aware of?

I confirm that my son is physically and mentally capable and fit to attend Hoosier Boys State.

I, individually, and on behalf of Participant and our respective heirs, successors, assigns, and personal representatives, hereby agree to indemnify and hold harmless The American Legion, Department of Indiana; Hoosier Boys State INC.; Trine University; and Indiana American Legion Foundation for any and all damages, losses, or injuries (including but not limited to death) to persons or property or both, including but not limited to any and all claims, demands, actions, cause of actions, damages, losses, injuries, costs, expenses, and attorney’s fees, that result from, arise out of, or are related to Participant’s negligent or intentional act(s) or omission(s) during Participant’s participation in the program, Participant’s travel to or from the program, or Participant’s presence on premises owned, leased, or operated by The American Legion, Department of Indiana; Hoosier Boys State INC.; Trine University; and Indiana American Legion Foundation.

By selecting the "I agree" button, I am signing this document electronically. I agree that my electronic signature is the legal equivalent of my manual/handwritten signature on this document.

Printed name of parent/guardian*

First NameLast Name

Excellent! Once you hit submit, you'll receive an email with instructions on how to finalize your application. PLEASE CHECK YOUR JUNK/SPAM FOLDER IF YOU DON’T RECEIVE AN EMAIL WITHIN 24 HOURS OF SUBMITTING YOUR APPLICATION. IF YOU STILL DON’T SEE AN EMAIL, PLEASE CONTACT HBSADMIN@HOOSIERBOYSSTATE.ORG.

Now the fun begins...Hoosier Boys State truly is a week that shapes a lifetime and we're so excited you've applied to join us.

I understand that submission of this application does not guarantee my selection to Hoosier Boys State.

I am a current high school junior residing in Indiana.