Bridge Builder’s Boot Camp Registration Form

Boot Camp Registration Form

Boot Camp is a fun and enriching experience where kids get to learn, explore, and grow outside of a regular classroom setting. It combines education with hands-on activities, allowing children to build confidence, make new friends, and discover new interests. At a camp like Bridge Builder’s Boot Camp, kids don’t just play—they develop important life skills. Through activities like reading, writing, math, arts & crafts, and field trips, they stay mentally active while still enjoying their summer. Boot Camp also create a safe, structured environment where children can express themselves, try new things, and build independence. For older youth, the program allows scheduled activities, one-on-one services, and go even deeper—offering mentorship, tutoring, and real-world skills like cooking, computer use, and community service. It’s all about preparing them not just for the next school year, but for life. Boot camp is where fun meets growth—and where memories are made that last a lifetime. 🌞✨ Please fill out the form with your child’s details to register for Bridge Builder’s Boot Camp.
Bridge Builders Youth Boot Camp

6896 Hwy. 49

Hattiesburg, MS 39402

769-207-2711

bridgebuilderslove@gmail.com

Camp: M-F 7:30am-4:30pm

Additional Service Available until 5:30pm (ask for details)

Mini Sessions: TBA ($10-$40 per session)

Camp: $125 weekly

Sibling discount available

Drop In: $40 (if space is available). Parent must give a 24 hour notice and be approved for drop off.
Camper's Full Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Parent/Guardian Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Email
example@example.com
Parent/Guardian Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Email
example@example.com
Parent/Guardian Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Tuition: I understand that tuition is due Monday of each week, regardless if your child attends. Tuition payment secures your child’s space.
I understand that non-payment of my child’s tuition may result in his/her spot being terminated.
I will need service for my child the following: (more dates maybe available)
Does your child have any allergies or medical conditions? If so, explain.
Emergency Contact Name

First NameLast Name
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Emergency Contact Name

First NameLast Name
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Emergency Contact Name

First NameLast Name
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Emergency Release Authorization: In the event that no authorized individual can be reached, I authorize Bridge Builder Boot Camp and it’s staff or volunteers to take reasonable steps to ensure the safety and care of my child, including contacting emergency services if necessary. I understand that I am responsible for any cost associated with treatment.
Pick-Up Policy: A valid photo ID may be required at pick-up. No child will be released to an unauthorized individual. Late pick-up fees may apply (if applicable). I understand and agree to the pick-up policies listed above.
For the safety of all campers, only individuals listed will be authorized to pick up the child from camp. Please include first and last name, as it appears on their photo identification. A photo identification will be REQUIRED upon pick up.
Restrictions (if any): Please list any individuals who are NOT authorized to pick up the child. Put N/A if not applicable.
Upload Court Order (if applicable). It is not mandatory to share court documents. We ask for it for the safety of the child. In the event the restricted individual shows up, the authorities are contacted, and were unable to contact you. We have proof! Sharing this document is voluntary and confidential!

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Please provide Camper’s (most recent) photo identification.

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Upload Camper’s (Current) 121 Form (Shot Record)

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Upload Birth Certificate

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COVID-19/ Health & Safety Acknowledgement: I acknowledge that participation in boot camp activities may expose the participant to illnesses, including but not limited to COVID-19 or other communicable diseases. GI agree to the following: I will not allow my child to attend camp if they are experiencing symptoms such as fever, cough, shortness of breath, or other signs of illness. I will notify Diamond Excursions Ladies’ Edition dba/ Bridge Builders if my child has been exposed to a contagious illness. I understand that reasonable health and safety precautions will be taken, but exposure cannot be completely eliminated. I voluntarily assume all risks related to illness and release Diamond Excursions Ladies’ Edition dba/ Bridge Builders from liability related to exposure or transmission.
Assumption of Risk: I, the undersigned, acknowledge that participation in boot camp activities may involve inherent risks, including but not limited to physical activity, outdoor recreation, transportation, group activities, and use of equipment. I voluntarily assume all risks, both known and unknown, associated with participation in these activities.
Release of Liability: In consideration for being allowed to participate in boot camp hosted by Diamond Excursions Ladies’ Edition dba/ Bridge Builders. I hereby release, waive, discharge, and hold harmless Diamond Excursions Ladies’ Edition dba/ Bridge Builders, its directors, officers, employees, volunteers, sponsors, and affiliates from any and all liability, claims, demands, or causes of action arising out of or related to any loss, damage, or injury, including death, that may be sustained while participating in camp activities.
Photo & Media Release: I grant permission for Diamond Excursions Ladies’ Edition dba/ Bridge Builders to use photographs, video recordings, or other media of the participant for promotional, educational, or marketing purposes without compensation.
Transportation Waiver: I, the undersigned, give permission for the participant to be transported to and from camp-related activities, including field trips, using vehicles operated by Diamond Excursions Ladies’ Edition dba/ Bridge Builders, its staff, volunteers, or contracted providers. I understand that transportation may include vans, buses, or personal vehicles and that reasonable safety precautions will be taken. I acknowledge and accept all risks associated with transportation, including but not limited to accidents, delays, or unforeseen incidents. I hereby release and hold harmless Diamond Excursions Ladies’ Edition dba/ Bridge Builders, its staff, volunteers, and affiliates from any liability arising from transportation of the camper.
Field Trip Consent Form: I grant permission for the camper to attend all scheduled field trips as part of boot camp activities. I understand that field trips may include visits to parks, recreational facilities, community centers, or other approved locations.I acknowledge that I will be informed of field trips in advance and understand that participation may involve additional risks outside of the primary camp location. I authorize Diamond Excursions Ladies’ Edition dba/ Bridge Builders to supervise my child during these outings.
Code of Conduct: I understand that campers are expected to follow all rules and behave respectfully. Failure to do so may result in dismissal from the camp without refund.
Non-Refundable Registration Fee: I, the undersigned, understand and agree to the nonrefundable registration fee policies set forth by Diamond Excursions Ladies’ Edition dba/ Bridge Builders for participation in boot camp. Campers space will be reserved upon receipt of payment. Payment is due upon submission.
Tuition: I, the undersigned, understand and agree to the tuition policies set forth by Diamond Excursions Ladies’ Edition dba/ Bridge Builders for participation in boot camp. Tuition is due every Monday by 9:00 AM. Parents/Guardians may choose to pay tuition on a weekly, bi-weekly, or monthly basis.Tuition must be paid in advance of services. Failure to submit payment on time may result in late fees, suspension of participation, or loss of the participant’s spot. I acknowledge that I am responsible for ensuring timely payment regardless of attendance, unless otherwise stated in writing by the organization. I have read, understand, and agree to comply with the tuition policy.
Indemnification: I agree to indemnify and hold harmless Diamond Excursions Ladies’ Edition dba/ Bridge Builders from any claims resulting from my or my child’s participation in the camp.
Governing Law: This agreement shall be governed by and interpreted in accordance with the laws of the State of Mississippi.
Acknowledgement: I have read this waiver and fully understand its terms. I understand that I am giving up substantial rights, including the right to sue, and I sign this agreement voluntarily.
Additional Notes or Special Instructions
Signature
My Products
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Non-Refundable Registration Fee
$50.00 Quantity
Item subtotal:$0.00



Weekly Tuition

$125.00 Quantity



Scholarship
📌 Scholarship Qualifications:

• Child must be 5–11 years old

• Household must receive SNAP, TANF, SSI, or SSA benefits

• Proof of benefits is required

$85.00 Quantity



Total

$0.00
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