Name:________________________

Age: _____

Grade: ___

Address:_______________________

______________________________

______________________________

Emergency Information:

In the event of an emergency, we

need at least one person we can contact.

Name:

Home Phone:__________________

Cell Phone:____________________

 Indemnity Agreement

I hereby agree to indemnify and hold harmless the Warren County

Board of Education and persons associated with the

Jumpin' Jaguars camp from any liabilities, claims, actions,

or proceedings of every kind and character arising from my

child's participation in the camp.

If medical attention is required for injury or illness

while at camp I give permission for such medical care.

Minor injuries will be treated by the Jumpin' Jaguars staff. 

I will accept any expense for major medical treatment and

I will hold the Jumpin' Jaguars and the Warren County Board

of Education harmless from the actions of those giving such treatment.

Child's name:_____________________________

Signature:_______________________________

Date: ___________________________________

Child's Doctor:____________________________

Doctor's Phone:___________________________

Allergies/Asthma/special health concerns:

________________________________________

________________________________________