PHSCafeteria

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PHS Cafeteria
REGISTRATION BEGINS
AT SAM Tit lOAM ON
.JUNE 15TH.
19 .
ges 6 ana older are welcome
r~~.,..amp
Activities Include:
Team-Building
Mentorship Sessions
Marching Drill
Physical Fitness
Classes On:
Discipline
,Positive, Behavior
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Dontayvion
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Dollar
Registration Fee ~..
Includes T-Shirt anc
lleals
$40
Contact SgtMa j. Justice at
3183312106 or
rickey justice@ipsb.net
Ja'Qual Peterson at
2252270385 or ~~.~~
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pjaqual@gmail.conj..;f ..~~~~
more information;EanfQ~~~
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MCaJROTC
.JUNIOR
MARINE
CAMP
ApPLICATION
WE ARE GLAD THAT YOU HAVE CHOSE TO ALLOW YOUR CHiILD
i
OR CHILDREN TO BE APART OF PLAQUEMINE HIGH SCHOOIL'S
I
MC.JROTC .JUNIOR MARINE CAMP!
ATTIRE
FOR THE CAMP SHOULD
FITTING.
CAMPERS
.
BE CONFORMABLE
AND
IF THEY WISH TO DO SO.
CHILDS
!
NAME:
008: __
'_'
ADRESS
_
AGE:
SEX:
--_.
-j-
------------------------------------------------------~----CITY:
-------------------------~---SHIRT
SIZE:
ADULT
SIZE
(PLEASE
--------------------~------
INDICATE
IF CHILD
NEEDS
SHIRT)
PARENT/GUARDIAN
INFORMATION
NAME:
-t
CELL PHON E:
1_·\....;~~'-_.-
_
WORK PHONE:
OTHER:
-----------------------------
EMAIL:
EMERGENCY CONTACT
NAME:
CELL PHONE:
WORK PHONE:
~
~OOSE
ARE ALLOWED TO BRING THEIR OWN d.lNCH
AN
PLAQUEMINE HIGH
MCJROTC Kiddie Carn)!
Contact: Sgt. Maj. Justice @ 318-331-2106
59595 Belleview Road
Plaquemine, LA 70764
HOLD HARMLESS AGREEMENT
1. I hereby give my permission for my child, my ward,
_____________
(child's name) to participate in the
kiddie camp at Plaquemine High School.
2. I understand that my child or ward will attend from 8 am until 4 pm on the
15th through 19th of June 2015. I, the parents, am responsible for all
transportations to and from Plaquemine High.
3. (a) In granting this permission I hereby expressly waive any claim for
liability against the Board of Education, including its employees and
representatives, and release them from all liability in connection with this
camp.
(b) Further, I assume full responsibility for any damages to persons or
property caused by my child or ward. I further expressly agree that in the
event of the health of my child or ward, or disciplinary action may make it
necessary, at the discretion of the sponsors, my child or ward may be
forthwith returned home at my expense. Iunderstand that Iwill be
personally notified if it becomes necessary for my child or ward to be
returned home and/or require health treatment.
(c) I further consent and will be responsible for any medical or dental
treatment that may be advisable at the discretion of any physician or
dentist.
(d) It is further warranted that if this HOLD HARMLESS AGREEMENT is
signed by one of two parents or guardians, it is with the authority of the
other.
4. Sponsors and/or Chaperones will be on hand during all phases of
training/classes.
____________________________
Parent Signature:
Date:
Brittany Budd
Tuesday, April?, 2015 11:45:06 AM Central Daylight Time
SMI
_
Emergency #:
40:6c:8f:26:fc:be
_