2021-22 Bearcat Market Application
Please complete and submit this application to participate in monthly food box give aways at Baldwyn Schools.
This program prohibits discrimination against its clients on the bases of race, color, national origin or ancestry, age, physical and/or mental disability, sex, religion or creed.
Email *
Student Name (One application for each student) Please put Last Name, First Name such as: Doe, John *
Student's Grade *
Gender *
Student's Date of Birth *
Parent/Guardian Name *
Address *
County *
Parent/Guardian Cell Phone # *
CONSENT, RELEASE, AND WAIVER Please sign my child up for the Baldwyn Bearcats Market Program. By completing this form and submitting it, for as long as my child participates in this program, I release from liability and hold harmless The Orchard Northside, its affiliates, and its agents and Baldwyn Public School District and its employees, agents and Board, and all other organizations, individuals, and their affiliates involved with this program should my child or any other person become sick, injured, or die from the Baldwyn Bearcats Market Program box and its contents, including but not limited to sickness, injury, or death from allergies. I understand that it is my responsibility to instruct and teach my child and other persons likely to come in contact with the Baldwyn Bearcats Market Program box to not open it because I must first inspect it and its contents before any part of it is consumed. I assume all liability for receipt, exposure, and ingestion of items received through the Baldwyn Bearcats Market Program. This permission form is valid until another permission form is signed or an opt out form is signed. *
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