2018 RHMS Middle School Bootcamp Registration
PLEASE READ: Richmond Hill Middle School will be offering a day for students to come get a closer look at what middle school will be like for the next three years. The camp will be offered on Thursday July 26, 2018 at Richmond Hill Middle School from 8:00am until 3:00pm. A parent or guardian must fill out the form below in order to register your child. If you would like to register more than one child that is wonderful, BUT please fill out one form per child!! A follow up email will be sent in June with more details, including the itinerary and color group assignment. Please direct questions or concerns to Mrs. Barnwell at jbarnwell@bryan.k12.ga.us respectively.
Student's Last Name, First Name *
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Student's Date of Birth *
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Male or Female *
Email contact for more information regarding the day. *
Your answer
Student's Address *
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Primary Contact Phone Number *
Your answer
Primary Parent Guardian Name (Last, First) *
Your answer
Primary Contact Additional Phone Number *
Your answer
Secondary Parent/Guardian Name (Last, First) *
Your answer
Secondary Parent/Guardian Contact Number *
Your answer
Emergency Contact Name and Phone Number *
Your answer
Please list any known allergies. *
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Does your child have any special needs, medical conditions or serious behaviors we should know about? *
Your answer
Does your child require any medication during the camp? *
Your answer
How did you hear about this camp? *
Your answer
DELIVERY, PICK UP & ABSENTEEISM · I understand that no child will be released if staff are of the opinion that the child may be at risk. · I will be responsible for the care and transportation of my child to and from Richmond Hill Middle School, and I will deliver my child directly to a program staff member. I am aware that my child must be promptly dropped off and picked up by the start and end time for each day of the program. · If my child will be leaving early I understand I must bring a signed note to the staff the morning of the early pick up. *By typing your initials below, you are signing that you understand and agree with the terms. *
Your answer
HEALTH · I understand that I must sign the Consent to Administer Medication form before staff can give any medication to my child. Please inform staff if you need to fill this form out. · If my child is too sick to participate in the program, I understand that I may be called to pick up my child. · I hereby acknowledge that participation in this camp and related activities is at the sole discretion and judgments of the parents or guardian and involves an inherent risk of physical injury. I, on behalf of my child, hereby assume all such risk. I hereby agree to hold harmless the staff, Richmond Hill Middle Schools, and Bryan County Public Schools from all claims, actions, damages, and liabilities for personal injury or damage relating to or arising out of any day camp activity. I authorize the day camp staff to act for me in any medical emergency according to their best judgment, including 911 emergency care if deemed necessary. I understand that any and all charges resulting from this medical treatment will be billed to the parent, guardian, or their insurance carrier. *By typing your initials below, you are signing that you understand and agree with the terms. *
Your answer
ACKNOWLEDGEMENT AND ASSUMPTION OF RISK · I acknowledge that I am aware of the details of day camp activities and that there is a possibility of personal risk or damage of injury in the activities and willingly agree to assume responsibility for those risks as a condition of registering for the program. - I acknowledge that Bryan County Schools nor Richmond Hill Middle School staff members are responsible for any lost, damaged, or stolen property your children may bring to camp on this day. *By typing your initials below, you are signing that you understand and agree with the terms. *
Your answer
INDEMNIFICATION & RELEASE · I hereby represent that my child has no physical restriction, which would prohibit his/her participation in the event(s) that I have selected for him/her. I, the undersigned parent/guardian, on behalf of myself agree to indemnify, save and hold harmless the Richmond Hill Middle School and Bryan County Schools or any of their agents, representatives, employees or assigns for my child’s health, safety, or any injury and/or disability arising out of or resulting from the trip(s)/event(s). *By typing your initials below, you are signing that you understand and agree with the terms. *
Your answer
PHOTO RELEASE · I hereby release the right to use any photo materials for promotional, instructional and educational purposes for the programs, which operate under Richmond Hill Middle School, while participating in the program without limitation on time or frequency. · I understand that these photos may be used in program brochures, photo displays, and on our Richmond Hill Middle School website & social media. We will not release any names of give any other information out regarding the identification of individuals in the photos without their prior consent. *By typing your initials below, you are signing that you understand and agree with the terms. *
Your answer
Sign-out Permission: At the end of the day, children MUST be signed out. You may choose for your child to be signed out by a parent, guardian, friend or neighbor, whom you are comfortable with. Please indicate your choice by checking the appropriate box. *RHMS will not release students to adults who have not been indicated on this form or in writing to Ms. Tremble *
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