Brave Information

Date of Birth
Confirm Email*
Phone (xxx-xxx-xxxx)

Parent Goals

Response Required:  What would you like your child to learn from the Warrior Guides Program and his/her mentor?

Important Notes

Child's Interests

Tell us some of your child’s favorite activities, interests and hobbies so that we can better match him or her up with a Henderson High School Warrior Guide:

Special Interests

Guardian Information

Parents will be informed electronically of each upcoming event for INFORMATIONAL purposes only; the Warrior Guide is solely responsible for registering your Brave for the events. The Guide will personally invite your Brave via a phone call or text.

Guardian #1 Name/ Relationship
Guardian #1 Cell Phone (xxx-xxx-xxxx)
Guardian #1 E-Mail
Guardian #2 Name/ Relationship
Guardian #2 Cell Phone (xxx-xxx-xxxx)
Guardian #2 E-Mail
Lives with
Emergency Contact Name/ Relationship
Emergency Phone (xxx-xxx-xxxx)

Medical Information

Medical Conditions
Dietary Restrictions

Liability Waiver

I do hereby assume full responsibility for any and all damages, injuries (including death), or losses that my child may sustain or incur, if any, while attending, practicing, participating or witnessing in any club exercise program, sport or physical activity occurring in or about the club premises or at any offsite location.  I hereby assume full risk, waive all claims and release and hold B. Reed Henderson High School and the Andrew L. Hicks, Jr. Foundation, its instructors, or partners of said program or event, individually or otherwise, harmless for any and all claims for injuries or damages.


I am fully aware and understand that the club does not have on or about the club premises, or employ or contract with any medical services, provisions for ordinary or emergency medical services.


In consideration of my child’s participation in and the use of the Club’s facilities, I hereby release and covenant not to sue the Club, its owners, shareholders, directors, officers, employees, representatives, agents, and lessees from any and all claims resulting from any physical injury that may occur to my child while participating in any program or event sponsored by the Warrior Guides or the Andrew L. Hicks, Jr. Foundation.


I have read and fully understand the above release/waiver and fully understand that I have given up substantial rights by signing this waiver voluntarily.


Parent or guardians must type name as signature.

Liability Release Signature

Photo/Video Permission

I hereby grant permission to the Warrior Guides club and the Andrew L. Hicks, Jr. Foundation to photograph my image and/or that of my minor child and to edit, crop, or retouch such photographs.  I consent to permit those photographs to be used by the Warrior Guides and the Andrew L. Hicks, Jr. Foundation for any purpose, including education and advertisement purposes, and in any medium including print and electronic. I understand that without permission granted, my child may not be able to participate in programming, as group photographs are taken at all events. 


Parent or Guardian must type name as signature.

Photo Permission Signature
Additional Comments


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