Guide Information

Date of Birth
Homeroom #/Teacher
Country
Cell Phone # (XXX-XXX-XXXX)
Email*
Confirm Email*

All invitations to events will come by email. You must RSVP for the events electronically by the deadline. Please list the email address you check most.

Medical Information

Guide Medical Conditions
Guide Medication
Guide Allergies
Guide Dietary Restrictions

Guide Essay

Response is Required:

Part 1-What do you hope to learn from being a Guide?

Part 2- What would you like your Brave to learn from you?

Essay Response

Interests

Tell us some of your favorite activities, interests and hobbies so that we can better pair you up with your Brave. The more you give us, the better we can match you up with a 5th or 6th grader who shares your interests. If you want to be matched up with a specific Brave, please list his or her name.

Special Skills or Interests

Guardian Information

Your parents will be informed electronically of each upcoming event for informational purposes only; the Warrior Guide is solely responsible for registering for the events once they've personally invited their Brave.

Guardian #1 Name/ Relationship
Guardian #1 Cell Phone (XXX-XXX-XXXX)
Guardian #1 E-Mail
Guardian #2 Name/ Relationship
Guardian #2 E-Mail
Guardian #2 Cell Phone (XXX-XXX-XXXX)
Guide Lives With
Emergency Contact Name/ Relationship
Emergency Contact Phone (XXX-XXX-XXXX)

Liability Waiver

I do hereby assume full responsibility for any and all damages, injuries (including death), or losses that I or 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 if Warrior Guide is under 18.

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.

Parent or guardians must type name as signature if Warrior Guide is under 18.

Photo Permission Signature
Additional Comments

Security

Powered by eTapestry