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Youth Police Academy Application Form

Youth Police Academy Registration Form

LIABILITY RELEASE, INDEMNIFICATION AND MEDICAL AUTHORIZATION:

I am aware of the nature of this activity and I hereby assume responsibility for my child,to participate in the day camp program. I understand that such participation may include being photographed for publicity purposes.

I understand that my child's participation in the day camp program could result in personal injury to my child. As parent/guardian, I assume responsibility for all risks and dangers incidental to my child's participation in the day camp program, and I release from liability and will not hold responsible Gwinnett County and/or its elected and appointed officials, officers, employees, agents and volunteers for any injury suffered by my child as a result of his/her participation in the day camp program.

I further agree to indemnify, defend and hold harmless Gwinnett County, its elected officials, officers, employees, agents, and volunteers from any and all claims arising from my child's participation in the day camp program and its related activities. Such indemnification shall include, but not be limited to, liability settlements, damage awards, costs and attorney's fees associated with any such claim.

In emergencies and only when I cannot be reached immediately, I authorize a representative of Gwinnett County, Georgia to obtain immediate medical care for my child and I consent to the hospitalization of, the performance of necessary diagnostic tests upon, the use of surgery on, and/or the administration of drugs to my child if an emergency occurs and I cannot be located immediately. I will not hold responsible and release from liability Gwinnett County and/or its elected and appointed officials, officials, employees, agents and volunteers for injuries sustained by my child as a result of the immediate medical care. I understand that I am responsible for payment of medical expenses.

(Check box to indicate acceptance.)

Camper Information
Additional Information
Parent/Guardian Information (that lives with camper/same address)
Pick-Up/Drop-Off/Emergency Contact list

You authorize this list of people to act as a caregiver and pick-up/drop-off your child and, if needed, be contacted in an emergency situation. Parents/Guardians will remain the first point of contact in an emergency. Photo I.D. may be requested upon sign-out.