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Please complete all sections of this form and return to the Murfreesboro Police Department, 1004 N Highland Ave. as soon as possible. Space is limited and campers are selected on a first come, first serve basis. A $50 application fee will be required and can be paid the first day of camp. All campers MUST have a completed set of forms on file or he/she may not attend. Do not send money or medication with your child for them to take during the course of the day. Necessary medication must be administered by a parent or guardian either before or during camp hours.
No child will be allowed to leave the day camp with anyone other than the parent/guardian or a person on this authorized pick-up list. The following are authorized to pick up my child or to be contacted on my behalf in an emergency. Please select at least one emergency contact not listed above.
(Optional) In order for our staff to provide your child with a positive experience and safe camp, it would be helpful to list any special needs that he or she might have. (E.g. ALLERGIES, LEARNING DISABILITIES, MEDICATIONS) and notify staff of any changes to the child’s condition during the course of the camp.
I am aware that there are certain inherent risks involves in participating in educational, recreational, and/or performance activities. This includes, but is not limited to, the risk of theft, damage to personal property, and/or injury. In consideration of my being granted permission for my child to participate in these activities, I hereby agree to hold harmless and indemnify the City of Murfreesboro, the Murfreesboro Police Department, Murfreesboro City School District, their officers, directors, agents, and employees from any and all claims, losses, damages, injuries, fines, penalties, and costs (including court and attorney fees), however caused, resulting from, arising out of, or in any way connected with participation by my child in any Murfreesboro Police Department summer camp activity. I authorize the Murfreesboro Police Department staff and medical personnel to take any appropriate and necessary emergency actions that my child may require, in the event that I am unable to be contacted immediately. By signing below, I certify that I have read and understand this agreement to release, to knowingly assume risk and to the herein described persons and entities hold harmless, and by my signature, I hereto agree to its terms. I hereby give my child permission to participate in the Murfreesboro Police Department’s summer camp activities.
My electronic signature below hereby acknowledges to the Murfreesboro Police Department, City of Murfreesboro, Tennessee and its School Resource Officers Instructor or Instructors: That my son/daughter and I are aware of the physical nature and possible risks of injury incident to taking this practical course in personal safety; That he/she is physically fit to participate in this course, involving various physical techniques; and, we realize that such techniques cannot be successfully employed in every situation, and proficiency can only be achieved through continued practice, exercise of good judgment, and a person’s natural ability. I also understand that sensitive subject matter will be discussed and is in the Parent’s Manual for my review. My signature also releases the Murfreesboro Police Department, City of Murfreesboro., and its School Resource Officers Instructor or Instructors, and sponsor, and agrees to hold them harmless, from any liability for injury that may be incurred as a result of this course, or use of the strategies within. I HAVE READ THE ABOVE WAIVER AND RELEASE. I UNDERSTAND THAT THERE ARE PHYSICAL SKILLS AND ACTIVITIES IN THIS PROGRAM. I SIGN IT VOLUNTARILY. My signature also grants permission for my child’s picture to be taken for the purpose of the graduation certificate and/or general media or press release from the Junior Officer Summer Camp. (No names or personal information will be included in media release). By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
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