LEADERSHIP APPLICATION

(SPONSORED BY THE AMERICAN LEGION AUXILIARY)

LEADERSHIP FOR JUNIOR MEMBERS AGES 8-18 YEARS

Dates for 2019 Are Yet To Be Determined

CAMP BOOTH

GREENPOND, ALABAMA 35074


NAME:_________________________________________________________________DOB:____________________________

ADDRESS:_____________________________________________________________AGE:_____________________________

CITY:_____________________________________________STATE:____________ZIP:________________________________

​PHONE:___________________________________EMERGENCY #:_____________________________________________

GRADE:____________________________________SHIRT SIZE:_________________________________________________

UNIT NAME:_________________________________________UNIT #:___________DISTRICT:____________________

EMAIL:___________________________________________________________________________________________________

YOUR FAVORITE ACTIVITIES:__________________________________________________________________________

___________________________________________________________________________________________________________


I, THE UNDERSIGNED PARENT/GUARDIAN OF _____________________________________________________

IN CONSIDERATION OF THE INSTRUCTION AND TRAINING GIVEN TO SAID

DAUGHTER/WARD AT LEADERSHIP, HEREBY DISCHARGE THE AMERICAN LEGION, AMERICAN LEGION AUXILIARY, THE OFFICERS, INSTRUCTORS, AND EMPLOYEES FROM ANY AND ALL CLAIMS, DEMANDS, OR CAUSE OF ACTION I MAY HAVE BY REASON OF ILLNESS, INJURY OR ACCIDENT INCURRED OR SUFFERED BY SAID DAUGHTER/WARD WHILE ATTENDING SAID LEADERSHIP NO MATTER HOW CAUSED OR OCCASIONED. 


SIGNATURE:___________________________________________________________________DATE:____________________

                                   (PARENT OR GUARDIAN)


CONTACT #:__________________________________________E-MAIL:___________________________________________

ADDRESS IF DIFFERENT FROM ABOVE:________________________________________________________________

_____________________________________________________________________________________________________________


THIS APPLICATION WITH REGISTRATION FEE OF $160.00 MUST BE MAILED TO:


THE AMERICAN LEGION AUXILIARY

P.O. BOX 606

MONTGOMERY, AL. 36101

MAKE ALL CHECK PAYABLE TO: ALA DEPARTMENT OF ALABAMA


​PLEASE ALSO SEND A COPY TO:

GLORIA FOCHTMANN-HAYGOOD

2521 HWY 17

MONTEVALLO, AL. 35115


PLEASE MAIL ALL PAYMENTS AND REGISTRATION FORMS NO LATER THAN THE FIRST OF JULY, EACH YEAR.  PLEASE MARK "JUNIOR LEADERSHIP" IN THE MEMO SECTION OF THE CHECK, ALONG WITH THE CHILDS NAME.  INCLUDE A SMALL PHOTO, INSURANCE INFORMATION AND COPY OF INSURANCE CARD IF APPLICABLE.  IF YOU HAVE ANY QUESTIONS, PLEASE CALL GLORIA AT (205) 531-9227