LEADERSHIP APPLICATION

(SPONSORED BY THE AMERICAN LEGION AUXILIARY)

LEADERSHIP FOR JUNIOR MEMBERS AGES 8-18 YEARS

July 14-18, 2017

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 UNDERSIGNER PARENT/GUARDIAN OF _____________________________________________________

IN THE CONSIDERATION OF THE INSTRUCTION AND TRAINING GIVEN TO SAID

DAUGHTER/WARD AT LEADERSHIP, HEREBY AND 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 REASON OF ILLNESS, INJURY OR ACCIDENT INCURRED OR SURRERED 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


​WITH A COPY TO GLORIA FOCHTMANN-HAYGOOD, 2521 HWY 17, MONTEVALLO, AL. 35115.

PLEASE MAIL NO LATER THAN July 7, 2017

(EARMARK FOR JUNIOR LEADERSHIP) INCLUDE A SMALL PHOTO AND INSURANCE INFORMATION AND COPY OF INSURANCE CARD IF APPLICABLE. IF YOU HAVE ANY QUESTIONS PLEASE CALL 205-531-9227

MAKE ALL CHECK PAYABLE TO: ALA DEPARTMENT OF ALABAMA