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2024 Junior Lifeguard Day Camp Program

June 3, 2024 through July 12, 2024

Please complete a separate application for each applicant.

Applicant Information

Applicant's First Name

Applicant's Last Name

Applicant's Sex *

Female
Male
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Applicant’s Date of Birth *

Shirt Size *

Youth Small
Youth Medium
Adult Small
Adult Medium
Adult Large
Adult X-Large
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Age (On First Day of Program) *

Applicant’s Address *

Parent or Guardian Information

Parent or Guardian’s Name *

Parent or Guardian’s Phone Number *

Parent or Guardian's Email *

Emergency Contact Information

This will be used if the parent or guardian is unavailable.

Emergency Contact Name *

Emergency Contact Address *

Emergency Contact Phone Number *

Emergency Contact's Relationship to Jr. Lifeguard *

Physician Information

Jr. Lifeguards Primary Care Physician

Primary Care Physician Phone Number *

Payment can be made by credit card or via ACH. Registration is not complete until payment is received. Available spots are limited and are filled on a first come basis. No refunds will be made after the first day of the camp. No prorating or late fees. No exceptions on age limitations. If your child is unable to pass the requirements specified, we will request a refund for you from the Park Board of Trustees. Please allow three to four weeks for receipt of refund.

*GALVESTON ISLAND BEACH PATROL RESERVES THE RIGHT TO DISMISS ANY JUNIOR LIFEGUARD FROM THE PROGRAM AT ANY TIME FOR ANY REASON WITH NO REFUND*

How would you like to pay? *

Credit card - $12.80 Processing Fee will be added to each registration (Contact Dawn Robinson at 409-797-5195)

ACH - $3.00 Processing Fee

Agreement, Release and Waiver of Liability

In consideration of my child participating in the Galveston Island Beach Patrol’s Junior Lifeguard Program;

I ACKNOWLEDGE, UNDERSTAND AND DECLARE THAT:

• I have given my child parental or legal guardian approval to participate in the Galveston Island Beach Patrol’s Junior Lifeguard Program.

• To the best of my knowledge, my child is in GOOD PHYSICAL CONDITION and has no disease or injury that would prevent him/her from performing activities in the Galveston Island Beach Patrol’s Junior Lifeguard Program.

• Participation in the Galveston Island Beach Patrol’s Junior Lifeguard Program may involve RISK OF INJURY TO MY CHILD, INCLUDING DEATH, LOSS OR DAMAGE TO MY CHILD OR MY CHILD’S PROPERTY, or other consequences, which might result not only from my child’s actions, in-actions or negligence, but also the actions, in-actions or negligence of others, or the conditions of the premises or of any equipment used;

• There may be OTHER RISKS not known or not reasonably foreseeable; and understanding all of the above.

I ASSUME ALL OF THE ABOVE RISKS AND RELEASE WAIVE, DISCHARGE, HOLD HARMLESS, INDEMNIFY AND COVENANT NOT TO SUE:

• Galveston Island Beach Patrol, the Park Board of Trustees of the City of Galveston or any of its agencies, its Board of Directors, its employees, affiliated with their programs;

• Any other participants, municipalities, governmental agencies

I CONSENT TO:

• ALL EMERGENCY MEDICAL TREATMENT as may be deemed appropriate under existing circumstances by medical personnel or personnel associated with Galveston Island Beach Patrol I HAVE READ THIS FORM IN ITS ENTIRITY AND HAVE PROVIDED TRUTHFUL INFORMATION.

Name of Junior Lifeguard *

Date of Birth *

Full Address *

Telephone *

Email *

Name of Parent / Legal Guardian *

By signing the box below, I certify I am the parent/guardian of the Jr. Guard and I agree to all of the rules as stated above.

Signature of Parent / Legal Guardian required *

Clear

Date *

Galveston Beach Patrol Junior Guard Rules

Rules:

1. Respect the authority of all Instructors and Supervisors. Respect fellow Junior Guards.

2. Report each day wearing assigned Junior Guard T-shirt and shorts. (Not the old Sheriff’s Office JG uniforms).

3. Report each day wearing a competitive swimsuit (no bikinis or board shorts). Your Junior Guard shorts are considered competitive swimwear.

4. Wear lifeguard buoy at all times while in the ocean and any other time the Instructors direct you to do so.

5. Always bring a towel, sunscreen of at least SPF 15, water bottle, running shoes, and Inhaler (if needed).

6. At all times, display a courteous and professional attitude to all persons with whom you come in contact with while in uniform.

7. Assist in cleaning up instructional areas after use.

8. Use extreme care when using lifeguard equipment.

9. Never use any form of profane language or gestures.

10. Never take or use any gear or personal property of another Junior Guard or of Beach Patrol without permission from that Junior Guard or a Beach Patrol Supervisor.

11. Cell phones are not to be used during Junior Guard training.

12. Electronics are not to be used during Junior Guard training. Beach Patrol will not be held responsible for lost or miss placed property.

Disciplinary Actions:

First Course of Action: Counseling by the Instructor

Second Course of Action: Meet with Director; written report sent home to Parents

Third Course of Action: Chief of Galveston Island Beach Patrol will meet with Director of Junior Guards and the Junior Guard.

Fourth Course of Action: Immediate removal from Junior Guard Program

1st Severe Offense Junior Guard Program: Meeting with Junior Guard, and Parent/Guardian. Possible dismissal from program. Loss of eligibility for National Competition funding.

If a Junior Guard is removed from the program, you will not receive reimbursement of the registration fee. The Galveston Island Beach Patrol reserves the right to remove any child from the program at anytime. The Junior Guard staff asks that if a Junior Guard has been ill or run a fever in the past 24 hours, they are kept at home. We do not have the facilities to accommodate sick Junior Guards and strive to keep all participants and staff healthy. If a Junior Guard becomes ill while attending, the parent/guardian will be notified and expected to take the child home.