BALDWIN COUNTY SHERIFF’S OFFICE
2012 JUNIOR DEPUTY CAMP REGISTRATION FORM
The annual Baldwin County Sheriff’s Office Junior Deputy Camp will begin Monday, June 4, 2012 and will run
through Friday, June 8, 2012. The Camp hours are 8:00 a.m. to 12:00 p.m. (Children usually begin to arrive at
approximately 7:45) The cost to register for camp is $10.00 per child. This amount must be paid, in cash,
when the registration form is returned to the Sheriff’s Office. (Cash only. Checks will not be accepted.)
The camp will be held at the current G.N.E.T.S. of Oconee building, on Orchard Hill Road, behind Graham
Homes (Boddie Projects).
Ages for the camp are 5 to 11, or kindergarten through fifth grade. If you have questions, please contact Deputy
Jason Simmons at the Baldwin County Sheriff’s Office at 478-445-4893 or 478-288-0212.
CAMPER INFORMATION
NAME: _______________________________________________ DOB: ________________ AGE: ________
GENDER:
MALE
FEMALE
SHIRT SIZE: Youth/ Sm. Med.
Lg.
Adult/ Sm. Med. Lg.
ADDRESS: _______________________________________________________________________________
CITY: __________________________________ STATE: ________ ZIP CODE: ________________
CURRENT SCHOOL: ___________ ____________________________ UPCOMING GRADE: ___________
PARENT INFORMATION
MOTHER: ____________________________________________ HOME PHONE: _____________________
PLACE OF EMPLOYMENT: _____________________________ WORK PHONE: ____________________
CELL PHONE: __________________________ OTHER: ________________________
FATHER: ____________________________________________ HOME PHONE: _____________________
PLACE OF EMPLOYMENT: ____________________________ WORK PHONE: _____________________
CELL PHONE: __________________________ OTHER: ________________________
GUARDIAN: _________________________________________ HOME PHONE: _____________________
PLACE OF EMPLOYMENT: ____________________________ WORK PHONE: _____________________
CELL PHONE: __________________________ OTHER: ________________________
EMERGENCY CONTACT (OTHER THAN PARENT/GUARDIAN): ________________________________
RELATIONSHIP TO CHILD: __________________________________ PHONE: ______________________
(CONTINUED ON REVERSE)
MEDICAL INFORMATION
ALLERGIES: ______________________________________________________________________________
__________________________________________________________________________________________
PERTINENT MEDICAL PROBLEMS: _______________________________________
PHYSICIAN: ____________________________________________________________
PHYSICIAN’S ADDRESS AND PHONE NUMBER: ___________________________
I grant permission for my child to attend the Baldwin County Sheriff’s Office Jr. Deputy Camp and all activities
and/or field trips that may take place during the camp. Specifically, camp participants will be transported by bus
and/or van throughout the week for various activities. I hereby grant specific permission for my child to be
transported in the above described vehicles. I hereby agree to hold the Baldwin County Sheriff’s Office,
Baldwin County, Ga., and any individual associated with the Jr. Deputy Camp and the transportation provided
for the campers harmless of any and all liability.
In the event of an emergency, I authorize the Baldwin County Sheriff’s Office employees to administer and
seek medical treatment for my child and for a physician or hospital staff to make such examinations and render
such treatments which may be deemed necessary for my child’s health and welfare. I further understand that in
the event of a medical emergency, the Baldwin County Sheriff’s Office will not be held financially responsible
for the costs incurred during said medical treatment.
I further acknowledge that the Baldwin County Sheriff’s Office and all employees and persons providing
services for the Junior Deputy Camp will be held harmless for any accidents incurred for the duration of the
camp.
________________________________________________
Parent/Guardian
______________________________
Date
Registration forms and fees must be returned by 12 p.m. on May 31st to:
Deputy Jason Simmons (478-288-0212)
Baldwin County Sheriff’s Office
119 Old Monticello Road
Milledgeville, GA 31061
Any questions can be answered at 478-445-4893
***Registration will not be accepted without accompanying fees.***
***There is a limited amount of spaces for the camp, register early.***