Register for YSSP – North Caddo Shooting Club

Participant Name *

First

Last

Date of Birth *

Age as of January 1, 2024 *

Shooting Team Affiliation

YSSP Registration Fee *

YSSP Registration – $50.00

Discipline(s) to Participate in *

Shotgun – Trap – $50.00
Shotgun – Skeet – $50.00
Rifle – Optical – $50.00
Archery – Compound 3D – $50.00
Archery – Traditional/Genesis 3D – $50.00

Total

$0.00

Be clicking below, I certify that my child has or will have a minimum of 8 hours of training on the regulations of the selected discipline(s). I furthermore certify that my child can safely compete in the selected discipline(s) without endangering them self or others. I also understand that if the YSSP officials deem my child's actions unsafe or that they are unaware of the regulations of the selected discipline(s), they may be eliminated from the competition.

Yes, my child has or will have a minimum of 8 hours of training on the regulations and safety involved with the selected discipline(s), prior to preliminary competition.

Parent/Guardian Name *

First

Last

Parent/Guardian Name

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Primary Contact Number *

Secondary Contact Number

Email *

Participant's Medical Background Information

Respecting the privacy of our participants is a basic value of the YSSP program. Personal information provided here will not be disclosed or discussed without permission or authorization from the individual and/or parent/guardian listed above, unless the individual is involved in the care and supervision of the minor. Care shall also be taken to ensure that unauthorized individuals do not overhear any discussion or confidential information and that documents containing confidential information are not left in the open or inadvertently shared.

Family Physician *

Physician's Contact Number *

Desired Hospital

In the event of an emergency, transport to: *

Nearest Hospital
Desired Hospital

Insurance Company

Policy Holder

Group Number and Policy Number

Emergency Contact Other Than Parent/Guardian (Name and Number) *

Past or Present Medical History *

Asthma
Bleeding Disorder
Fainting
Epilepsy
Diabetes/Hypoglycemia
Eye Impairment
Ear/Hearing Impairment
Head Injury / Concussion
Infectious Disease
Joint or Limb Conditions
Nervous Condition / Depression
Physical Disability
Serious Illness
Serious Injury
Stomach or Bowel Problems
Urinary Problems
NO KNOWN MEDICAL HISTORY

Please Explain any Selected Medical Issues That May Interfere With or Require Special Attention While Participating in YSSP

Mental and Emotional Health – Has the participant: *

Ever been treated for attention deficit disorder (ADD) or attention deficit/hyperactivity disorder (ADHD)?
Ever been treated for emotional or behavioral difficulties?
In the past 12 months, seen a professional to address mental/emotional health concerns?
Had a significant life event that continues to affect the participant’s life?
No Mental or Emotional Health Concerns

Please Explain any Selected Mental and Emotional Health Concerns

Signature of Parent/Guardian *

Clear Signature

To my knowledge, this participant has no health problems, unless stated earlier and can SAFELY PARTICIPATE in the YSSP program. Furthermore, in my absence, I consent for my child to receive medical care and medical transport as dictated above.

Parent Guardian Permission Statement

I hereby give permission for the above named participant to participate in the Youth Scholarship Shooting Program (YSSP). It is my understanding that strict rules of conduct are required and safety habits are a must. Any participant found in violation at any time can be dispelled from the program without reimbursement. The YSSP program will communicate all associated safety rules and practices, but cannot assume responsibility for any individual who does not comply. By signing below I agree to these terms.

Participant's Name *

First

Last

Date Signed *

Signature of Parent/Guardian for Permission Statement *

Clear Signature

Signature of Participant *

Clear Signature

Annual Hold Harmless Waiver & Release Form

I understand that I hold the Youth Scholarship Shooting Program (YSSP), North Caddo Shooting Club (NCSC), the Parish of Caddo, and any affiliated entity, their officers, agents, employees, and volunteers (collectively referred to as “Released Parties”) harmless from any and all liability or claims, which may arise out of or in connection with participation in the YSSP program. I release from all liability for damages arising out of personal injury to participant (including death) or any damage to property whether from anyone’s negligence or not, or any other cause arising out of my participation in any and all YSSP activities. I will keep the Released Parties by this agreement free of any damages or costs, including but not limited to attorney’s fees that may arise from any claims. Furthermore, I state that I have read the above authorization and release prior to its execution, and that I am fully familiar with the contents thereof. I furthermore agree that my electronic signature below binds myself and the participant to the agreement. This form must be completed and signed before participants are eligible to participate in the YSSP program. I have read, understand, and agree to comply with the information in this document. The Hold Harmless Participant Waiver & Release Form shall be considered valid for a period of one (1) year from the date of signature.

Participant's Name *

First

Last

Parent's or Guardian's Name (Printed or Typed) *

First

Last

Date Signed – Hold Harmless Waiver & Release Form *

Signature of Parent or Guardian – Hold Harmless Waiver & Release Form *

Clear Signature

Signature of Participant (If Over the Age of 18)

Clear Signature