{"id":307,"date":"2020-08-05T13:37:39","date_gmt":"2020-08-05T13:37:39","guid":{"rendered":"https:\/\/ncscshooting.org\/?page_id=307"},"modified":"2020-08-05T13:37:39","modified_gmt":"2020-08-05T13:37:39","slug":"register-for-yssp","status":"publish","type":"page","link":"https:\/\/ncscshooting.org\/?page_id=307","title":{"rendered":"Register for YSSP"},"content":{"rendered":"<div class=\"wpforms-container wpforms-container-full wpforms-block\" id=\"wpforms-305\"><form id=\"wpforms-form-305\" class=\"wpforms-validate wpforms-form\" data-formid=\"305\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/index.php?rest_route=%2Fwp%2Fv2%2Fpages%2F307\" data-token=\"b4e0515bf34f27dca5ba4a490de8ed40\" data-token-time=\"1778250985\"><noscript class=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/noscript><div class=\"wpforms-page-indicator progress\" data-indicator=\"progress\" data-indicator-color=\"#72b239\" data-scroll=\"1\"><span class=\"wpforms-page-indicator-page-title\" ><\/span><span class=\"wpforms-page-indicator-page-title-sep\" style=\"display:none;\"> &#8211; <\/span><span class=\"wpforms-page-indicator-steps\">Step <span class=\"wpforms-page-indicator-steps-current\">1<\/span> of 4<\/span><div class=\"wpforms-page-indicator-page-progress-wrap\"><div class=\"wpforms-page-indicator-page-progress\" style=\"width:25%;background-color:#72b239\"><\/div><\/div><\/div><div class=\"wpforms-field-container\"><div class=\"wpforms-page wpforms-page-1 \" data-page=\"1\"><div id=\"wpforms-305-field_38-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"38\"><\/div><div id=\"wpforms-305-field_7-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"7\"><label class=\"wpforms-field-label\">Participant Name <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-305-field_7\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][7][first]\" required><label for=\"wpforms-305-field_7\" class=\"wpforms-field-sublabel after\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-305-field_7-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][7][last]\" required><label for=\"wpforms-305-field_7-last\" class=\"wpforms-field-sublabel after\">Last<\/label><\/div><\/div><\/div><div id=\"wpforms-305-field_22-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-id=\"22\"><label class=\"wpforms-field-label\">Date of Birth <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-date-dropdown-wrap wpforms-field-medium\"><select name=\"wpforms[fields][22][date][m]\" id=\"wpforms-305-field_22-month\" class=\"wpforms-field-date-time-date-month wpforms-field-required\"  required><option value=\"\" class=\"placeholder\" selected disabled>MM<\/option><option value=\"1\" >1<\/option><option value=\"2\" >2<\/option><option value=\"3\" >3<\/option><option value=\"4\" >4<\/option><option value=\"5\" >5<\/option><option value=\"6\" >6<\/option><option value=\"7\" >7<\/option><option value=\"8\" >8<\/option><option value=\"9\" >9<\/option><option value=\"10\" >10<\/option><option value=\"11\" >11<\/option><option value=\"12\" >12<\/option><\/select><select name=\"wpforms[fields][22][date][d]\" id=\"wpforms-305-field_22-day\" class=\"wpforms-field-date-time-date-day wpforms-field-required\"  required><option value=\"\" class=\"placeholder\" selected disabled>DD<\/option><option value=\"1\" >1<\/option><option value=\"2\" >2<\/option><option value=\"3\" >3<\/option><option value=\"4\" >4<\/option><option value=\"5\" >5<\/option><option value=\"6\" >6<\/option><option value=\"7\" >7<\/option><option value=\"8\" >8<\/option><option value=\"9\" >9<\/option><option value=\"10\" >10<\/option><option value=\"11\" >11<\/option><option value=\"12\" >12<\/option><option value=\"13\" >13<\/option><option value=\"14\" >14<\/option><option value=\"15\" >15<\/option><option value=\"16\" >16<\/option><option value=\"17\" >17<\/option><option value=\"18\" >18<\/option><option value=\"19\" >19<\/option><option value=\"20\" >20<\/option><option value=\"21\" >21<\/option><option value=\"22\" >22<\/option><option value=\"23\" >23<\/option><option value=\"24\" >24<\/option><option value=\"25\" >25<\/option><option value=\"26\" >26<\/option><option value=\"27\" >27<\/option><option value=\"28\" >28<\/option><option value=\"29\" >29<\/option><option value=\"30\" >30<\/option><option value=\"31\" >31<\/option><\/select><select name=\"wpforms[fields][22][date][y]\" id=\"wpforms-305-field_22-year\" class=\"wpforms-field-date-time-date-year wpforms-field-required\"  required><option value=\"\" class=\"placeholder\" selected disabled>YYYY<\/option><option value=\"2027\" >2027<\/option><option value=\"2026\" >2026<\/option><option value=\"2025\" >2025<\/option><option value=\"2024\" >2024<\/option><option value=\"2023\" >2023<\/option><option value=\"2022\" >2022<\/option><option value=\"2021\" >2021<\/option><option value=\"2020\" >2020<\/option><option value=\"2019\" >2019<\/option><option value=\"2018\" >2018<\/option><option value=\"2017\" >2017<\/option><option value=\"2016\" >2016<\/option><option value=\"2015\" >2015<\/option><option value=\"2014\" >2014<\/option><option value=\"2013\" >2013<\/option><option value=\"2012\" >2012<\/option><option value=\"2011\" >2011<\/option><option value=\"2010\" >2010<\/option><option value=\"2009\" >2009<\/option><option value=\"2008\" >2008<\/option><option value=\"2007\" >2007<\/option><option value=\"2006\" >2006<\/option><option value=\"2005\" >2005<\/option><option value=\"2004\" >2004<\/option><option value=\"2003\" >2003<\/option><option value=\"2002\" >2002<\/option><option value=\"2001\" >2001<\/option><option value=\"2000\" >2000<\/option><option value=\"1999\" >1999<\/option><option value=\"1998\" >1998<\/option><option value=\"1997\" >1997<\/option><option value=\"1996\" >1996<\/option><option value=\"1995\" >1995<\/option><option value=\"1994\" >1994<\/option><option value=\"1993\" >1993<\/option><option value=\"1992\" >1992<\/option><option value=\"1991\" >1991<\/option><option value=\"1990\" >1990<\/option><option value=\"1989\" >1989<\/option><option value=\"1988\" >1988<\/option><option value=\"1987\" >1987<\/option><option value=\"1986\" >1986<\/option><option value=\"1985\" >1985<\/option><option value=\"1984\" >1984<\/option><option value=\"1983\" >1983<\/option><option value=\"1982\" >1982<\/option><option value=\"1981\" >1981<\/option><option value=\"1980\" >1980<\/option><option value=\"1979\" >1979<\/option><option value=\"1978\" >1978<\/option><option value=\"1977\" >1977<\/option><option value=\"1976\" >1976<\/option><option value=\"1975\" >1975<\/option><option value=\"1974\" >1974<\/option><option value=\"1973\" >1973<\/option><option value=\"1972\" >1972<\/option><option value=\"1971\" >1971<\/option><option value=\"1970\" >1970<\/option><option value=\"1969\" >1969<\/option><option value=\"1968\" >1968<\/option><option value=\"1967\" >1967<\/option><option value=\"1966\" >1966<\/option><option value=\"1965\" >1965<\/option><option value=\"1964\" >1964<\/option><option value=\"1963\" >1963<\/option><option value=\"1962\" >1962<\/option><option value=\"1961\" >1961<\/option><option value=\"1960\" >1960<\/option><option value=\"1959\" >1959<\/option><option value=\"1958\" >1958<\/option><option value=\"1957\" >1957<\/option><option value=\"1956\" >1956<\/option><option value=\"1955\" >1955<\/option><option value=\"1954\" >1954<\/option><option value=\"1953\" >1953<\/option><option value=\"1952\" >1952<\/option><option value=\"1951\" >1951<\/option><option value=\"1950\" >1950<\/option><option value=\"1949\" >1949<\/option><option value=\"1948\" >1948<\/option><option value=\"1947\" >1947<\/option><option value=\"1946\" >1946<\/option><option value=\"1945\" >1945<\/option><option value=\"1944\" >1944<\/option><option value=\"1943\" >1943<\/option><option value=\"1942\" >1942<\/option><option value=\"1941\" >1941<\/option><option value=\"1940\" >1940<\/option><option value=\"1939\" >1939<\/option><option value=\"1938\" >1938<\/option><option value=\"1937\" >1937<\/option><option value=\"1936\" >1936<\/option><option value=\"1935\" >1935<\/option><option value=\"1934\" >1934<\/option><option value=\"1933\" >1933<\/option><option value=\"1932\" >1932<\/option><option value=\"1931\" >1931<\/option><option value=\"1930\" >1930<\/option><option value=\"1929\" >1929<\/option><option value=\"1928\" >1928<\/option><option value=\"1927\" >1927<\/option><option value=\"1926\" >1926<\/option><option value=\"1925\" >1925<\/option><option value=\"1924\" >1924<\/option><option value=\"1923\" >1923<\/option><option value=\"1922\" >1922<\/option><option value=\"1921\" >1921<\/option><option value=\"1920\" >1920<\/option><\/select><\/div><\/div><div id=\"wpforms-305-field_12-container\" class=\"wpforms-field wpforms-field-number\" data-field-id=\"12\"><label class=\"wpforms-field-label\" for=\"wpforms-305-field_12\">Age as of January 1, 2026 <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"number\" id=\"wpforms-305-field_12\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][12]\" step=\"any\" required><\/div><div id=\"wpforms-305-field_11-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"11\"><label class=\"wpforms-field-label\" for=\"wpforms-305-field_11\">Shooting Team Affiliation<\/label><input type=\"text\" id=\"wpforms-305-field_11\" class=\"wpforms-field-medium\" name=\"wpforms[fields][11]\" ><\/div><div id=\"wpforms-305-field_66-container\" class=\"wpforms-field wpforms-field-payment-checkbox\" data-field-id=\"66\"><label class=\"wpforms-field-label\">YSSP Registration Fee <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-305-field_66\" class=\"wpforms-field-required\"><li class=\"choice-1 wpforms-selected\"><input type=\"checkbox\" id=\"wpforms-305-field_66_1\" class=\"wpforms-payment-price\" data-amount=\"50.00\" name=\"wpforms[fields][66][]\" value=\"1\" required  checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-305-field_66_1\">YSSP Registration &#8211; <span class=\"wpforms-currency-symbol\">&#036;50.00<\/span><\/label><\/li><\/ul><\/div><div id=\"wpforms-305-field_69-container\" class=\"wpforms-field wpforms-field-payment-checkbox\" data-field-id=\"69\"><label class=\"wpforms-field-label\">Discipline(s) to Participate in  <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-305-field_69\" class=\"wpforms-field-required\"><li class=\"choice-2\"><input type=\"checkbox\" id=\"wpforms-305-field_69_2\" class=\"wpforms-payment-price\" data-amount=\"50.00\" name=\"wpforms[fields][69][]\" value=\"2\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-305-field_69_2\">Shotgun &#8211; Trap &#8211; <span class=\"wpforms-currency-symbol\">&#036;50.00<\/span><\/label><\/li><li class=\"choice-3\"><input type=\"checkbox\" id=\"wpforms-305-field_69_3\" class=\"wpforms-payment-price\" data-amount=\"50.00\" name=\"wpforms[fields][69][]\" value=\"3\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-305-field_69_3\">Shotgun &#8211; Skeet &#8211; <span class=\"wpforms-currency-symbol\">&#036;50.00<\/span><\/label><\/li><li class=\"choice-4\"><input type=\"checkbox\" id=\"wpforms-305-field_69_4\" class=\"wpforms-payment-price\" data-amount=\"50.00\" name=\"wpforms[fields][69][]\" value=\"4\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-305-field_69_4\">Rifle &#8211; Optical &#8211; <span class=\"wpforms-currency-symbol\">&#036;50.00<\/span><\/label><\/li><li class=\"choice-5\"><input type=\"checkbox\" id=\"wpforms-305-field_69_5\" class=\"wpforms-payment-price\" data-amount=\"50.00\" name=\"wpforms[fields][69][]\" value=\"5\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-305-field_69_5\">Archery &#8211; Compound 3D &#8211; <span class=\"wpforms-currency-symbol\">&#036;50.00<\/span><\/label><\/li><li class=\"choice-9\"><input type=\"checkbox\" id=\"wpforms-305-field_69_9\" class=\"wpforms-payment-price\" data-amount=\"50.00\" name=\"wpforms[fields][69][]\" value=\"9\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-305-field_69_9\">Archery &#8211; Traditional\/Genesis 3D &#8211; <span class=\"wpforms-currency-symbol\">&#036;50.00<\/span><\/label><\/li><\/ul><\/div><div id=\"wpforms-305-field_67-container\" class=\"wpforms-field wpforms-field-payment-total wpforms-field-medium\" data-field-id=\"67\"><label class=\"wpforms-field-label\">Total<\/label><div class=\"wpforms-payment-total\" style=\"\">&#036;0.00<\/div><input type=\"hidden\" id=\"wpforms-305-field_67\" class=\"wpforms-field-medium wpforms-payment-total\" name=\"wpforms[fields][67]\" value=\"0\"><\/div><div id=\"wpforms-305-field_61-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"61\"><label class=\"wpforms-field-label\">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&#039;s actions unsafe or that they are unaware of the regulations of the selected discipline(s), they may be eliminated from the competition. <\/label><ul id=\"wpforms-305-field_61\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-305-field_61_1\" name=\"wpforms[fields][61][]\" value=\"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.\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-305-field_61_1\">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.<\/label><\/li><\/ul><\/div><div id=\"wpforms-305-field_13-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"13\"><label class=\"wpforms-field-label\">Parent\/Guardian Name <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-305-field_13\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][13][first]\" required><label for=\"wpforms-305-field_13\" class=\"wpforms-field-sublabel after\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-305-field_13-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][13][last]\" required><label for=\"wpforms-305-field_13-last\" class=\"wpforms-field-sublabel after\">Last<\/label><\/div><\/div><\/div><div id=\"wpforms-305-field_15-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"15\"><label class=\"wpforms-field-label\">Parent\/Guardian Name<\/label><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-305-field_15\" class=\"wpforms-field-name-first\" name=\"wpforms[fields][15][first]\" ><label for=\"wpforms-305-field_15\" class=\"wpforms-field-sublabel after\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-305-field_15-last\" class=\"wpforms-field-name-last\" name=\"wpforms[fields][15][last]\" ><label for=\"wpforms-305-field_15-last\" class=\"wpforms-field-sublabel after\">Last<\/label><\/div><\/div><\/div><div id=\"wpforms-305-field_19-container\" class=\"wpforms-field wpforms-field-address\" data-field-id=\"19\"><label class=\"wpforms-field-label\">Address <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-row wpforms-field-medium\"><div ><input type=\"text\" id=\"wpforms-305-field_19\" class=\"wpforms-field-address-address1 wpforms-field-required\" name=\"wpforms[fields][19][address1]\" required><label for=\"wpforms-305-field_19\" class=\"wpforms-field-sublabel after\">Address Line 1<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div ><input type=\"text\" id=\"wpforms-305-field_19-address2\" class=\"wpforms-field-address-address2\" name=\"wpforms[fields][19][address2]\" ><label for=\"wpforms-305-field_19-address2\" class=\"wpforms-field-sublabel after\">Address Line 2<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-305-field_19-city\" class=\"wpforms-field-address-city wpforms-field-required\" name=\"wpforms[fields][19][city]\" required><label for=\"wpforms-305-field_19-city\" class=\"wpforms-field-sublabel after\">City<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><select id=\"wpforms-305-field_19-state\" class=\"wpforms-field-address-state wpforms-field-required\" name=\"wpforms[fields][19][state]\" required><option class=\"placeholder\" value=\"\" selected disabled>Louisiana<\/option><option value=\"AL\" >Alabama<\/option><option value=\"AK\" >Alaska<\/option><option value=\"AZ\" >Arizona<\/option><option value=\"AR\" >Arkansas<\/option><option value=\"CA\" >California<\/option><option value=\"CO\" >Colorado<\/option><option value=\"CT\" >Connecticut<\/option><option value=\"DE\" >Delaware<\/option><option value=\"DC\" >District of Columbia<\/option><option value=\"FL\" >Florida<\/option><option value=\"GA\" >Georgia<\/option><option value=\"HI\" >Hawaii<\/option><option value=\"ID\" >Idaho<\/option><option value=\"IL\" >Illinois<\/option><option value=\"IN\" >Indiana<\/option><option value=\"IA\" >Iowa<\/option><option value=\"KS\" >Kansas<\/option><option value=\"KY\" >Kentucky<\/option><option value=\"LA\" >Louisiana<\/option><option value=\"ME\" >Maine<\/option><option value=\"MD\" >Maryland<\/option><option value=\"MA\" >Massachusetts<\/option><option value=\"MI\" >Michigan<\/option><option value=\"MN\" >Minnesota<\/option><option value=\"MS\" >Mississippi<\/option><option value=\"MO\" >Missouri<\/option><option value=\"MT\" >Montana<\/option><option value=\"NE\" >Nebraska<\/option><option value=\"NV\" >Nevada<\/option><option value=\"NH\" >New Hampshire<\/option><option value=\"NJ\" >New Jersey<\/option><option value=\"NM\" >New Mexico<\/option><option value=\"NY\" >New York<\/option><option value=\"NC\" >North Carolina<\/option><option value=\"ND\" >North Dakota<\/option><option value=\"OH\" >Ohio<\/option><option value=\"OK\" >Oklahoma<\/option><option value=\"OR\" >Oregon<\/option><option value=\"PA\" >Pennsylvania<\/option><option value=\"RI\" >Rhode Island<\/option><option value=\"SC\" >South Carolina<\/option><option value=\"SD\" >South Dakota<\/option><option value=\"TN\" >Tennessee<\/option><option value=\"TX\" >Texas<\/option><option value=\"UT\" >Utah<\/option><option value=\"VT\" >Vermont<\/option><option value=\"VA\" >Virginia<\/option><option value=\"WA\" >Washington<\/option><option value=\"WV\" >West Virginia<\/option><option value=\"WI\" >Wisconsin<\/option><option value=\"WY\" >Wyoming<\/option><\/select><label for=\"wpforms-305-field_19-state\" class=\"wpforms-field-sublabel after\">State<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-305-field_19-postal\" class=\"wpforms-field-address-postal wpforms-field-required wpforms-masked-input\" data-inputmask-mask=\"(99999)|(99999-9999)\" data-inputmask-keepstatic=\"true\" data-rule-inputmask-incomplete=\"1\" name=\"wpforms[fields][19][postal]\" required><label for=\"wpforms-305-field_19-postal\" class=\"wpforms-field-sublabel after\">Zip Code<\/label><\/div><\/div><\/div><div id=\"wpforms-305-field_16-container\" class=\"wpforms-field wpforms-field-phone\" data-field-id=\"16\"><label class=\"wpforms-field-label\" for=\"wpforms-305-field_16\">Primary Contact Number <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"tel\" id=\"wpforms-305-field_16\" class=\"wpforms-field-medium wpforms-field-required wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][16]\" placeholder=\"(xxx)-xxx-xxxx\" aria-label=\"Primary Contact Number\" required><\/div><div id=\"wpforms-305-field_17-container\" class=\"wpforms-field wpforms-field-phone\" data-field-id=\"17\"><label class=\"wpforms-field-label\" for=\"wpforms-305-field_17\">Secondary Contact Number<\/label><input type=\"tel\" id=\"wpforms-305-field_17\" class=\"wpforms-field-medium wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][17]\" placeholder=\"(xxx)-xxx-xxxx\" aria-label=\"Secondary Contact Number\" ><\/div><div id=\"wpforms-305-field_18-container\" class=\"wpforms-field wpforms-field-email\" data-field-id=\"18\"><label class=\"wpforms-field-label\" for=\"wpforms-305-field_18\">Email <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"email\" id=\"wpforms-305-field_18\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][18]\" spellcheck=\"false\" required><\/div><div id=\"wpforms-305-field_37-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"37\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><button class=\"wpforms-page-button wpforms-page-next\" data-action=\"next\" data-page=\"1\" data-formid=\"305\" disabled>Next<\/button><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-2  \" data-page=\"2\" style=\"display:none;\"><div id=\"wpforms-305-field_26-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"26\"><h3 id=\"wpforms-305-field_26\">Participant&#039;s Medical Background Information<\/h3><div class=\"wpforms-field-description\">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. <\/div><\/div><div id=\"wpforms-305-field_28-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"28\"><label class=\"wpforms-field-label\" for=\"wpforms-305-field_28\">Family Physician <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-305-field_28\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][28]\" required><\/div><div id=\"wpforms-305-field_29-container\" class=\"wpforms-field wpforms-field-phone\" data-field-id=\"29\"><label class=\"wpforms-field-label\" for=\"wpforms-305-field_29\">Physician&#039;s Contact Number <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"tel\" id=\"wpforms-305-field_29\" class=\"wpforms-field-medium wpforms-field-required wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][29]\" aria-label=\"Physician&#039;s Contact Number\" required><\/div><div id=\"wpforms-305-field_32-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"32\"><label class=\"wpforms-field-label\" for=\"wpforms-305-field_32\">Desired Hospital<\/label><input type=\"text\" id=\"wpforms-305-field_32\" class=\"wpforms-field-medium\" name=\"wpforms[fields][32]\" ><\/div><div id=\"wpforms-305-field_31-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"31\"><label class=\"wpforms-field-label\">In the event of an emergency, transport to: <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-305-field_31\" class=\"wpforms-field-required\" data-choice-limit=\"1\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-305-field_31_1\" data-rule-check-limit=\"true\" name=\"wpforms[fields][31][]\" value=\"Nearest Hospital\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-305-field_31_1\">Nearest Hospital<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-305-field_31_2\" data-rule-check-limit=\"true\" name=\"wpforms[fields][31][]\" value=\"Desired Hospital\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-305-field_31_2\">Desired Hospital<\/label><\/li><\/ul><\/div><div id=\"wpforms-305-field_33-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"33\"><label class=\"wpforms-field-label\" for=\"wpforms-305-field_33\">Insurance Company <\/label><input type=\"text\" id=\"wpforms-305-field_33\" class=\"wpforms-field-medium\" name=\"wpforms[fields][33]\" ><\/div><div id=\"wpforms-305-field_34-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"34\"><label class=\"wpforms-field-label\" for=\"wpforms-305-field_34\">Policy Holder<\/label><input type=\"text\" id=\"wpforms-305-field_34\" class=\"wpforms-field-medium\" name=\"wpforms[fields][34]\" ><\/div><div id=\"wpforms-305-field_35-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"35\"><label class=\"wpforms-field-label\" for=\"wpforms-305-field_35\">Group Number and Policy Number<\/label><input type=\"text\" id=\"wpforms-305-field_35\" class=\"wpforms-field-medium\" name=\"wpforms[fields][35]\" ><\/div><div id=\"wpforms-305-field_36-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"36\"><label class=\"wpforms-field-label\" for=\"wpforms-305-field_36\">Emergency Contact Other Than Parent\/Guardian (Name and Number) <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-305-field_36\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][36]\" required><\/div><div id=\"wpforms-305-field_58-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-list-3-columns\" data-field-id=\"58\"><label class=\"wpforms-field-label\">Past or Present Medical History <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-305-field_58\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-305-field_58_1\" name=\"wpforms[fields][58][]\" value=\"Asthma\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-305-field_58_1\">Asthma<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-305-field_58_2\" name=\"wpforms[fields][58][]\" value=\"Bleeding Disorder\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-305-field_58_2\">Bleeding Disorder<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-305-field_58_3\" name=\"wpforms[fields][58][]\" value=\"Fainting\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-305-field_58_3\">Fainting<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-305-field_58_4\" name=\"wpforms[fields][58][]\" value=\"Epilepsy\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-305-field_58_4\">Epilepsy<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-305-field_58_5\" name=\"wpforms[fields][58][]\" value=\"Diabetes\/Hypoglycemia\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-305-field_58_5\">Diabetes\/Hypoglycemia<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"checkbox\" id=\"wpforms-305-field_58_6\" name=\"wpforms[fields][58][]\" value=\"Eye Impairment\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-305-field_58_6\">Eye Impairment<\/label><\/li><li class=\"choice-7 depth-1\"><input type=\"checkbox\" id=\"wpforms-305-field_58_7\" name=\"wpforms[fields][58][]\" value=\"Ear\/Hearing Impairment\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-305-field_58_7\">Ear\/Hearing Impairment<\/label><\/li><li class=\"choice-8 depth-1\"><input type=\"checkbox\" id=\"wpforms-305-field_58_8\" name=\"wpforms[fields][58][]\" value=\"Head Injury \/ Concussion\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-305-field_58_8\">Head Injury \/ Concussion<\/label><\/li><li class=\"choice-9 depth-1\"><input type=\"checkbox\" id=\"wpforms-305-field_58_9\" name=\"wpforms[fields][58][]\" value=\"Infectious Disease\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-305-field_58_9\">Infectious Disease<\/label><\/li><li class=\"choice-10 depth-1\"><input type=\"checkbox\" id=\"wpforms-305-field_58_10\" name=\"wpforms[fields][58][]\" value=\"Joint or Limb Conditions\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-305-field_58_10\">Joint or Limb Conditions<\/label><\/li><li class=\"choice-11 depth-1\"><input type=\"checkbox\" id=\"wpforms-305-field_58_11\" name=\"wpforms[fields][58][]\" value=\"Nervous Condition \/ Depression\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-305-field_58_11\">Nervous Condition \/ Depression<\/label><\/li><li class=\"choice-12 depth-1\"><input type=\"checkbox\" id=\"wpforms-305-field_58_12\" name=\"wpforms[fields][58][]\" value=\"Physical Disability\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-305-field_58_12\">Physical Disability<\/label><\/li><li class=\"choice-13 depth-1\"><input type=\"checkbox\" id=\"wpforms-305-field_58_13\" name=\"wpforms[fields][58][]\" value=\"Serious Illness\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-305-field_58_13\">Serious Illness<\/label><\/li><li class=\"choice-14 depth-1\"><input type=\"checkbox\" id=\"wpforms-305-field_58_14\" name=\"wpforms[fields][58][]\" value=\"Serious Injury\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-305-field_58_14\">Serious Injury<\/label><\/li><li class=\"choice-15 depth-1\"><input type=\"checkbox\" id=\"wpforms-305-field_58_15\" name=\"wpforms[fields][58][]\" value=\"Stomach or Bowel Problems\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-305-field_58_15\">Stomach or Bowel Problems<\/label><\/li><li class=\"choice-16 depth-1\"><input type=\"checkbox\" id=\"wpforms-305-field_58_16\" name=\"wpforms[fields][58][]\" value=\"Urinary Problems\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-305-field_58_16\">Urinary Problems<\/label><\/li><li class=\"choice-17 depth-1\"><input type=\"checkbox\" id=\"wpforms-305-field_58_17\" name=\"wpforms[fields][58][]\" value=\"NO KNOWN MEDICAL HISTORY\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-305-field_58_17\">NO KNOWN MEDICAL HISTORY<\/label><\/li><\/ul><\/div><div id=\"wpforms-305-field_42-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"42\"><label class=\"wpforms-field-label\" for=\"wpforms-305-field_42\">Please Explain any Selected Medical Issues That May Interfere With or Require Special Attention While Participating in YSSP<\/label><textarea id=\"wpforms-305-field_42\" class=\"wpforms-field-medium\" name=\"wpforms[fields][42]\" ><\/textarea><\/div><div id=\"wpforms-305-field_59-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"59\"><label class=\"wpforms-field-label\">Mental and Emotional Health &#8211; Has the participant: <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-305-field_59\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-305-field_59_1\" name=\"wpforms[fields][59][]\" value=\"Ever been treated for attention deficit disorder (ADD) or attention deficit\/hyperactivity disorder (ADHD)?\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-305-field_59_1\">Ever been treated for attention deficit disorder (ADD) or attention deficit\/hyperactivity disorder (ADHD)?<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-305-field_59_2\" name=\"wpforms[fields][59][]\" value=\"Ever been treated for emotional or behavioral difficulties?\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-305-field_59_2\">Ever been treated for emotional or behavioral difficulties?<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-305-field_59_3\" name=\"wpforms[fields][59][]\" value=\"In the past 12 months, seen a professional to address mental\/emotional health concerns?\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-305-field_59_3\">In the past 12 months, seen a professional to address mental\/emotional health concerns?<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-305-field_59_4\" name=\"wpforms[fields][59][]\" value=\"Had a significant life event that continues to affect the participant&#039;s life?\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-305-field_59_4\">Had a significant life event that continues to affect the participant&#8217;s life?<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-305-field_59_5\" name=\"wpforms[fields][59][]\" value=\"No Mental or Emotional Health Concerns\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-305-field_59_5\">No Mental or Emotional Health Concerns<\/label><\/li><\/ul><\/div><div id=\"wpforms-305-field_44-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"44\"><label class=\"wpforms-field-label\" for=\"wpforms-305-field_44\">Please Explain any Selected Mental and Emotional Health Concerns <\/label><textarea id=\"wpforms-305-field_44\" class=\"wpforms-field-medium\" name=\"wpforms[fields][44]\" ><\/textarea><\/div><div id=\"wpforms-305-field_45-container\" class=\"wpforms-field wpforms-field-signature\" data-field-id=\"45\"><label class=\"wpforms-field-label\" for=\"wpforms-305-field_45\">Signature of Parent\/Guardian <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-305-field_45\" class=\"wpforms-signature-input wpforms-screen-reader-element wpforms-field-required\" data-is-wrapped-field=\"1\" name=\"wpforms[fields][45]\" autocomplete=\"off\" inputmode=\"none\" required><div class=\"wpforms-signature-wrap wpforms-field-row wpforms-field-large\"><canvas class=\"wpforms-signature-canvas\" id=\"wpforms-305-field_45-signature\" data-color=\"#000000\"><\/canvas><div class=\"wpforms-signature-clear\" title=\"Clear Signature\" tabindex=\"0\">\n\t\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"1em\" height=\"1em\" preserveAspectRatio=\"xMidYMid meet\" viewBox=\"0 0 1536 1536\">\n\t\t\t\t\t<path fill=\"var( --wpforms-field-text-color, rgba(0, 0, 0, 0.25) )\" d=\"M1149 994q0-26-19-45L949 768l181-181q19-19 19-45q0-27-19-46l-90-90q-19-19-46-19q-26 0-45 19L768 587L587 406q-19-19-45-19q-27 0-46 19l-90 90q-19 19-19 46q0 26 19 45l181 181l-181 181q-19 19-19 45q0 27 19 46l90 90q19 19 46 19q26 0 45-19l181-181l181 181q19 19 45 19q27 0 46-19l90-90q19-19 19-46zm387-226q0 209-103 385.5T1153.5 1433T768 1536t-385.5-103T103 1153.5T0 768t103-385.5T382.5 103T768 0t385.5 103T1433 382.5T1536 768z\"\/>\n\t\t\t\t<\/svg>\n\t\t\t\t<div class=\"wpforms-signature-clear-caption\">Clear Signature<\/div>\n\t\t\t<\/div><\/div><div class=\"wpforms-field-description\">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. <\/div><\/div><div id=\"wpforms-305-field_46-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"46\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><button class=\"wpforms-page-button wpforms-page-next\" data-action=\"next\" data-page=\"2\" data-formid=\"305\" disabled>Next<\/button><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-3  \" data-page=\"3\" style=\"display:none;\"><div id=\"wpforms-305-field_47-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"47\"><h3 id=\"wpforms-305-field_47\">Parent Guardian Permission Statement<\/h3><div class=\"wpforms-field-description\">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.<\/div><\/div><div id=\"wpforms-305-field_57-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"57\"><label class=\"wpforms-field-label\">Participant&#039;s Name <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-305-field_57\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][57][first]\" required><label for=\"wpforms-305-field_57\" class=\"wpforms-field-sublabel after\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-305-field_57-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][57][last]\" required><label for=\"wpforms-305-field_57-last\" class=\"wpforms-field-sublabel after\">Last<\/label><\/div><\/div><\/div><div id=\"wpforms-305-field_50-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-id=\"50\"><label class=\"wpforms-field-label\" for=\"wpforms-305-field_50\">Date Signed <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-305-field_50\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-required wpforms-field-medium\" data-date-format=\"m\/d\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][50][date]\" required><a title=\"Clear Date\" data-clear role=\"button\" tabindex=\"0\" class=\"wpforms-datepicker-clear\" aria-label=\"Clear Date\" style=\"display:none;\"><\/a><\/div><\/div><div id=\"wpforms-305-field_48-container\" class=\"wpforms-field wpforms-field-signature\" data-field-id=\"48\"><label class=\"wpforms-field-label\" for=\"wpforms-305-field_48\">Signature of Parent\/Guardian for Permission Statement <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-305-field_48\" class=\"wpforms-signature-input wpforms-screen-reader-element wpforms-field-required\" data-is-wrapped-field=\"1\" name=\"wpforms[fields][48]\" autocomplete=\"off\" inputmode=\"none\" required><div class=\"wpforms-signature-wrap wpforms-field-row wpforms-field-large\"><canvas class=\"wpforms-signature-canvas\" id=\"wpforms-305-field_48-signature\" data-color=\"#000000\"><\/canvas><div class=\"wpforms-signature-clear\" title=\"Clear Signature\" tabindex=\"0\">\n\t\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"1em\" height=\"1em\" preserveAspectRatio=\"xMidYMid meet\" viewBox=\"0 0 1536 1536\">\n\t\t\t\t\t<path fill=\"var( --wpforms-field-text-color, rgba(0, 0, 0, 0.25) )\" d=\"M1149 994q0-26-19-45L949 768l181-181q19-19 19-45q0-27-19-46l-90-90q-19-19-46-19q-26 0-45 19L768 587L587 406q-19-19-45-19q-27 0-46 19l-90 90q-19 19-19 46q0 26 19 45l181 181l-181 181q-19 19-19 45q0 27 19 46l90 90q19 19 46 19q26 0 45-19l181-181l181 181q19 19 45 19q27 0 46-19l90-90q19-19 19-46zm387-226q0 209-103 385.5T1153.5 1433T768 1536t-385.5-103T103 1153.5T0 768t103-385.5T382.5 103T768 0t385.5 103T1433 382.5T1536 768z\"\/>\n\t\t\t\t<\/svg>\n\t\t\t\t<div class=\"wpforms-signature-clear-caption\">Clear Signature<\/div>\n\t\t\t<\/div><\/div><\/div><div id=\"wpforms-305-field_49-container\" class=\"wpforms-field wpforms-field-signature\" data-field-id=\"49\"><label class=\"wpforms-field-label\" for=\"wpforms-305-field_49\">Signature of Participant  <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-305-field_49\" class=\"wpforms-signature-input wpforms-screen-reader-element wpforms-field-required\" data-is-wrapped-field=\"1\" name=\"wpforms[fields][49]\" autocomplete=\"off\" inputmode=\"none\" required><div class=\"wpforms-signature-wrap wpforms-field-row wpforms-field-large\"><canvas class=\"wpforms-signature-canvas\" id=\"wpforms-305-field_49-signature\" data-color=\"#000000\"><\/canvas><div class=\"wpforms-signature-clear\" title=\"Clear Signature\" tabindex=\"0\">\n\t\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"1em\" height=\"1em\" preserveAspectRatio=\"xMidYMid meet\" viewBox=\"0 0 1536 1536\">\n\t\t\t\t\t<path fill=\"var( --wpforms-field-text-color, rgba(0, 0, 0, 0.25) )\" d=\"M1149 994q0-26-19-45L949 768l181-181q19-19 19-45q0-27-19-46l-90-90q-19-19-46-19q-26 0-45 19L768 587L587 406q-19-19-45-19q-27 0-46 19l-90 90q-19 19-19 46q0 26 19 45l181 181l-181 181q-19 19-19 45q0 27 19 46l90 90q19 19 46 19q26 0 45-19l181-181l181 181q19 19 45 19q27 0 46-19l90-90q19-19 19-46zm387-226q0 209-103 385.5T1153.5 1433T768 1536t-385.5-103T103 1153.5T0 768t103-385.5T382.5 103T768 0t385.5 103T1433 382.5T1536 768z\"\/>\n\t\t\t\t<\/svg>\n\t\t\t\t<div class=\"wpforms-signature-clear-caption\">Clear Signature<\/div>\n\t\t\t<\/div><\/div><\/div><div id=\"wpforms-305-field_51-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"51\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><button class=\"wpforms-page-button wpforms-page-next\" data-action=\"next\" data-page=\"3\" data-formid=\"305\" disabled>Next<\/button><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-4 last \" data-page=\"4\" style=\"display:none;\"><div id=\"wpforms-305-field_52-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"52\"><h3 id=\"wpforms-305-field_52\">Annual Hold Harmless Waiver &amp; Release Form<\/h3><div class=\"wpforms-field-description\">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 &#8220;Released Parties&#8221;) 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&#8217;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&#8217;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 &amp; Release Form shall be considered valid for a period of one (1) year from the date of signature. <\/div><\/div><div id=\"wpforms-305-field_56-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"56\"><label class=\"wpforms-field-label\">Participant&#039;s Name <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-305-field_56\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][56][first]\" required><label for=\"wpforms-305-field_56\" class=\"wpforms-field-sublabel after\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-305-field_56-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][56][last]\" required><label for=\"wpforms-305-field_56-last\" class=\"wpforms-field-sublabel after\">Last<\/label><\/div><\/div><\/div><div id=\"wpforms-305-field_60-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"60\"><label class=\"wpforms-field-label\">Parent&#039;s or Guardian&#039;s Name (Printed or Typed) <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-305-field_60\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][60][first]\" required><label for=\"wpforms-305-field_60\" class=\"wpforms-field-sublabel after\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-305-field_60-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][60][last]\" required><label for=\"wpforms-305-field_60-last\" class=\"wpforms-field-sublabel after\">Last<\/label><\/div><\/div><\/div><div id=\"wpforms-305-field_53-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-id=\"53\"><label class=\"wpforms-field-label\" for=\"wpforms-305-field_53\">Date Signed &#8211; Hold Harmless Waiver &amp; Release Form <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-305-field_53\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-required wpforms-field-medium\" data-date-format=\"m\/d\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][53][date]\" required><a title=\"Clear Date\" data-clear role=\"button\" tabindex=\"0\" class=\"wpforms-datepicker-clear\" aria-label=\"Clear Date\" style=\"display:none;\"><\/a><\/div><\/div><div id=\"wpforms-305-field_54-container\" class=\"wpforms-field wpforms-field-signature\" data-field-id=\"54\"><label class=\"wpforms-field-label\" for=\"wpforms-305-field_54\">Signature of Parent or Guardian &#8211; Hold Harmless Waiver &amp; Release Form <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-305-field_54\" class=\"wpforms-signature-input wpforms-screen-reader-element wpforms-field-required\" data-is-wrapped-field=\"1\" name=\"wpforms[fields][54]\" autocomplete=\"off\" inputmode=\"none\" required><div class=\"wpforms-signature-wrap wpforms-field-row wpforms-field-large\"><canvas class=\"wpforms-signature-canvas\" id=\"wpforms-305-field_54-signature\" data-color=\"#000000\"><\/canvas><div class=\"wpforms-signature-clear\" title=\"Clear Signature\" tabindex=\"0\">\n\t\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"1em\" height=\"1em\" preserveAspectRatio=\"xMidYMid meet\" viewBox=\"0 0 1536 1536\">\n\t\t\t\t\t<path fill=\"var( --wpforms-field-text-color, rgba(0, 0, 0, 0.25) )\" d=\"M1149 994q0-26-19-45L949 768l181-181q19-19 19-45q0-27-19-46l-90-90q-19-19-46-19q-26 0-45 19L768 587L587 406q-19-19-45-19q-27 0-46 19l-90 90q-19 19-19 46q0 26 19 45l181 181l-181 181q-19 19-19 45q0 27 19 46l90 90q19 19 46 19q26 0 45-19l181-181l181 181q19 19 45 19q27 0 46-19l90-90q19-19 19-46zm387-226q0 209-103 385.5T1153.5 1433T768 1536t-385.5-103T103 1153.5T0 768t103-385.5T382.5 103T768 0t385.5 103T1433 382.5T1536 768z\"\/>\n\t\t\t\t<\/svg>\n\t\t\t\t<div class=\"wpforms-signature-clear-caption\">Clear Signature<\/div>\n\t\t\t<\/div><\/div><\/div><div id=\"wpforms-305-field_55-container\" class=\"wpforms-field wpforms-field-signature\" data-field-id=\"55\"><label class=\"wpforms-field-label\" for=\"wpforms-305-field_55\">Signature of Participant (If Over the Age of 18)<\/label><input type=\"text\" id=\"wpforms-305-field_55\" class=\"wpforms-signature-input wpforms-screen-reader-element\" data-is-wrapped-field=\"1\" name=\"wpforms[fields][55]\" autocomplete=\"off\" inputmode=\"none\" ><div class=\"wpforms-signature-wrap wpforms-field-row wpforms-field-large\"><canvas class=\"wpforms-signature-canvas\" id=\"wpforms-305-field_55-signature\" data-color=\"#000000\"><\/canvas><div class=\"wpforms-signature-clear\" title=\"Clear Signature\" tabindex=\"0\">\n\t\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"1em\" height=\"1em\" preserveAspectRatio=\"xMidYMid meet\" viewBox=\"0 0 1536 1536\">\n\t\t\t\t\t<path fill=\"var( --wpforms-field-text-color, rgba(0, 0, 0, 0.25) )\" d=\"M1149 994q0-26-19-45L949 768l181-181q19-19 19-45q0-27-19-46l-90-90q-19-19-46-19q-26 0-45 19L768 587L587 406q-19-19-45-19q-27 0-46 19l-90 90q-19 19-19 46q0 26 19 45l181 181l-181 181q-19 19-19 45q0 27 19 46l90 90q19 19 46 19q26 0 45-19l181-181l181 181q19 19 45 19q27 0 46-19l90-90q19-19 19-46zm387-226q0 209-103 385.5T1153.5 1433T768 1536t-385.5-103T103 1153.5T0 768t103-385.5T382.5 103T768 0t385.5 103T1433 382.5T1536 768z\"\/>\n\t\t\t\t<\/svg>\n\t\t\t\t<div class=\"wpforms-signature-clear-caption\">Clear Signature<\/div>\n\t\t\t<\/div><\/div><\/div><div id=\"wpforms-305-field_39-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"39\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><\/div><\/div><\/div><\/div><!-- .wpforms-field-container --><div class=\"wpforms-field wpforms-field-hp\"><label for=\"wpforms-305-field-hp\" class=\"wpforms-field-label\">Message<\/label><input type=\"text\" name=\"wpforms[hp]\" id=\"wpforms-305-field-hp\" class=\"wpforms-field-medium\"><\/div><div class=\"wpforms-submit-container\" style=\"display:none;\"><input type=\"hidden\" name=\"wpforms[id]\" value=\"305\"><input type=\"hidden\" name=\"page_title\" value=\"\"><input type=\"hidden\" name=\"page_url\" value=\"https:\/\/ncscshooting.org\/index.php?rest_route=\/wp\/v2\/pages\/307\"><input type=\"hidden\" name=\"url_referer\" value=\"\"><button type=\"submit\" name=\"wpforms[submit]\" id=\"wpforms-submit-305\" class=\"wpforms-submit\" data-alt-text=\"Sending...\" data-submit-text=\"Submit\" aria-live=\"assertive\" value=\"wpforms-submit\">Submit<\/button><\/div><\/form><\/div>  <!-- .wpforms-container --> 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