HOT Camp Registration

2. Please check the City of Longview Privacy Policy and Disclaimer before completing this form.

4. All required fields must be completed to validate registration.

6. Name of Participant*

7. Age*

8. Date of Birth*

10. School Attending*

11. Grade*

13. Address*

14. City*

15. State*

17. Primary Phone*

18. Secondary Phone

19. Zip Code*

21. How did you hear about HOT Camp?

23. Camp Info

25. Location: Longview Fire Dept. Training Center, 411 American Legion Blvd.

27. Time: 8:15a - 3p

29. Camp Attending*
    -- Select One --June 10 (Jr. Camp grades)July 21

30. T-Shirt Size*
    -- Select One --Youth SmallYouth MediumYouth LargeAdult SmallAdult MediumAdult LargeAdult XLAdult 2XL

32. Parents are encouraged to join their child(ren) for a lunch and info session, Noon - 1 p.m. Please indicate if you will attend by checking one of the boxes below:*

    1. I am unable to attend
    2. I will attend and eat lunch
    3. I will attend but not eat lunch

36. Medical Information

38. Please list all known allergies: (if none, please answer N/A)*

40. Please list any medical conditions HOT Camp facilitators should be aware of: (if none, please answer N/A)*

42. List any medications your child will be administered the day of the camp: (if none, please answer N/A)*

44. PLEASE READ CAREFULLY:

    I understand that the registered activities and services may have an element of hazard or inherent danger and I take full responsibility for any injury or illness that may occur to myself or my child due to participation in this activity or service. I agree to indemnify and hold the City of Longview, the Community Services Department, and /or school district and its representatives, successors, employees, and volunteers harmless from any liability, loss, cost, or expense (including attorney’s fees, medical, and ambulance costs) that may incur while participating in Community Services activities. In case of emergency, I give my permission for emergency medical treatment. This form shall be considered valid until canceled or changed in writing by the undersigned participant/ parent/ guardian.

    I understand that the registered activities and services may have an element of hazard or inherent danger and I take full responsibility for any injury or illness that may occur to myself or my child due to participation in this activity or service. I agree to indemnify and hold the City of Longview, the Community Services Department, and /or school district and its representatives, successors, employees, and volunteers harmless from any liability, loss, cost, or expense (including attorney’s fees, medical, and ambulance costs) that may incur while participating in Community Services activities. In case of emergency, I give my permission for emergency medical treatment. This form shall be considered valid until canceled or changed in writing by the undersigned participant/ parent/ guardian.

46. Permission is given for my child to have his/her picture taken by Partners in Prevention and the Longview Fire Department for the purpose of promoting the Heroes of Tomorrow summer camp. *

    1. Agree
    2. Disagree

48. Statement of Agreement*

    By typing your name in the above box, you agree to the terms of this document and acknowledge that all information I have provided is true and correct. By signing this application electronically or manually, I certify that I have read and understand all of the information and agree to these terms and conditions.

49. Date*

Leave This Blank:


51. 1. Receive email copy
52. Email address

    This field is not part of the form submission.

53. Submit Submit and Print

* indicates a required field