EMERGENCY DATA FORM

(Instructions on Page 6)

Name:

DOB:

Address: City: Zip:

Parents(s) Name (Mom) Cell: ( )

Parents(s) Name (Dad) Cell: ( )

Email Address:

Email Address:

Other person who may be contacted in case of an emergency:

Name: Relationship: Phone ( )

---------------------------------------------------------------//---------------------------------------------------------------

Is this student taking any prescribed medication ☐ Yes or ☐ No If yes, please explain what medication(s) and for what condition

Are there any mental or physical limitations that we need to be aware of? ☐Yes or ☐ No If yes, please explain

Name of Family Doctor Phone: ( )

Medical Insurance Provider ☐ Yes or ☐No If yes, Name of Provider

Additional Comments:

Parent/Guardian Signature: X

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HEALTH APPRAISAL FORM

Last Name	First Name	MI	DOB	Grade

If your student has had a history of any of the following medical conditions please mark with an X and explain in full detail in the comments area any precautions we should take regarding the condition.

Chicken Pox	☐	Kidney Disease	☐
Measles	☐	Menstrual Concerns	☐
German Measles	☐	Orthopedic Problems	☐
Mumps	☐	Convulsions or Equivalent	☐
Allergies	☐	Neurological Disorder	☐
Eye Problems	☐	Emotional Problems	☐
Hearing Problems	☐	Accidents (Wetting)	☐
Pulmonary Disease	☐	Operations	☐
Cardiac Disease	☐	Hospitalizations	☐
Thyroid Disorder	☐	Other Problems	☐

To the best of my knowledge:

(☐) My child is physically qualified to participate in the JROTC program.

(☐) My child is physically qualified to participate in JROTC but with the following limitations:

(☐) My child is not physically or otherwise qualified to participate in the JROTC program

Signature of Parent/Guardian: X Date:

Last Name	First Name	MI

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The cadets are provided with uniforms that value several hundreds of dollars for their use while in the MCJROTC Leadership Education Program, at no cost to them or the parent(s)/guardian. The U. S. Marine Corps pays for the initial dry cleaning/laundry and alterations. After uniforms are issued to the cadets it is the cadet’s responsibility to keep the uniforms clean and ready for use. (Uniforms will only be professionally dry cleaned and laundered with the exception of the camouflage uniform)

When a Cadet leaves the program, all uniforms and related items must be returned (cleaned) and in the same condition as issued. Should items of clothing or books become damaged or lost through neglect by the cadet, the cadet will be liable for replacement of those items at the government’s cost. Uniforms that cadets outgrow will be replaced at no expense to the cadet provided they are not damaged.

The uniforms provided to the cadets are for MCJROTC functions only and should only be worn when prescribed by the MCJROTC Staff on specified dates at school or for community service activities (ushering, parades etc.). Additionally, these uniforms should never be loaned to other cadets or persons for any purpose.

Prices of uniform items vary and will not be listed but consist of the following…

SERVICE UNIFORMS	DRESS UNIFORMS	UTILITY UNIFORMS

PHYSICAL TRAINING UNIFORM	SHOES/BOOTS

The MCJROTC Department is authorized to issue my son/daughter, the required uniform clothing as described on this form with associated items (i.e. rank insignia, emblems etc.).

I am aware that these uniform items are the property of the United States Government and

I agree to promptly return these items to the MCJROTC Department professionally cleaned and in serviceable condition upon any call for them to be returned or upon my son/daughter dis-enrolment from this program.

Parent/Guardian Signature X Date:

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From: Senior Marine Instructor

To: Parent(s) and/or Guardian

Subj: CADET UNIFORM POLICY

1. Thursday is the designated day for the cadets to wear their uniform to school, unless otherwise advised. Cadets are required to wear the uniform properly from the time they leave home until they return home. Only those cadets in an after school activity may change after school.

2. The JROTC Staff will designate which uniform will be worn on each Thursday on the weekly schedules posted in the classroom. If your child is absent on Thursday, they are expected to wear the designated uniform the next day that they attend school.

3. The Cadet/parent/guardian are responsible for the cleanliness and pressing of their uniforms and should plan and prepare in advance for each Thursday. If there is a problem, a short note with a phone number to verify will be considered.

4. Failure to wear the uniform properly as expected in excess of 3 times or 3 or more notes for excuses to this policy during each semester will result in dis-enrollment from the program.

5. We appreciate your cooperation in helping is to enforce this policy. If you have any questions please don’t hesitate to contact the JROTC Department at (706) 796-4959 ext. 1021 or 1022.

MSGT M. T. Fletcher / 1stSgt W. Hood

Marine Instructors

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I have read and understand the uniform policy and will comply

Parent/Guardian Signature X Date:

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MARKSMANSHIP CONSENT FORM

We authorize our son/daughter (Student’s name) ,

to participate in marksmanship training. We grant our consent with the knowledge that the training will involve first and foremost passing a marksmanship safety class prior to firing the Challenger Air Rifle. We understand that we may arrange a visit to the range facilities and acquaint ourselves with procedures and safety precautions prior to this training.

Parent or Guardian Signature X

Date:

Home Address:

Telephone Number: ( )

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DIRECTIONS ON HOW TO USE THESE FORMS

To type inside of the gray boxes, ensure that the cursor is inside the gray box and appears to be one space to the right. It should look like this:

----------------------------------------------------------------------------------------------------

It Should NOT look like this:

For the Check boxes, simply click on the box to put an “X” in the box. Click again to delete the “X”

For Signatures, change to font to script so that is looks like this: Devil Dawg

Save the document as the student’s first and last name and upload file in Canvas.

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