2. Important Information

   Please complete all sections of the form carefully to ensure your child is registered for the desired date(s).

   ⚠️ Space is limited to the first 60 registered children. Registrations will be accepted on a first-come, first-served basis.

   You will receive an email confirmation within one (1) business day once your registration has been processed.

   If you have any questions, please contact Alyssa at 830-997-7585 or arivera@fbgtx.org.

4. 
6. 

8. Registration

   Please fill out one for EACH child!

10. Child's First Name*
11. Child's Last Name*
13. Child's Date of Birth*
    Child's Date of Birth
14. Child's Age*
15. Child's Sex*
    -- Select One --FemaleMale
17. Child's Home Address*
19. City*
20. Zip*
22. Swimming Level*
    -- Select One --Non-SwimmerBeginner (requires a life jacket)Advanced (deep water)

    Please select one option from above that most accurately describes your child's swimming abilities. Beginners should bring their own lifejacket. All participants will be required to complete a swim test for activities that take place at the LBJ Park Pool.

23. Medical Concerns (allergic reactions, diabetic, seizures, etc.)*

    Please list all medical concerns. If none, please type N/A.

25. Communication Notice:

    Program updates, schedule changes, and reminders will be sent via text message and email to the contact information provided. Parents/guardians are responsible for regularly checking their phone and email for important program communications.

27. Guardian Phone Number*
28. Guardian Email*
30. Please select only the activities your child will attend. Please refer and review the attendance policy above:*

    1. June 2- Swimming at Lady Bird Park Pool
    2. June 9- Fishing & Bounce Houses
    3. June 16- Jellystone Waterpark Fredericksburg
    4. June 23- Kroc Center in Kerrville (transportation provided)
    5. June 30- Jellystone Waterpark in Kerrville (transportation provided)
    6. July 7- Arrows Active Play Park in Boerne (transportation provided)
    7. July 14- Swimming at Lady Bird Park Pool
32. Release of Liability & Media Consent

    As the parent or legal guardian of the participant listed above, I hereby knowingly grant permission for my child to participate in the 2026 Law Enforcement Summer Youth Program sponsored by the Fredericksburg Police Department.

    I fully release, discharge, and hold harmless the City of Fredericksburg, the Fredericksburg Police Department, their personnel, and any volunteer workers from any and all claims of liability, injury, or damage that may arise from my child’s participation in this program.

    Further, I agree to indemnify and hold harmless the City of Fredericksburg, the Fredericksburg Police Department, their personnel, and volunteers for any injuries or damages sustained as a result of my child's participation.

    In the event of an emergency, I authorize the sponsoring agencies of the Law Enforcement Summer Youth Program to seek and obtain medical treatment for my child at the nearest available medical facility if, in their judgment, medical attention is necessary.

    Additionally, I grant permission for my child’s image (photographs, video recordings, or other media) to be captured during program activities and used by the Fredericksburg Police Department and the City of Fredericksburg for promotional or informational purposes. I understand that these materials may be used in publications, social media, official websites, and news releases without further consent or compensation.

    By typing my name and the date below, I acknowledge that I have read, understood, and agreed to the terms outlined above. I further understand that my electronic signature has the same legal effect as a handwritten signature.

34. Signature*
35. Date*
    Date
Leave This Blank:


37. 1. Receive an email copy of this form.
38. Email address

    This field is not part of the form submission.

39. Submit

* indicates a required field