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Heroes Semester Application

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Which training program are you applying for?
Parent Name (1)
Parent Name (2)
Mentor or Pastor
Will you be bringing your own vehicle?
Do you have any allergies?
Do you have any dietary restrictions?
Medical Problems?
Physical Disabilities?
Medications Required?
Special Needs?
Do you have any face or body piercings?
Emergency Contact Name (1)
Emergency Contact Name (2)
Insured's Name
Medical Authorization

In case of sickness or an emergency, I authorize such medical procedures as are deemed necessary at the discretion of The Inn staff, using qualified medical personnel or institutions.

I understand that the activities at The Inn are organized and safe. However, in the event of a mishap, I agree to assume the risk and liability of any injuries that I may suffer.

Electronic Signature
Reference #1
Reference #2
Reference #3