Assateague State Park
2012 Junior Beach Patrol Program

Get a taste of what it’s like being a part of the Assateague State Park Beach Patrol by training with the lifeguards! Participants will have the opportunity to learn about and get involved with many different components of lifeguarding, including lessons about beach and ocean ecology; basic surf rescue techniques; physical fitness challenges; and rescue equipment and how it is used.

This camp is open to Assateague State Park campers as well as Day Use visitors. Camp meets at Lifeguard Office at Assateague State Park Concession building. The cost is $10 per participant for the 2-day camp. For more information about the Assateague State Park Junior Beach Patrol, contact us at (410) 641-2120 ext. 13 or srodriguez@dnr.state.md.us

Registration for the 2012 Junior Beach Patrol Program will be available beginning April 30, 2012. At that time, an online registration form will be available or you can register in person at the State Park Ranger Station.

Junior Beach Patrol Program

Ages: 7 – 15
Tuesdays and Thursdays (2-day session)
10:15 a.m. – 12:00 p.m.

Session 1: June 26th and June 28th
Session 2: July 3rd and July 5th
Session 3: July 10th and July 12th
Session 4: July 17th and July 19th
Session 5: July 24th and July 26th
Session 6: July 31st and August 2nd

* Equipment is provided. Registered participants receive a water bottle and certificate of completion. Participants should wear bathing suits, sunscreen, and hats are recommended. Service charge of $10 per participant. Pre-registration by phone or email is recommended beginning April 30, 2012. Space is limited.

Assateague State Park 2012 Junior Beach Patrol Registration

Please print clearly

Name of Child: ______________________________________________________________

Birth Date: _____________ Age: _____________

Parent/guardian name: ______________________________________________________

Street or P.O. Box: __________________________________________________________

City, State, Zip: ______________________________________________________________

Telephone (H): _________________________ Telephone (W): _____________________

Telephone (C): _________________________

Campsite # (if applicable): _______________

Can your child swim? Yes/ No

Can your child tread water? Yes/ No

Please use the space below to provide any pertinent medical information (medical considerations, allergies, special needs, etc):

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

Please register my child for the following sessions.

June 26th & June 28th _________________
July 3rd & July 5th _________________
July 10th & July 12th _________________
July 17th & July 19th _________________
July 24th & July 26th _________________
July 31st & August 2nd _________________

Parent/Camper Agreement:
In signing this application, I affirm that my child is in good health, capable of performing the required exercise to participate, and that I accept as my personal responsibility the hazards of such participation. Hazards of the Junior Beach Patrol program include, but are not limited to: sun exposure, personal fatigue, deep water, currents, etc. I agree to hold harmless Assateague State Park and all of its employees, officers, and agents in the event of an injury occurring to my child. I recognize that participating in these activities has a certain amount of risk and that injury is always possible. I certify that my child is, to the best of my knowledge, physically able to participate in this activity. I assume full financial responsibility for medical expenses arising out of such an injury. I hereby authorize the camp director to act for me according to his or her best judgment in any emergency medical situation. I further authorize Assateague State Park staff to transport my child as needed between sites within the park in Maryland Park Service vehicles as needed.

______________________________________________________________________
Parent’s Signature:

_____________________________________________________________________
Camper’s Health Insurance information (if applicable):

I also understand that by participating in the Junior Beach Patrol Program, my child will not be certified as a Professional Lifeguard, nor will they be trained in the full range of skills and responsibilities that Professional Lifeguards obtain. Therefore my child and I understand that he/she is never to attempt a rescue in any real-life situation, but instead should seek help from an adult and call 911.

______________________________________________________________________
Participant’s Signature:

_______________________________________________________________________
Parent’s Signature:

Photo Release

I hereby grant to the Maryland Department of Natural Resources and to its employees, agents and assigns the right to photograph my dependent and use the photo and or other digital reproduction of him/her or other reproduction of his/her physical likeness for publication processes, whether electronic, print, digital or electronic publishing via the Internet.

Please Circle: Yes / No

_________________________________________________________________________
Parent/Guardian Signature & Date

Full payment will be collected upon check-in at first session of Junior Beach Patrol Program.
Please mail application to:
Assateague State Park - Junior Beach Patrol
7307 Stephen Decatur Highway
Berlin, MD 21811

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