September 26, 2023

The American Legion Arizona Boys State Application

Parent/Guardian Information

Emergency Contact

Arizona Boys State may contact the above phone numbers or email addresses regarding problems with this application.

Delegate Profile

Payment Election

Arizona Boys State costs $450.  This is typically paid as:

  • $300 Tuition Fee, paid by the sponsoring American Legion Post or other Sponsor; and
  • $150 Registration Fee, paid by the student
    • Online payment includes a $5 convenience fee
    • A Delegate who does not have a Sponsor must pay the full cost

Waiver of Claim and Permission for Medical Treatment

I, the undersigned parent or guardian of the Delegate, In consideration of the benefits derived by my son, in the event he is a member of The American Legion Arizona Boys State to be held in Flagstaff, AZ 4 June – 10 June 2023, do hereby release and discharge The American Legion  and Arizona  Boys State, its officers, agents, instructors, and employees from any and all claims, demands, damages, suits, actions, or causes of action which  may, can, or shall  by reason of any illness or accident incurred or suffered by said son while traveling to, attendance at, or participation in American Legion Arizona Boys State from the time of his departure from home until his return thereto.

I understand that my son is insured by The American Legion ONLY for that amount not paid by family insurance, or in the case of no medical  insurance.

This Medical Consent Form must be completed, digitall signed, and uploaded with your application in the upload area below.  You may only upload this file as a .pdf file.  Please download and complete it prior to submitting this application.

Boys State - Medical Consent Form

Click or drag files to this area to upload. You can upload up to 2 files.
This file upload location is to be used to attach your Medical Consent Form provided above. Please insure you are only saving and submitting the file as a .pdf file.

COVID WAIVER AND RELEASE OF LIABILITY

This COVID Release and Waiver is in addition to, and does not replace, any other releases of liability, waivers or documents that have been executed  in connection with this Event.

Assumption of Risk: You acknowledge that you are aware that participants in Arizona Boys State taking place at Northern Arizona University on the dates of June 4 - J u ne 11, 2022 {the "Event") are not required to prove immunization against COVID-19 and its variants {"COVID") or to wea r masks, unless required to do so by state or local guidelines, i n order to participate or attend the Event, and that certain risks associated with exposure to COVID may exist at the Event.

For Parents/Legal Guardians of Minors - As the parent or legal guardian of the "Minor" Delegate by allowing the Minor to participate in the Event, and by signing this COVID Waiver and Release of Liability, I, on my own behalf and/or on behalf of Minor, am assuming all risks, responsibility and liability concerning Minor's and my health and safety and possible exposure to COVID in connection with the Event.

Release: In consideration for the privilege of Minor participating i n the Event, the sufficiency of which is hereby acknowledged, I, on my own behalf and/or on behalf of Minor, agree to release and to hold harmless Arizona Boys State, Arizona  Boys State's corporate and individua l sponsors, the hosting site, (university, convention center) on whose premises the Event will occur, the affiliates and brands of The America n Legion, the Arizona Boys State Foundation, Inc., a not for profit corporation, and the respective directors, officers,  representatives,  members, agents, employees and  contractors of the preceding parties (hereinafter  collectively "Releasees") from any and a ll liability, whether caused by negligence of the Releasees or otherwise, for any claim, judgment,  loss, liability, cost and expenses (including, without limitations, attorney's fees and costs) arising out of or connected with associated with Minor's participation in the Event and Minor's and /or my possible exposure to COVID.

I, on my own behalf and/or on behalf of Minor, hereby warrant that I have read this COVID Waiver and Release of Liability in its entirety and fully understand its contents. I, on my own behalf and/or on behalf of Minor, am aware that this document releases Releasees from liability and contains an acknowledgement of my voluntary and knowing assumption of the risk of injury, ill ness and death. I, on my own behalf and/or on behalf of Minor, have signed this document voluntarily and of my own free will.

 

SELF-CERTIFICATION

I certify the above information is true and correct according to school records:

IF NOT PAYING ONLINE:

This application, once submitted and by selecting “Pay Directly With Cash or Check” will be delivered to the email address provided in this form. Please print and send a copy of this application, together with a check made payable to ARIZONA BOYS STATE, which must be filed with The American Legion, Department of Arizona, 4701 N.19th Ave., Ste. 200, Phoenix, AZ 85015, not later than March 31, 2023. A delegate paying his entire fee (including the tuition) must pay $450; otherwise the fee is $150. Online payment includes a $5 convenience fee.

 

Print Friendly, PDF & Email