Junior Bulldog Club Registration - Mississippi Gulf Coast Community College

Junior Bulldog Club is for kids 3 to 12 years of age. Be sure you've read Join Junior Bulldog Club for complete details.

A parent or guardian should complete the registration form below.

Junior Bulldog Information

Name*

First Middle Last

Address*

Street Address Address Line 2 City State ZIP Code

Date of Birth*

T-Shirt Size*

Parent/Guardian Information

Name*

First Middle Last

Phone

Email

Is your address the same as the Junior Bulldog Club participant's?*

Yes
No

Address*

Street Address Address Line 2 City State ZIP Code

Are you an MGCCC graduate?*

Yes
No

Graduation Year*

Campus/Center Attended*

Model Release and Liability Waiver

Model Release*

For value received and without further consideration, I hereby consent that all photographs, video and/or recordings of this Junior Bulldog Club member’s voice taken at all Junior Bulldog Club events and activities may be used by Mississippi Gulf Coast Community College and/or others with its consent for the purposes of illustration, advertising or publication in any manner.

I agree.

Liability Waiver*

I/We hereby certify that I/We am (are) the parent(s) or legal guardian(s) of the Junior Bulldog Club participant. I/We hereby give permission for the MGCCC staff to seek appropriate medical attention for the Junior Bulldog Club participant and for the participant to receive medical attention in the event of accident, injury or illness. I/We will be responsible for any and all costs of medical attention and treatment, except for that covered by the participant’s excess-medical coverage policy. I/We, the undersigned for ourselves, our heirs, executors and administrators waive, release and forever discharge Mississippi Gulf Coast Community College and its staff, officers, agents, employees, representatives, successors and assigns of and from all rights and claims for damages, injury or loss to person or property which may be sustained or occur during participating in Junior Bulldog Club activities, whether or not damages, injury or loss is due to negligence. I/We hereby acknowledge that our child is physically fit and mentally capable of participating in Junior Bulldog Club activities.

I agree.

Payment Method and Signature

Payment Method*

Select the payment option for membership dues. Selecting the Online Payment option will direct you to a secure payment form.

Online Payment
Mail
In-person

Parent/Guardian Signature*

Junior Bulldog Information

Parent/Guardian Information

Model Release and Liability Waiver

Payment Method and Signature

Jackson County Campus

Harrison County Campus

Perkinston Campus

George County Center