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type N/A if not applicable don't leave blank
work / cel phone
*Grade (next fall)
Main areas of interest:
By checking "I consent" below, I certify that I am over 18 years of age and/or the legal guardian of the above-named applicant, and hereby authorize the directors and agents of the National Double Dutch League to act in my behalf using their best judgement in any emergency, including medical emergency. I hearby waive and release the League, Camp, its employees, volunteers, directors, sponsors, suppliers, and facilities from any and all liability for illness or injury incurred while attending the Double Dutch Camp. I know of no mental of physical problems that might adversely affect my/my child's ability to participate in this Camp. I hereby grant NDDL permission to use any photographs or video of me/my child for promotional purposes. I have read the information in the NDDL Camp brochure and agree to its terms and conditions, including the refund policy.
I have read the above and give my consent:
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