Registration - Indigo

50%

To be completed by a parent / guardian
Full name of participant / camper:*
Date of birth:
Physical address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Parent / Guardian’s contact numbers
Home*
Cell*
Parent / Guardian’s email address:
Next of kin (In case of emergency)
Name
Relationship
Contact Numbers
Home
Cell
Medical aid information
Date of arrival
Date of departure
I hereby give consent for my child (as specified above) to attend activities and day trips associated with Indigo Youth Movement / Indigo Skate Camp. I acknowledge that my child will be exposed to all risks associated with these activities and in being transported on public roads. I hereby indemnify Indigo Youth Movement and its staff members, event sponsors and tutors, and keep them indemnified against all claims, demands, actions and liabilities of any kind. Further I give permission for images and videos of my child obtained during a youth camp to be used for promotional purposes by Indigo Youth Movement / Indigo Skate Camp.
Name of Parent / Guardian:*
Date
I have acknowledged and agree to the above*
- I have acknowledged and agree to the above
We thank you in advance for your support and your willingness to allow your child to participate in our programs and events. Kind regards, Indigo Skate Camp
“Let skateboarding take you places”