PLEASE NOTE: REGISTRATION IS CURRENTLY CLOSED!
In the event that I cannot be reached in an emergency, I agree to accept any and all determinations of need for medical assistance and/or administration of medical attention deemed necessary by the D. Nicole representatives. I hereby give permission to the medical personnel selected by the D. Nicole representatives to secure any and all medical, hospitalization, dental, and/or surgical treatment. In event that such medical attention is needed from a healthcare provider, all costs shall be the responsibility of the parent or guardian.
Authorization for Media Release
For Use Only if the Participant is a Minor
I represent that I am the parent/guardian of _____________________ who is under 18 years of age. I give permission for the child named above to participate in the activities at the D. Nicole Girls Academy, including any special events or activities.
If paying by check, please make payable to D. Nicole and mail to P.O. Box 34813, Omaha, NE 68134. Fees are nonrefundable or transferable to another person.
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