I understand that it is a crime, punishable as a class "A" misdemeanor, under the laws of the State of New York, for a person, in and by written instrument, to knowingly make a false statement, or to make a statement that such person does not believe to be true.
By signing this document, I give Camp Bayouca permission to submit my information through the sexual abuse registry. I also authorize my character references to provide Camp Bayouca with the information requested. I release him/her from all liability in the giving of this information.