2023 DDG Summer Camp Registration Form

2023 DDG Summer Camp Registration

Serving youth ages 10-18 years old
Dapper and Distinguished Gentlemen (DDG) is a movement that is designed to cultivate young boys into gentlemen. DDG will host our 3rd Annual 5 day Summer Camp to continue to foster character, a legacy and a vision for the young men in the community.
Camper Information

Please submit one form per camper
Camper Name*

First NameLast Name
Preferred Name:
Church Name
School Name
Gender*

MaleFemale
Date of Birth*

MonthDayYear
Age:*
Allergies, Food Allergies, Medications or Other Medical Conditions:*
Any additional health issues or limitations for the camper:*
T-shirt Size (Adult Sizes)*

SmallMediumLargeX-Large1X

PARENT/GUARDIAN INFORMATION
Parent/Guardian Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState

Postal CodeCountry
Home Phone Number

Area CodePhone Number
Business Phone Number

Area CodePhone Number
Cell Phone Number*

Area CodePhone Number
E-mail*
Do you have legal custody of the child who is being registered?*

YesNo
Emergency Contact (other than the parent above)

In the case that we are unable to reach you in an emergency, please provide the name and number of someone we can contact (other than the parent above).
Emergency Contact Name*

First NameLast Name
Emergency Contact Number*

Area CodePhone Number

Physical Activity Consent
You are being asked to give consent for DDG personnel (camp director or volunteer) to led your camper in physical activity to include, but not limited to, playing recreational basketball, excersing and lifting weights. Physical touching may be required in order for the camper to have proper positioning and technique for their body during these activities.
*

I GIVE permission for the camp director and volunteer to lead my camper in physical activity.I DO NOT give permission for the camp director and volunteer to lead my camper in physical activity.

Photographic & Media Consent
You are being asked to give consent for the collection and use of your campers personal images by photography or video recording. If you give consent, you are acknowledging that these images may be used on the DDG website, YouTube channel, newsletters, social media and publications as well as distributed to members or used for DDG promotion in the future. No personal information, such as names, will be used in any publications unless express consent is given.
*

I HEREBY GIVE consent to the collection and use of my campers personal images by photography or video recording.I DO NOT give consent for CEACT to collect and use my campers personal images by photography or video recording.
Alternative Arrangements
I understand that if I am unable to provide transportation, to and from camp each day, that I will make alternative arrangments. These arrangements will be made to ensure my child arrives on time and is picked up on time. These arrangments should be communicated to the DDG staff by email at ddgent3@gmail.com or by calling 843-624-2490.

Release Statement
I hereby consent to the participation of my camper in all of DDG supervised activities. I, the Parent or Guardian named below, authorize the Director or one of DDG volunteers to sign consent for medical treatment and to authorize any physician or hospital to provide medical assessment, treatment, or procedures for the participant named above. I, named below, undertake and agree to indemnify and hold blameless DDG, its Personnel, its Volunteers, its Leaders, and Board from and against any loss, damage or injury suffered by the participant as a result of being part of the activities of DDG Summer Camp, as well as of any medical treatment authorized by the supervising individuals representing DDG. This consent and authorization is effective only when participating in events of DDG Summer Camp. I have read, understood and agree with above.
Name*
Signature*
Should be Empty:

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2023 DDG Summer Camp Registration