2017 Jr. NAD Advisor Information Form

School/Chapter Name*

Advisor's Name*

First NameLast Name

Advisor's E-mail*

Advisor's Phone Number

Area CodePhone Number

Video Phone

YesNo

Emergency Contact*

First NameLast Name

Relationship*

T-Shirt Size*

The 2017 Jr. NAD National Conference is hosted by the Nebraska Association of the Deaf (NeAD) in Ashland, NE. The Junior NAD is a program of the National Association of the Deaf (NAD), www.nad.org. The participant has permission to engage in all conference activities, except noted on health history.Full permission and authority are granted to NeAD and its representatives and the NAD to photograph, record, or use the name of participant in publications or materials connected with the Junior NAD National Conference. All photographs and videotapes will conform to standard of good taste.

I hereby release and discharge the NeAD, the NAD, and all other parties of interest from all claims for damages of every kind, nature or description, which may arise from or out of any injury, incurred by this participant while in attendance at the Junior NAD National Conference.

Typing my name at the end of this paragraph at the end represents my electronic signature.

e-Signature*

First NameLast Name

Date*

MonthDayYear