On this day of __November 3, 2089__, I do hereby give permission for __Niomi Kelly___ to participate in the Dueling Club which will be hosted at Hogwarts School of Witchcraft and Wizardry.

___Niomi___ understands that the club is intended to help develop the necessary skills for successful and safe dueling. However, he/she both also understands that due to the immersive nature of the club, injury is possible and may occur.

___Niomi___ has read the entirety of the Rules and Etiquette of the Club, and agree to all terms and conditions within. He/she also understands that ___Niomi___ will be committed to practicing safe and respectful dueling techniques, and will be held accountable for any deviation from the rules of the club and sportsmanship of the duel.

By signing this form, it is understood that ___Niomi___ will be enrolled in the Dueling Club and signed into the Dueling Tournament that accompanies the club. Further details as to the nature of the tournament and the club will be disclosed on the first meeting on November 13.

The following information is required about the participant.
Name: Niomi Kelly
Age:15
Year:5th
House: Slytherin
Would Like to Participate In: (Please indicate Meetings and/or Tournament and/or Practice Hall/Assignments/Challenges)

Signed, _______Tabytha Kelly__________