Can anyone explain how to fill the form?

<p>So I am going to participate in the Blue Devil Days and have requested an overnight stay in a dorm. Duke asks me to fill out this form <a href=“http://admissions.duke.edu/images/uploads/BDDLiabilityForm2013.pdf[/url]”>http://admissions.duke.edu/images/uploads/BDDLiabilityForm2013.pdf&lt;/a&gt; but I don’t know how to answer “Executed as a sealed instrument this _____ day of _____, 2013” (on page two). I’m an international student and my parent’s also don’t know what this means. I searched the Internet but found no meaningful answers. Can anyone tell me what I should put in the two blanks?</p>

<p>Fill in the day of the month in the first blank, and the month in the second blank:
this 3rd day of April, 2013</p>

<p>^Thank you!</p>