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Release of Liability
First name
Last name
Email
Date of Birth
I am submitting this form on behalf of a minor to whom I am a legal guardian
First name of Minor
Last name of Minor
Date of Birth of Minor
Relationship to Minor
Please specify anything we should know about
I consent to allow the electronic signature below to serve as my legally binding signature
Electronic Signature
I declare that the info I’ve provided is accurate & complete
I hereby acknowledge this release from liability for accidental injury or illness which I may incur as a result of participating in any physical activity. I hereby assume all risks connected therewith and consent to participate in this program. I agree to disclose my physical limitations, disabilities, ailments, or impairments which may affect my ability to participate in this program.
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