WAIVER

Every participant in our facility must have a completed waiver form. If the participant is under 18 years of age, please use the waiver form for minors which needs to be completed by a parent or legal guardian.

Adult / Guardian Information

First Name

Last Name

Date of Birth

Referred by

Phone

Email Address

Street Address

City

State

Zip

Emergency Contact Name

Emergency Contact Relationship

Emergency Contact Phone

Child's First Name

Child's Last Name

Date of Birth

I agree to these terms

I have fully read and understand all of the above statements.

Please draw your signature in the box below.

Clear