Health & Liablility Waiver

Health & Liability Waiver

First Name

Last Name

Date of Birth

Emergency Contact & Phone #

Do you have a doctor’s permission to participate in intense physical activities?

Yes

Please specify anything we should know about: (Surgeries, diabetes, anemia, knee problems, etc.)

Initials: (if under 18 must be signed by parent/legal guardian)

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.View terms of use

Thanks for submitting!