Participant's Name (1) *

First Name

Last Name

Participant's Name (2)

First Name

Last Name

Participant's Name (3)

First Name

Last Name

Participant's Name (4)

First Name

Last Name

Signee's Name *

First Name

Last Name

Signee's Date of Birth *

I certify that I am 18 years of age or older

Today's Date *

MM

DD

YYYY

Acknowledgement of Waiver *

By signing, I agree that I have read and fully understand the Adult Waiver of Liability. I hereby agree that should any clause, portion or part of the Adult Waiver of Liability, as outlined above, be held invalid by a court of competent jurisdiction, the remainder of the agreement remains in full force and effect. I hereby acknowledge that I have read and understand the entire Adult Waiver of Liability agreement as outlined above, including all four parts thereof, and my signature indicates the same. My signing this acknowledgement is my free act and deed.

Acknowledgement of Electronic Signature *

By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.

Minor's Name (1) *

First Name

Last Name

Minor's Date of Birth (1) *

MM

DD

YYYY

Minor's Name (2)

First Name

Last Name

Minor's Date of Birth (2)

MM

DD

YYYY

Minor's Name (3)

First Name

Last Name

Minor's Date of Birth (3)

MM

DD

YYYY

Minor's Name (4)

First Name

Last Name

Minor's Date of Birth (4)

MM

DD

YYYY

Most Recent Tetanus Booster *

MM

DD

YYYY

Parent / Guardian's Name *

First Name

Last Name

Today's Date *

MM

DD

YYYY

Acknowledgement of Waiver *

By signing, I agree that I have read and fully understand the Child Waiver of Liability

Child Medical Release *

Parent(s) or court appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above. As the parent or legal guardian of the above names child/children, I hereby give my consent for emergency medical care prescribed by a duly licensed Doctor of Medicine or Doctor of Dentistry. This care may be given under whatever conditions are necessary to preserve the life, limb or well being of my dependent

Parent / Guardian Acknowledgement of Electronic Signature *

By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.