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lewisindoorathletics@gmail.com

9132194128

Gym & Fitness Liability Waiver

Participants Name

Parents Name

Email

Participant Date of Birth

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

Yes

No

Please specify anything we should know about

Initials

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.

Team Name

Thanks for submitting!

9132194128

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