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BIRTHDAY PARTY WAIVER
***Need to recreate this form in CRM***
BIRTHDAY PARTY WAIVER
Birthday Child’s Name
*
First
Last
Your Child’s Full Name
First Child’s Name
*
First
Last
First Child’s DOB
*
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First Child’s Gender
*
Second Child’s Name
First
Last
Second Child’s DOB
MM
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2
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9
10
11
12
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DD
1
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14
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18
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27
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29
30
31
/
YYYY
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
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2005
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2002
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1927
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1922
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Second Child’s Gender
Address
*
Address Line 1
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
School
Grade
*
Does the athlete have any allergies, chronic illness, or medical conditions that would limit high level activity?
*
Yes
No
Please describe.
PARENT/GUARDIAN INFO
Full Name
*
First
Last
Relation
*
Phone
*
Email
*
IMPORTANT INFORMATION ABOUT YOU AND YOUR CHILD’s HEALTH:
Wreck Room CrossFit services are not a substitute for professional medical advice or a medical examination. Prior to participating in any program, activity, or exercise you should seek the advice of your physician and other qualified health-care professionals. You understand that these exercises can be strenuous and should be done in moderation. There is an inherent risk in any exercise that, while providing some health benefits, can also cause unknown health issues. You understand that there are weights, balls, bars, mats, chairs, and many other items commonly associated with a gymnasium that can be left around by any person associated with Wreck Room CrossFit. It is every person’s responsibility to anticipate these items being left in places where they can cause injury. Application or reliance on the techniques, advice, ideas, and suggestions of any person associated with Wreck Room CrossFit are at the sole discretion and risk of the participant and his/her parent and guardian.
You agree, by participating in any program associated with Wreck Room CrossFit, that Wreck Room CrossFit shall not be liable for any direct, indirect, special, consequential, or exemplary damages for any injury or harm to you or your child incurred in or around the property where exercise occurs.
I willingly assume full responsibility for the risks that I am exposing my child to and accept full responsibility for any injury or death that may result from his/her participation in any activity or class while at Wreck Room CrossFit.
RELEASE: In consideration of the above mentioned risks and hazards and in consideration of the fact that I am willingly and voluntarily allowing my child’s participation in the activities available at Wreck Room CrossFit, I hereby release Wreck Room CrossFit, their principals, agents, employees, and volunteers from any and all liability, claims, demands, actions or rights of action, which are related to, arise out of, or are in any way connected with my child’s participation in this activity, including those allegedly attributed to the negligent acts or omissions of the above mentioned parties. I, the undersigned acknowledge that my child has no physical impairments or illnesses that will endanger him/her or others.
IN CASE OF EMERGENCY: I also give full permission for any person connected to Wreck Room CrossFit to administer first aid deemed necessary, and in case of serious illness or injury, I give permission to call for medical and or surgical care for the child and to transport the child to a medical facility deemed necessary for the well being of the child.
IMAGES: I authorize Wreck Room CrossFit to take pictures and movies of me and use them on their website and in other promotional and educational materials. I also understand that I may request their removal at anytime.
INDEMNIFICATION: I recognize that there is a risk involved in the types of activities offered by Wreck Room CrossFit I therefore accept financial responsibility for any injury that I or my child may cause either to myself or to others. I will reimburse them for such fees and costs. I agree to indemnify an hold harmless Wreck Room CrossFit, their principals, agents, employees, and volunteers from liability for the injury or death of any person(s) and damage to property that may result from my negligent or intentional act or omission while participating in activities offered by Wreck Room CrossFit.
ACCEPTANCE: I have read and understood the foregoing and I understand that by signing it obligates me to indemnify the parties named for any liability for injury or death of any person and damage to property caused by me. I understand that by signing this form I am waiving valuable legal rights. By entering the information below, I am delivering an electronic signature that will have the same effect as an original manual paper signature. The electronic signature will be equally as binding as an original manual paper signature.
Parent/Guardian Full Name
*
First
Last
Parent/Guardian Signature
*
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