Waiver | S.E.A.D.S

Class Liability Waiver

Students First Name

Students Last Name

Students Date of Birth

Emergency Contact

Does the student have a doctor’s permission to participate in physical activities?

Yes

Please specify anything we should know about including but not limited to Allergys or pre-existing medical conditions.

Parents/ Legal Guardians 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.

Thanks for submitting!