PARALLAX KIDS WAIVER FORM

Please fill out the following form.

Child First name

Child Last name

Phone

Your Email

Child/Minor Date of birth

Month

Day

Year

Has your child/minor been hospitalized in the last 12 months?

No

Yes

Is your child/minor suffering from a medical condition, illness or injury?

No

Yes

If you answered yes to any of the questions above, please supply additional information.

Parent/Guardian over 18 Name PRINTED

Parent/Guardian over 18 SIGNATURE

I declare that the info I’ve provided is accurate and complete.

I agree to the terms & conditions, found HERE