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?

Yes

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

Yes

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

Does your child have any known allergies?

Parent/Guardian over 18 Name PRINTED

Parent/Guardian over 18 SIGNATURE

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

PHOTO RELEASE

I hereby give permission for images of my child, captured during regular class actives through video and camera, to be used solely for the purpose of Crossfit, Crossfit kids/gymnastics and/or licensed affiliate promotional material, publications, and website and I waive any rights of compensation or ownership thereto. Last names of minors will not be given or posted.

I agree to the terms & conditions, found HERE

Signature

Drawing mode selected. Drawing requires a mouse or touchpad. For keyboard accessibility, select Type or Upload.

PARALLAX KIDS WAIVER FORM

OUR LOCATION

SUBSCRIBE