Waiver | Pernetti Spn

Athlete First Name

Athlete Last Name

Email

Date of Birth

Month

Day

Year

Do you have any known medical issues restricting you from physical activity?

No

Yes

[ PASTE RELEASE CONSENT TEXT HERE ]

I declare that the info I've provided is accurate and complete

Athlete Signature (Parent/Guardian Signature if athlete is under 18)

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Type Full Legal Name (Parent/Guardian if athlete is under 18)

Date

Month

Day

Year

LIABILITY WAIVER & RELEASE