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

Click Here to View the Full Liability Waiver and Publicity Release

I have read and agree to the Waiver, Release, and Publicity Agreement, and I understand this checkbox constitutes my legal signature. If the participant is a minor, I am their parent or legal guardian agreeing on their behalf.

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