Liability Waiver & Enrollment Agreement

Who is this waiver for?

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01Participant Information

First Name

Last Name

Date of Birth

Phone

Street Address

City

State

ZIP

Emergency Contact

Relationship

Emergency Phone

02Medical Information

Allergies (food, clothing, materials)

Special Medical Needs (e.g. EpiPen, inhaler, conditions)

03Class Enrollment & Fees

Single Class (drop-in)$35

4-Class Pack$120

8-Class Pack$220

12-Class Pack$320

Registration Fee (non-refundable)$30

Card Processing Fee (credit/debit transactions)3%

Class packs are non-transferable. Fees are billed at enrollment.

03Terms & Agreement

04Acknowledgements & Consent

05Electronic Signature

Signer's First Name

Signer's Last Name

Draw Your Signature

Sign above using your mouse or finger

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