Coastal Athletics Activity Waiver
Child's Full Name
*
First Name
Last Name
Child's Birth Date
*
Please select a year
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
Year
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Day
Allergies or medical concerns
Child # 2 (Skip if this does not apply)
First Name
Last Name
Birth Date
-
Month
-
Day
Year
Date
Allergies or medical concerns
Child #3 (Skip if this does not apply)
First Name
Last Name
Birth Date
-
Month
-
Day
Year
Date
Allergies or medical concerns
Back
Next
Parent #1 Full Name
*
First Name
Last Name
Parent #2 Full Name
First Name
Last Name
Parent's E-mail
*
Parent's Cell Phone Number
*
-
Area Code
Phone Number
Please read and consent:
*
I hereby attest that I am (we are) the legal parent\guardian(s) of the above-named child and hereby consent to the child's participation in the all Coastal Athletics planned activities. I understand that activities of the kind described above may result in physical injury to my child but nonetheless specifically request that he or she be allowed to participate in those activities.
I also consent to Coastal Athletics FL using any media, photos, or videos of my child for social media or marketing purposes.
Submit
Should be Empty: