Special event Waiver

6 Week Hip Hop Session starting February 24th
Athlete's Name *

First Name Last Name
Birth Date *

Month Day Year
Parent/Guardian Information
Name *

First Name Last Name
Phone Number *
E-mail *
example@example.com
Address *

Street Address

Street Address Line 2

City State

Zip Code
Waiver & Consent
Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
Signature *

Clear
Date *

Month Day Year
Date
Should be Empty:

6 Week Hip Hop Session starting February 24th