Consent, Waiver, and Release of Liability
Name of RYLA Conferee
*
First Name
Last Name
Parent Name
*
First Name
Last Name
Parent Email Address
*
example@example.com
Please check all boxes that you have read and understand the following:
Waiver Signature
The waiver MUST be signed by a parent or legal guardian. If you have questions regarding the waiver form, please contact Melissa Kopp-Smith at office@rotary7390.org or 717-854-7842.
Parent/Guardian Signature
*
Please verify that you are human
*
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Should be Empty: