Blissful Throws Javelin Clinic Informed Consent and Assumption of Risk Assessment
Complete this waiver and health information form. Please review the legal terms carefully before agreeing and signing.
Participant Information
Participant First Name
*
Participant Last Name
*
Parent/Guardian First Name
Parent/Guardian Last Name
Parent/Guardian Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Parent/Guardian Email
example@example.com
Health, Restrictions, and Medication Information
Any activity the camper should be restricted from?
Any physical, mental, or other condition that would require special attention or medication while at camp?
List all medications, both prescribed and over the counter
List any allergies
Consent and Signature
Please review the following consent and assumption of risk language carefully before acknowledging below. By signing, you confirm that you have read, understood, and agree to the terms and conditions of this contract.
I agree to the terms and conditions of this contract
*
I agree
Date
*
-
Month
-
Day
Year
Date
Signature of Parent/Guardian (or Participant if 18 or older)
*
Submit
Submit
Should be Empty: