Participant (Child) Full Name
*
First Name
Last Name
Participant Age
*
Parent/Guardian Full Name
*
First Name
Last Name
Parent/Guardian Email Address
*
example@example.com
Parent/Guardian Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Waiver and Release of Liability: By signing below, I acknowledge and agree that I am voluntarily participating in the Mommy and Me class. I understand and accept all risks associated with participation for myself and my child, and release the organizers, instructors, and facility from any and all liability.
Parent/Guardian Signature
*
Date
*
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Month
-
Day
Year
Date
Appointment
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