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Gnarly Roots Wellness - Returning Participant
🌲 At Gnarly Roots Wellness, we believe healing, growth, and self-discovery are not reserved for a select few. Nature welcomes us all, and so do we.
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Has anything changed since you completed your annual packet?
Yes
No
If yes, please list any changes to your annual packet here:
Any new injuries or medical concerns that could affect participation? If so, please list below.
Returning Certification
I certify that my previously signed participant packet remains accurate except for any changes noted above. I understand that my prior waivers and Gnarly Roots policies remain in full effect.
Name
First Name
Last Name
Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Signature
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