WAIVER AND RELEASE OF LIABILITY
EPIC
Waiver Signed By:
*
Organization
Individual
Family
Organization Name
Enter your name
*
Number of Children
*
1
2
3
4
Child #1
*
First Name
Last Name
Child #2
*
First Name
Last Name
Child #3
*
First Name
Last Name
Child #4
*
First Name
Last Name
Emergency Contact Name
*
Emergency Contact Phone
*
-
Area Code
Phone Number
By signing below, you agree to the terms and conditions of the waiver. Signature
*
Submit
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