In-Person Class Participation Waiver
Please complete this form to provide your consent and necessary information for participating in the classes conducted by Fitphile LLC at Champion Martial Arts.
Participant Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Date of Birth
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Do you have any medical conditions or allergies we should be aware of?
Signature (Participant or Legal Guardian if under 18)
*
Additional Comments or Special Needs (optional)
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Submit Waiver
Submit Waiver
Should be Empty: