Health Waiver
Please take a minute to fill in the following info
First Name
Last Name
Email
Phone Number
Does your child have a doctor’s permit to participate in physical activities?
Yes
No
Please specify anything we should know about:
Emergency Contact 1
Emergency Contact 2
Biloball has my permission to use images of my child in marketing materials. Note: Biloball will request personal permission for any online marketing.
Your Signature
*
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