IWC Health Waiver
Please take a minute to fill in the following info:
Child's First Name
Child's Last Name
Parent/Guardian First Name
Parent/Guardian Last Name
Email
Phone Number
Do you permit your the above child to participate in physical activities?
Yes
No
What is the name of your child's physician?
Physician Phone Number
I agree to the terms & conditions
Your Signature
*
Clear
Please specify anything you feel we should know about to assist with the health and safety of your child:
Submit
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