Disclaimer: Class Participation with an Injury
Child
*
First Name
Last Name
Child's Date of Birth
-
Day
-
Month
Year
Date Picker Icon
Class(es)
*
Description of current injury
*
Part of body affected
*
Full Name of Coach
*
Disclaimer
*
I would like my child to participate in the class(es) indicated above. I declare that my child has a current injury as documented and that this occurred away from The Academy. I agree to abide by the Senior Coach's decision on safe participation. I understand that this form will be retained for a period of 3 years from the child's 18 birthday for insurance purposes.
Parent / Guardian Signature
*
Name of Parent/Guardian:
*
Date
*
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
Submit
Should be Empty: