In-Person Class Participation Waiver
Please complete this form to provide your consent and necessary information for participating in the class.
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
Class Name or Type
*
Class Date
*
 -
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)
Submit Waiver
Submit Waiver
Should be Empty: