Participation Waiver

Waiver of Liability and Photography Release

Please fill out the following form
in order to participate in our programs (H.I.M and Boys 2 Men)

Child's First and Last Name

Guardians First and Last Name

Child's Date of Birth

Does the child listed have any physical limitations or restrictions that will affect their participation in the program?

Yes

Does the child listed suffer from a medical condition, illness, or injury?

Yes

If you answered yes to any question, please elaborate

Initials (of individual completing the form)

I declare that the info I’ve provided is accurate & complete

I hereby acknowledge this release for the child listed above from liability for accidental injury or illness which may occur as a result of participating in any physical activity. I hereby assume all risk for the child listed above connected therewith and consent to partcipate in this program. I agree to disclose any physical limitations, allergies, disabilities and physical restrictions listed for the child above which may affect their ability to participate in the program.

I hereby give consent to use the photographs of the child listed above for the purpose of advertising to our website, social media platforms, and program related purposes.

Thanks for submitting!