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Waiver Signature Form

Please fill out the following form
in order to participate in club activities.

Participant First Name

Participant Last Name

Parent/Guardian Name

Email

Participant Date of Birth

Phone

Street Address

Street Address Line 2

City

Region/State/Province

Postal / Zip code

Country

I have read and understand the foregoing release and, by filling out this online form, signify my clear intention to be legally bound to it.

Thanks for submitting!

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