Liability Release Form printable pdf download

Liability Release Form

R.R.#2 – 1145 Bradley Road

Chelmsford, ON P0M 1L0

Tel: (705) 855-5818

info@bhranch.ca

Liability Release Form

Rider Personal Information:

Name:

_____________________________________________

Date of Birth: _____________________________________________ (if junior)

Address:

_____________________________________________

Email:

_____________________________________________

Tel:

__________________________ (home)

__________________________ (work)

Known medical problems: ___________________________________

Under any medication:

___________________________________

Emergency Contact Info:

Name:

______________________________________________

Relationship: ______________________________________________

Tel:

___________________________ (home)

___________________________ (work)

Doctor:

______________________________________________

**All riders will be required to pay in full any lesson that has not been cancelled at

least 48 hours in advance.

Liability Release Form