Hale Kids Waiver Crossfit Hale printable pdf download

Hale Kids Waiver Crossfit Hale

CROSSFIT HALE

HALE KIDS & TEENS

Registration & Release of Liability Waiver Form

1. Child’s Name: _______________________________________ Age:________ DOB:____/_____/____

2. Child’s Name: _______________________________________ Age:________ DOB:____/_____/____

3. Child’s Name: _______________________________________ Age:________ DOB:____/_____/____

4. Child’s Name: _______________________________________ Age:________ DOB:____/_____/____

Home Address:_____________________________________________________________

City:_____________________________________ Zip:____________________

Parent/Guardian Name(s):______________________________________________________________________

Phone:_________________________________ Email:_______________________________________________

Emergency Contact:_________________________________ Phone:_____________________ Relation:____________

PHYSICAL ACTIVITY

What is your child’s current level of activity?_____________________________________________________________

Does your child participate in team sports?________ If yes, which ones?______________________________________

Approximate number of minutes per day of physical activity: ___________________

GENERAL HEALTH

Has your child suffered or been diagnosed with any of the following?

CONDITION

Y or N

CHILD’S NAME

IF YES, PLEASE GIVE DETAILS

that it applies to

Broken Bones

Head Trauma

Heart Condition

Allergies

Asthma

ADD/ADHD

Surgeries

Prescriptions & OTC

Medications

Rescue Inhaler

Epi Pen

Any other conditions we

should know about?

Hale Kids Waiver Crossfit Hale