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New Child Registration
First Name*
Last Name*
Birthday*
Please enter in the format of YYYY-MM-DD
School Name
Emergency Contact Name*
Emergency Contact Phone*
Emergency Contact Email*
Emergency Contact Relationship*
Family Doctor Name
Family Doctor Phone
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Family Doctor Email
Concerns
Do you authorize us to photograph your child?*
Yes, I authorize
No, I do not authorize
Liability Waiver
Permission to Participate:
Your child may have the opportunity to participate in activities using the transverse climbing wall. At its highest point the wall measures eight feet in height. Participants climb horizontally across the wall and their feet should never be higher than 3 to 3.5 feet off the ground.
Your child may also have the opportunity to participate in activities using the balance discs, giant blow up log roll and ball and the soft stairs and wedge.
Your child will be informed of the safety rules and will participate in these activities under the supervision of an adult instructor at all times.
Do you acknowledge and agree to our Liability Waiver?
Yes, I consent
No, I do not consent
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