Waiver | Elite Athletics

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Health Waiver

Athlete First Name*

Athlete Last Name*

Parents Email

Phone*

Birthday*

Month

Day

Year

Any known allergies (e.g, nuts, bee stings, medications)

Yes

No

If checked yes, what are conditions?

Any current injuries or conditions we should be aware of?*

Yes

No

If checked yes, what are conditions?

Permission to use images for marketing and social media

Yes

No

Emergency Contact *

Emergency Contact Number*

I agree to terms and conditions*

Yes

No

Signature*

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