BASIC INFORMATION Name Date of Birth Age Phone Emergency Contact Name Emergency Contact Number SHARED EMERGENCY INFORMATION Any known allergies? Yes No If yes, please specify Any medical conditions we should be aware of? (e.g. asthma, heart disease, high blood pressure, diabetes, seizure, etc) Yes No If yes, please select below or specify Asthma Heart Disease High Blood Pressure Diabetes Seizure Please specify: ____________________________________ Any current medications or supplements? Yes No If yes, please list CONSENT & LIABILITY WAIVER I confirm that the information provided is accurate to the best of my knowledge. I understand that participation in this event is voluntary and may involve physical activity. I acknowledge the risks involved and agree to take full responsibility for my health and safety during the event. In case of an emergency, I authorize event organizers to provide or seek medical assistance as necessary. I release the organizers, volunteers, sponsors, and all affiliated personnel from any liability for injury, illness, or accident that may occur as a result of my participation. Name Signature Date PARENT/GUARDIAN ACKNOWLEDGEMENT I acknowledge that I am responsible for the safety and well-being of my child/children during the event. I understand and agree that the event organizers, hosts, and affiliated parties will not be held liable for any accidents, injuries, or untoward incidents that may occur during the course of the event. Name of Parent/Guardian Signature Date Submit