Parent/Guardian Full Name*
Address*
City*
*
Zip code*
Email Address*
cell number*
Full Name and age of First Child*
Name of and age Second Child
Full name and Age of third child
Full name and Age of fourth child
By initialing here you are agreeing that you have the right to make custodial decisions for this child. This is also your initial agreeing to waive any liability for injury or illnesses arising from participation.*