WAIVER | Lilbeastninjas

Parent First Name

Parent Last Name

Street Address

City

State

Zip code

Phone

Emergency Contact & Phone Number

How did you hear about us? If you were referred by a friend, please list their name.

Child #1 Name

Child #1 Birthdate

Allergies/Medical: Any pertinent information that we should be aware of?

Add another child? 2

Child #2 Name

Child #2 Birthdate

Allergies/Medical: Child #2?

Add another child? 3

Child #3 Name

Child #3 Birthdate

Allergies/Medical: Any pertinent information Child #3?

Add another child? 4

Child #4 Name

Child #4 Birthdate

Which activity will you be participating in?

Birthday Party

Special Event

Garage gym private class

Other

Allergies/Medical: Any pertinent information Child #4?

Name of Birthday Child