Personal Injury and Damage Release Form and COVID-19 Facility Waiver of Liability
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First and Last Name *
Date of Birth: *
MM
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DD
/
YYYY
Emergency Contact Name & Phone #:  *
Email: *
Electronic Signature
By electronically signing this release, hereby certifies that the undersigned has read and fully understands and agrees with the conditions herein provided.
Electronic Signature:  *
By electronically signing this release, hereby certifies that the undersigned has read and fully understands and agrees with the conditions herein provided.
COVID-19 Facility Waiver of Liability Electronic Signature *
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