Challenge Fitness & Ignite Cheer Academy Waiver of Liability and Information Form
Samantha McChesney - Owner and Head Trainer/Coach
Email address *
Name (First and Last) *
Street Address *
City *
State *
Zip Code *
Phone Number *
Email *
Birthday *
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Injuries, Allergies, or Preexisting Medical Conditions (Please write N/A if no pertinent medical history) *
Emergency Contact: Name *
Emergency Contact: Phone Number *
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