2022 Medical Release Form
One form needs to filled out for each participant for 2022. One form will cover all trainings for 2022.
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Participant's Name *
Participant's Age *
Parent/Legal Guardian Name *
Address *
Email *
Phone Number *
Physician's Name *
Physician's Phone *
Insurance/Policy Number *
Known Allergies/Medications *
Special Needs *
I, ___________ (parent/guardian type name below), hereby acknowledge that Elevate90 is not responsible for any injury my child may incur during their time spent at Elevate90 camp and or training. I further release any liability elevate90 and its staff and/or leadership in the event of any accident, and authorize elevate90 Staff and/or leadership to provide medical assistance. I authorize Elevate90 to see appropriate medical attention if needed. *
Date Completed and Signed *
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