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LIBERATORIA LEZIONI PROVA
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IO SOTTOSCRITTO/A (GENITORE)
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RESIDENTE A
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IN VIA
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CELLULARE
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In qualità di genitore/tutore del minore
NOME E COGNOME (ATLETA)
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NATO A
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IL
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RESIDENTE A
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IN VIA
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Con la presente dichiaro di sollevare di ogni responsabilità l'Associazione Sportiva Dilettantistica VIVISPORT per le due lezioni di prova di Micro/Minibasket
FIRMA
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