Malia Racing Program Participation
You must complete and sign this form before participating in any of our on-land or on-water programs.
Email address *
Last name *
Your answer
First name *
Your answer
Gender *
Your answer
Phone # *
Your answer
Address *
Your answer
Emergency contact (name) *
Your answer
Emergency contact (phone #) *
Your answer
Health conditions/injuries? *
Required
Type of health conditions/injuries *
If none, enter "none".
Your answer
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