Rebel Challenge Course Health History Form & Waiver
Please complete this form to provide pertinent health information for the participant. The challenge course staff will keep this information confidential, and information provided will assist staff in providing necessary accommodations, risk management protocols, and treatments to ensure that participants have a safe and fun experience at the course.
First Name *
Your answer
Last Name *
Your answer
Group Name *
Your answer
Date of Session *
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DD
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YYYY
Date of Birth *
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/
DD
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YYYY
Weight (lbs) *
Your answer
Please list any allergies or medical conditions that may affect your participation in physical activities? *
Your answer
Please list any limitations that may affect your participation in physical activities? *
Your answer
Are you pregnant? *
Do you have adequate medical insurance?
Medical insurance is strongly encouraged to participate. Please review your personal insurance for adequate coverage. Some companies may specifically exclude high-risk activities, therefore, in case of injury all expenses will be borne by you.
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