PARENT/GUARDIAN INFORMATION IF MINOR PARTICIPANTS
Name of Parent/Guardian:____________________________ Birth Date:____________ Driver’s License #:_______________
Address:____________________________________________________ City:_______________ State:_____Zip:___________
Relationship to minor: ________________Email:__________________________________Phone:______________________
By signing below, I agree to that all releases, waivers and promises herein are binding on the minor participant(s) listed below, and I further agree that I have full authority as Parent/Guardian to bind the minor participant to this agreement.
PARTICIPANT INFORMATION
Name of Participant #1: _______________________________________ Birth Date:____________ Emergency contact #:___________
Name of Participant #2: _______________________________________ Birth Date:____________ Emergency contact #:___________
Name of Participant #3: _______________________________________ Birth Date:____________ Emergency contact #:___________
Name of Participant #4: _______________________________________ Birth Date:____________ Emergency contact #:___________
Signature of Adult Participant or Parent/Guardian if a minor participant(s): _________________________ Date:__________