Waiver/Intake Form | RUSH Athletics

First name

Last name

Birthday

Month

Day

Year

Check this box if you are 18 or older

First and Last Name of Parent or Guardian (If under 18 years old)

Signature of Participant/Parent/Guardian

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Date

Month

Day

Year

Emergency Contact Name:

Emergency Contact Phone:

I have truthfully responded to the information requested above and have read and agree to the RUSH Athletics LLC Release, Waiver of Liability, Assumption of Risk & Indemnity Agreement.

RUSH
ATHLETICS

Participant Waiver