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Release Assumption Risk Waiver Form Template
________________________________________________________
DATE OF BIRTH (MO/DAY/YR) AND AGE: ____________________________________________________
ADDRESS: __________________________________________________________________________________
LOCATION OF ACTIVITY(IES): ________________________________
DATE(S) OF ACTIVITY(IES): START DATE:
Check one:
STUDENT OR
END DATE:
NON-STUDENT
DESCRIPTION OF ACTIVITIES:
POTENTIAL RISKS INCLUDE BUT ARE NOT LIMITED TO:
I, or I on behalf of my minor child,...
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