Class Participation Waiver | Rebel Movement Proj

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RMP Liability Waiver

First Name

Last Name

Email

Date of Birth

Are you in good physical health? If not , do you have pemission from your doctor to participate in physical exercise

No

Yes

Please specify anything we should know about your health

Initials

I declare that the info I’ve provided is accurate & complete

I hereby acknowledge this release from liability for accidental injury or illness which I may incur as a result of participating in any physical activity. I hereby assume all risks connected therewith and consent to participate in this program. I agree to disclose my physical limitations, disabilities, ailments, or impairments which may affect my ability to participate in this program.

Thanks for submitting!

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