Parent Consent Form

Participant Information

Minor First name

Minor Last name

Minor Birthday

Parent/Guardian Consent

Parent/Guardian First Name

Parent/Guardian Last Name

I consent to my child participating in Group Exercise with Specialized Equipment.

Medical Information

Please list any medical conditions, allergies, or special needs we should be aware of:

Medical Insurance Information

Insurance Provider

Policy Number

Emergency Contact Information

First and Last Name

Relationship

Phone Number

In the event of an emergency, I authorize the activity supervisors to:

Seek medical treatment
Contact emergency services
Provide necessary first aid

Additional Permissions

Photo/Media Release

Yes, I allow photos/videos of my child to be taken during the activity.

No, I do not want my child photographed or filmed.

Liability Waiver

I understand that participation involves potential risks. I agree to release and hold harmless "BODY by Scuvotti" from any liability arising from my child's participation in this activity.

Signature

Date and time