I, acknowledge that I have read and that I understand each and by jqlq3K

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									         I, acknowledge that I have read and that I understand each and every one of the provisions in this parental
            waiver release of liability indemnification consent form roster agreement and agree to abide by them.

   Name of Child (print)    Name of Parent         Street Address      City, State, Zip Code Parent’s Signature Date
1______________________ _____________________ _______________________ ___________________ _______________ ______

2______________________ _____________________ _______________________ ___________________ _______________ ______

3______________________ _____________________ _______________________ ___________________ _______________ ______

4______________________ _____________________ _______________________ ___________________ _______________ ______

5______________________ _____________________ _______________________ ___________________ _______________ ______

6______________________ _____________________ _______________________ ___________________ _______________ ______

7______________________ _____________________ _______________________ ___________________ _______________ ______

8______________________ _____________________ _______________________ ___________________ _______________ ______

9______________________ _____________________ _______________________ ___________________ _______________ ______

10_____________________ _____________________ _______________________ ___________________ _______________ ______

11_____________________ _____________________ _______________________ ___________________ _______________ ______

12_____________________ _____________________ _______________________ ___________________ _______________ ______

13_____________________ _____________________ _______________________ ___________________ _______________ ______

14_____________________ _____________________ _______________________ ___________________ _______________ ______

15_____________________ _____________________ _______________________ ___________________ _______________ ______

16_____________________ _____________________ _______________________ ___________________ _______________ ______

17_____________________ _____________________ _______________________ ___________________ _______________ ______

								
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