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School Name: 

Child Attending: 

Parent/Guardian of
child Attending: 

Email Address: 

Phone Number: 

Address: 

The participant and "signer" of this agreement acknowledge that the center Brill's or any affiliate are not responsible for any injury and by this agreement the undersigned assumes all risks inherent and incidental to this type of sports activity as a condition of admission.

Thank you for supporting your local PTA/PTO

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