Mini Athletes Birthday Party Waiver

Welcome to Athletic republic and Mini Athletes! We are going to have a lot of fun, but before you may participate, we need a responsible adult to fill out this form. The information is for Athletic Republic only and will not be sold or distributed to outside parties.

Name of Participant*

Name of Birthday boy/girl*

Party date

Date of Birth*

Age

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Email*

Parent/Legal Guardian Name*

Relationship to participant

Street Address*

Town/City*

State*

Zip Code*

Phone Number*

Emergency Phone Number*

Emergency contact name