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Taylors Rec Participant Form

I understand that Taylors First Baptist Church and Taylors Rec Center assume no responsibility for injuries which I, my children, or these under my guardianship, may sustain as a result of my physical condition or resulting from my participation in any athletic activities, sports program, the use of any equipment, exercise or other activities. I expressly acknowledge that I assume risk for any and all injuries and illnesses that may result from participation in these activities. In consideration of the privileges of joining or visitng Taylors Rec Center, I hereby voluntarily release and discharge Taylors First Baptist Church and Taylors Rec Center, its agents, and employees from any and all claims for injury, illness, death, loss or damage that I may suffer as a result of my participation in these activities. I understand Taylors First Baptist Church and Taylors Rec Center are NOT responsible for personal property lost or stolen while members and/or program participants are using Taylors Rec Center facilities on the premises. I understand that this membership may be revoked at any time if the behavior of myself, family members, or guests are not in accordance with the Taylors Rec Center policies.

First Particpants Name

First Name*

Last Name*

Phone*
First Particpants Date of Birth*
First Particpants Signature*
Second Particpants Name

First Name*

Last Name*
Second Particpants Date of Birth*
Third Particpants Name

First Name*

Last Name*
Third Particpants Date of Birth*
Fourth Particpants Name

First Name*

Last Name*
Fourth Particpants Date of Birth*
Fifth Particpants Name

First Name*

Last Name*
Fifth Particpants Date of Birth*
Sixth Particpants Name

First Name*

Last Name*
Sixth Particpants Date of Birth*
Seventh Particpants Name

First Name*

Last Name*
Seventh Particpants Date of Birth*
Eighth Particpants Name

First Name*

Last Name*
Eighth Particpants Date of Birth*
Ninth Particpants Name

First Name*

Last Name*
Ninth Particpants Date of Birth*
Tenth Particpants Name

First Name*

Last Name*
Tenth Particpants Date of Birth*
Parent or Guardian Email Address

Email*
A signed copy of this waiver will be sent to the email address you provide.
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
Parent or guardian must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.
Parent or Guardian Name

First Name*

Last Name*

Phone*
Parent or Guardian Date of Birth*
Parent or Guardian Signature*
Electronic Signature Consent*
By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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