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Name:_____________________________ Phone:________________________
Address:_________________________________________________________
________________________________________________________________
Session(s): February March April May June
Medical Insurance Company:_________________________________________
In case of Emergency, call (if different than home):__________________________
I, the undersigned, intending to be legally bound for myself, my heirs, executors, administrators, and assigns, hereby waive and release any and all rights and claims for damages I may now
or hereafter have against West Goshen Township and its respective employees for any and all damages or injuries which may be sustained by me or my family arising out of participation in the above activity.
____________________________ ___________________________
Signature Date
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