Name of Parent / Guardian completing this form*
  • – Title –
  • Mr
  • Ms
  • Mrs
  • Prof
  • Dr
– Title –
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First Name
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Last Name
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Contact No.
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E-mail
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Child’s Name*
Child’s First Name
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Child’s Last Name
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Child’s Date of Birth
Select a date
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OPEN GYM TIME SLOT [20 SEPT – 24 SEPT]
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Waiver Release:

I hereby give my consent for my child participation in the class conducted by Power Kids Gym and hereby absolve and release Power Kids Gym from any and all liability for any injuries or damages that may be incurred by my child in the activities conducted by Power Kids Gym.
I have read and agree to the waiver release.
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