PURSUED REGISTRATION FORM

 
 
Name *
Name
Address *
Address
Phone
Phone
Emergency Contact Information *
Emergency Contact Information
Emergency Contact Phone *
Emergency Contact Phone
Weekend experience will not be confirmed until payment of $75 has been received *
LIABILITY WAIVER *
I CERTIFY THAT I HAVE READ THIS DOCUMENT AND I FULLY UNDERSTAND ITS CONTENT. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT.
 
 

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