Waiver Form

Waiver is good for one calendar year. Thank you for taking the time to fill it out (again).
Questions? Please email Sara@SaraHollandSports.com

Name of Participant *
Name of Participant
Date of birth
Date of birth
Start Date
Start Date
Class time
Class time
Contact Information for Participant
Contact Information for Participant
Enter parent name
Address
Address
Home phone
Home phone
Cell phone or best number to be reached
Cell phone or best number to be reached
Please list any allergies, medications, or special health considerations we should be aware
First emergency contact
First emergency contact
Second emergency contact
Second emergency contact
Waiver of Participant by parent or self *
In consideration of your accepting my or my child’s registration and entry, I hereby for myself, my child, my heirs, executors and administrators, waive and release any and all rights and claims for damages I or my child may have against The Town of Westport,The Field House, Growing Tree Yoga,LLC, or Sara Holland; and its representatives, successors and assigns, for any and all injuries suffered by myself or my child at the activity sponsored by these groups. I understand there is inherent risk associated with the(se) activity(ies) and authorize emergency medical treatment and transportation in my absence. If any of the above participants are minors, I certify by my signature that I am the custodial parent or guardian; or I have the expressed authorization of the custodial parent, or guardian to enroll said participant(s) in the specified activities listed.
Please type in your full name and today's date
Kids’ Sports Zone has my permission to use my or my child’s photograph publically to promote the camps and clinics. I also understand that no royalty, fee or other compensation shall become payable to me by reason of such use.

*If paying by Venmo, then my ID is:  Sara-Holland-7   (Please make sure you spell Sara with no H on the end)

*If paying by check then please send to Sara Holland – 75 Girard Ave, New Haven, CT 06512