Please fill in the following form. This is a secured site so that all information entered is private and secure.
In case of EMERGENCY, call:
All of the information provided above is true and
accurate, to the best of my knowledge.
I agree to accept responsibility for any medical costs
which may result from his / her participation in this program.
I have read this release and indemnification agreement
and understand its meaning. Being fully
informed as to the risks associated with participation in this program, I
hereby consent to the minor participating in this Program. I understand that my
child will perform physical activity. I understand that my child will be
transported from site to site using GLA Transportation. I understand that my
child will be photographed and photo’s may be used for marketing purposes
Submission of this form implies that I understand that this is a legally binding contract, and I have read it and understand it.