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Alchemy 399 Event Waiver
Date of Birth
I, (the undersigned named above), being aware of my own health and physical condition, and having knowledge that my participation in any exercise program may be injurious to my health, am voluntarily participating in a physical activity.
Having such knowledge, I hereby acknowledge this release, any representatives, agents and successors from liability for accidental injury or illness which I may incur as a result of participating in the said physical activity. I hereby assume all risks connected there with and consent to participate in said program.
I declare that the info I’ve provided is accurate & complete
Emergency Contact Name and Number
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