Student Age
Students Last Name
Students First Name
Street Address
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Level
Parents Last Name
Parents First Name
Home Phone Number
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ATHLETES IN MOTION LLC, AIM USA INC. LIABILITY RELEASE, I, the parent or guardian of the student(s) listed below, do hereby agree to release all liability and claims, against ATHLETES IN MOTION LLC, AIM USA INC, and agree to hold harmless any liability against ATHLETES IN MOTION LLC, AIM USA INC, any sponsoring organization, facility, instructor, and any other party involved, due to any injuries, accidents, negligence, or any other circumstance arising from participation in any ATHLETES IN MOTION LLC, AIM USA INC program / activity with respect to any time prior, during and after class.



PARENT / GUARDIAN SIGNATURE: __________________________________________________



DATE:_____________________________
OFFICE USE ONLY

Reg. Fee $______ Class Fee $______ Other $_______ Total $______ Check #______
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