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Child First Name
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Child First Name 3
Child Last Name 3
I affirm that neither my child nor I, nor any other immediate family member, has experienced any signs of illness, including but not limited to runny nose, cough, sore throat, shortness of breath, chills, rash, etc. in the last 72 hours.
For today, the person picking up my child from camp will be (if different than the name above or on family account & Must show ID):
Chaperone Name
Chaperone Phone
Today's Date
Release of Liability: By typing my name below each category, I agree to the release of liability as stated below
When my child(ren) participate in in-gym activities, in case of an emergency when I cannot be reached, I authorize the staff of MY GYM to obtain whatever medical treatment deemed necessary for the welfare of my child(ren).
I acknowledge that My Gym cannot screen and/or monitor all such individuals. I also recognize that all adults entering the facility, including myself, have agreed to the My Gym Illness Policy.
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