Name *
Name
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Date of Birth
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I,(full name listed above) on behalf of myself or on behalf of my child(ren), hereby waive in advance any and all actions or causes of action and claims for injury or property damage which I may have, or which may hereby accrue to me, my heirs or other successors as a result of my participation in any activity, or activities incidental thereto, (hereafter referred to as the (“activity”) sponsored by Xtreme Unity, Xtreme Unity FitCity, and all other Xtreme Unity programs, in the sign up form. This is intended to release and hold harmless Xtreme Unity and its elected officials, officers, employees, contractors and agents.
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