Reebok | CrossFit Velocity Kids Emergency Card & Photo Release

 

 

Please print and bring along to your first session.

What information do we need to know so that we may provide the best care for your child?

 

 

 

Emergency Contact Information: _________________________________________

 

 

Date: Child/Minor Name (and nickname if any): ______________________________

 

 

DOB: _________________________

 

 

Parent/Guardian: Mobile Phone : ___________________________________

 

 

 

Email:_________________________________________________________

 

 

Home phone:___________________________________________________

 

 

Work phone with area code:_______________________________________

 

 

Spouse/Partner Contact Info

The following people have my consent to pick up my child from Reebok CrossFit Velocity Kids Classes:

 

1)____________________________________________________________________________

 

2)____________________________________________________________________________

 

 

 

Photo Release

I hereby give permission for images of my child, captured during regular and special activities, through video, camera and digital camera, to be used solely for the purposes of CrossFit, CrossFit Kids or Licensed CrossFit affiliate promotional material publications and website and waive any rights of compensation or ownership thereto. Last names of children will not be given or posted on the internet or website.

 

 

Name of Child: _________________________________________________________

 

 

 

 

 

Name of Parent/Guardian:________________________________________________

 

 

 

 

 

Signature:_____________________________________________________________

 

 

 

 

 

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