Medical & Liability Waiver Form DOWNLOAD A PRINTABLE VERSION Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Name of Group *WGTBBTBEffective June 2024-May 2025 BEATER'S INFORMATIONBeater's Name *FirstLastAddress *Address Line 1CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeHome Phone *Work PhoneCell PhoneEmail *Beater's Birthdate *Beater's Age *Beater's Gender *Date of Last Tetanus Shot *AllergiesFood RestrictionsActivity RestrictionsBeater's Physician *Physician's Phone *EMERGENCY CONTACTIn Emergency, Notify: *Relationship *Phone *MEDICAL RELEASEThis health history is correct so far as I know and this person has permission of the undersigned to engage in all activities except as noted. In case of illness or injury, Brenda Myers/We Got the Beat/Beyond the Beat/Jazz Fresno has my permission to procure medical treatment for the above named (minor, if applicable). I understand Brenda Myers/We Got the Beat/Beyond the Beat/Jazz Fresno does not provide medical insurance or reimbursement for medical fees or prescriptions and that I am responsible for any/all such fees and charges arising from illness or injury that may occur. LIABILITY RELEASEThe undersigned, for himself or herself and on behalf of his or her child(ren) or ward(s) and their personal representatives assigns or heirs, (hereinafter referred to as Releasors,) hereby releases and agrees and covenants not to sue Brenda Myers/We Got the Beat/Beyond the Beat/Jazz Fresno, their owners, directors, stock holders, agents, successors, or any employee, (herein after referred to as Releasees,) from any and all liability or loss, damage, injury, death, or any other claim whatever to the person or property of any guest or participant whether caused by negligence of Releasees or any other person or thing while participating in activities sponsored by or associated with Brenda Myers/We Got the Beat/Beyond the Beat/Jazz Fresno. The undersigned elects to participate and/or allow his or her child(ren), ward(s), to participate voluntarily and assumes all risk of loss, damage, injury or death, known or unknown, foreseen or unforeseen that may be sustained. YOU HAVE THE OPTION NOT TO PARTICIPATE OR ALLOW YOUR CHILD, CHILDREN, WARD OR WARDS NOT TO PARTICIPATE IN ANY ACTIVITY WHERE YOU DO NOT WISH TO WAIVE LIABILITY. IT SHALL BE YOUR RESPONSIBILITY TO INSURE THAT YOUR CHILD, CHILDREN, WARD OR WARDS DO(ES) NOT PARTICIPATE IN THE ACTIVITIES FOR WHICH YOU CHOOSE NOT TO BEAR LIABILITY. The undersigned has read and voluntarily signs this medical release and waiver of all liability. Parent/Guardian Signature * Clear Signature Date SignedSubmit