Name *

First Name

Last Name

Birth Date *

MM

DD

YYYY

Phone Number *

(###)

###

####

Terms and Conditions *

I read, agree and accept the Release of Liability and CSL Rules.

Parent / Guardian

By adding your name into this column you are agreeing that you are the parent/guardian of the minor submitting the above information and signing for your agreement of the release of liability form.

First Name

Last Name