If yes, please list up to 5:
Primary Emergency Contact Name*
Primary Emergency Contact Phone*
Please list any and all Medical Conditions that apply: (if none, please type N/A)*
Additional Medical Information
Please list any and all allergies that may apply:*
List any daily medications with useful information, instructions, and activity restrictions: (if none, please type N/A)*
Please initial and date to confirm that you have read and agreed with the Photo Release Form, Liability Waiver and Safety/Behavioral Guidelines:*