Build and Grow Clinics
Lets Build Something Together
0637-110611-947392-jeZ9KUIfYM
Clinic Waiver Form
Clinic Name: Goofy Golf Store #:
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(To be lled out by Kids Clinic Captain.)
Clinic Date: Saturday Jun 11, 2011 Total Attendees: 1 Age: 4 Age: Age: Age: Age: Age: Age: Age: Age: Age: Gender: Male Gender: Gender: Gender: Gender: Gender: Gender: Gender: Gender: Gender:
Attendee Info: Name: Cannon Russo Name: Name: Name: Name: Name: Name: Name: Name: Name: Parent/Guardian: (Please Print) Name: Address:
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The information you provide will only be used to record your participation in the clinic. Liability Waiver:
Intended to be legally bound hereby, I give permission for the child(ren) listed above to participate in the Lowes Build and Grow Clinic. In addition, I authorize and release all photographs taken at the Lowes Build and Grow Clinic, and in consideration of receiving the supplies and materials for this activity, I hereby release Lowes Companies, Inc. and all its subsidiaries and their agents and employees of all liability for any injuries or accidents that may occur during this activity.
Parent/Guardian Signature:
2009 by Lowes. All rights reserved. Lowes and the gable design are registered trademarks of LF, LLC.