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BURN.BUILD.BELLS Bootcamp Class
WHEN:
Wednesday's - 7:30pm-8:30pm
November 30th
December 7th, 14th, 21st, 28th
January 4th, 11th, 18th
WHERE:
Lake Peekskill Community Center - 7 Northway, Lake Peekskill
COST
: $150 for 8 Weeks / $25 per Class
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Liability Emergency Medical Release:
I hereby give my permission to participate in the town sponsored Putnam Valley Parks & Recreation program. I certify that I am physically fit and that I will not hold PVPR or its agencies and/or representatives liable for any accidents and/or injuries incurred during the course of the program. I give my personal consent to be transported to any emergency facility if injury is sustained. I also consent to any treatment, surgery, diagnostic procedure or the administration of anesthesia that may be deemed necessary based on the medical judgment of the attending physician. PVPR will not tolerate abusive language or any type of misconduct at any of its functions.
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Parent/Guardian Name (If Under 18):
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Email:
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Phone #:
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Which Classes are you signing up for?
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Wednesday, November 30th
Wednesday, December 7th
Wednesday, December 14th
Wednesday, December 21st
Wednesday, December 28th
Wednesday, January 4th
Wednesday, January 11th
Wednesday, January 18th
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I understand this informed Consent Form & agree to its conditions. Participant Name & Date:
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