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RGA Henley Liability Waiver

First Name

Last Name

Email

Date of Birth

Do you need a doctor’s permit to participate in intense physical activities?

No

Yes

Please specify anything we should know about

Initials

I declare that the info I’ve provided is accurate & complete

I hereby acknowledge this release from liability to RGA HENLEY or any of it's instructors or members for accidental injury or illness which I may incur as a result of participating in any physical activity. I hereby assume all risks connected therewith and consent to participate in these classes. I agree to disclose my physical limitations, disabilities, ailments, or impairments which may affect my ability to participate in these classes.

Thanks for submitting!

RGA Henley Location

RGA Henley,

Henley Practice,

The Oast House,

Greys Road Car Park,

Henley-on-Thames

RG9 2AA

Email: info@rgahenley.co.uk

Tel: 07360 542 677

CONTACT US

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© 2018 RGA Henley

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