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Date Of Birth
Insurance Policy and Group #
I do hereby approve my child's participation in the Prime Athletic Development Basketball Clinic. I certify that my child is in good health and able to participate with no limitations. In the event that a medical emergency occurs and I am not on the premises or cannot be contacted, I give my permission to secure medical attention. Also, I do hereby release Prime Athletic Development and all of the clinic instructors of all liabilities due to any injury or illness.
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