DBLK Waiver Form

Please click the red icon on the right to read the DBLK Participant Waiver Form. After reviewing it, complete the form below and provide your signature.

Participant's first name

Participant's last name

Phone

Participant date of birth

Month

Day

Year

Emergency contact and phone number

Has the Participant been hospitalized in the last 12 months?

Yes

Does the Participant suffer from a medical condition, illness or injury?

Yes

If you answered yes to any of the questions above, please supply additional information.

Name of person completing the form and relation to the Participant

The person signing this document must be at least 18 years of age (and/or be the legal guardian of any minor Participant). By signing below, you acknowledge that you have read and agree to the terms of the DBLK Sports & Wellness Waiver.

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I declare that the info I’ve provided is accurate and complete.

Website Waiver.pdf