WAIVER

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First Name

Last Name

Email Address

Date of Birth

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

No

Yes

Have you lost your consciousness in the last past 12 months? *

No

Yes

Initials

Today's Date

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

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Top Floor (Access via the rear of building)

57 London Road

Enfield Town

EN2 6DU

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