Waiver Form | Littleroo.ie

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Little Roo Liability Waiver

First name

Last name

Email

Date of Birth

Do you have 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 for accidental injury or illness which I may incur as a result of participating in any physical activity, any class, sessions and events at Little Roo, including private hire of the venue. I hereby assume all risks connected therewith and consent to participate in this program. I agree to disclose my physical limitations, disabilities, ailments, or impairments which may affect my ability to participate in this program.

Thanks for submitting!

086 842 5344

karen@littleroo.ie

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6 Temple Rd, Blackrock, Dublin, A94 WY46

Sandyford Community Centre, D18 E0A3

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