Baylor Tom Landry Fitness Center
Attn: Accounting
411 N Washington, Suite 3000
Dallas, TX 75246
Participant Name:
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Gender:
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Age:
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Address:
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City:
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State:
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Zip:
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Doctor Name:
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Area Code & Phone:
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I am ______________________________ who is participating in a training program at Baylor Tom Landry Fitness Center. I waive all claims against the BTLFC, the Baylor Health Care System and any of its affiliates, including all employees of such entities. I have no current health problems that would prevent me from participating fully in this program. I hereby give consent to be medically treated for injury or illness if the need arises while I am attending swimming lessons.
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Signature and Date