banner

Emergency Contact and Authorized
Drop-off/Pick-up Form

Good2Go Mixed Martial Arts Summer Camp
1195 Hisey Ave. Woodstock, Va 22664
571-210-0142 | [email protected]

First and Last Name of Participant(s)
Participant(s) DOB
Fill in the information requested where you see "Values" in gray.
Fill in the information requested where you see "Values" in gray.

Only the individuals listed below will be permitted to pick up the child from Good2Go Mixed Martial Arts. A valid photo ID must be presented at pickup.


Please list all persons authorized to pick up your child, including yourself. Under no circumstance will the participants be allowed to leave with anyone NOT listed below.

Full Name, Relationship to Child and Phone Number of those Authorized to pick up and drop off
Full Name, Relationship to Child and Phone Number of those Authorized to pick up and drop off
Full Name, Relationship to Child and Phone Number of those Authorized to pick up and drop off

I certify that the information provided above is accurate and complete. I understand that Good2Go Mixed Martial Arts staff will only release my child to individuals listed on this form, and I agree to update this form in writing if any changes occur.

I also understand that in the event of an emergency, Good2Go Mixed Martial Arts has my permission to contact the emergency contacts listed above and take all necessary steps to ensure my child's safety, including contacting emergency medical services.

First and Last Name of Signer (Parent/Guardian)
Parent/Guardian Phone Number
Parent/Guardian Email Address
Today's Date
Clear
Member Signature (Parent/Guardian)

Warranties-There are no warranties either express or implied in this Agreement that are not expressly contained in this Agreement.

This waiver applies to all current and future participation unless revoked in writing.

Applicable Law-This Agreement shall be governed by the laws of the State of Virginia.

In the event of a legal dispute between myself and Good2Go Mixed Martial Arts, each party will be responsible for their own legal fees and court costs. However, if a court determines that a claim was made without merit or primarily to cause harm or disruption, I understand that I may be required to cover the Organization’s legal expenses.

Any legal action shall be filed in Shenandoah County, Virginia.

First of three forms...