Parent First Name *

Parent Last Name *

Parent Phone *

Parent Email Address *

Child's First Name *

Child's Last Name *

Select Child's Age * 5678910111213

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T-Shirt Size (unisex t-shirt sizes) * Youth Unisex - SmallYouth Unisex - MediumYouth Unisex - LargeYouth Unisex - X-Large

By checking this box, which also acts as my signature, I, the parent/guardian of the child, grant permission for my child to participate in physical activities provided by Kobia Fitness, LLC, a Virginia limited liability company doing business as Fit Body Boot Camp Blacksburg at Tech Village Center, 210 Prices Fork Road, Unit C, Blacksburg, Virginia 24060. I understand and accept all potential risks, including injury, illness, or infection. Despite knowing these risks, I consent for my child to participate. I waive all claims against the company, except for gross negligence or willful misconduct. I confirm my child's good health and commitment to follow all related laws and company guidelines. I agree to indemnify the company against losses and consent to necessary medical treatment for my child, assuming all costs. This agreement is binding under Virginia law. *