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BLUE THERAPY ACTIVE
In, On, or Near the Water's Edge
Date of Birth
Please specify anything we should know about
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. I hereby assume all risks connected therewith and consent to participate in this activity. I agree to disclose my physical limitations, disabilities, ailments, or impairments which may affect my ability to participate in this activity.
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