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* 1. My name is

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* 2. I am the parent or legal guardian of [name the child].

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* 3. My relationship to this child is

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* 4. My child plans to be a part of the Rock Climbing Class during Winterim at CHS.

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* 5. I grant permission to CHS for my child to participate in the Rock Climbing Winterim on January 2-4, 7, 2019,
at Rock Climb Fairfield (RCF), 85 Mill Plain Rd, Fairfield, CT 06824. I grant approved CHS chaperones permission to transport my child to/from the venue and to take responsibility for my child throughout the Winterim program. Please write your name in the space provided to indicate that you approve.

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* 6. My child will do which of the following on each day?

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* 7. I grant permission for my child to

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* 8. As is required by Rock Climb Fairfield, I have also completed the online waiver that is essential for all minors to climb at the gym Rock Climb Fairfield Waiver Link.

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