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Waiver

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What activity is this Waiver and Release of Liability being created for?
Enter Activity:

What is the name of the party/organization being released from liability?
Enter Party Name:

What is the address of the party/organization being released from liability?
Address:
City:
State:
ZIP Code:

Is this waiver for a specific person or is this a general (blank) waiver form to be filled out by participants at a later time?
Select:
If 'general form' is selected, this form will be adjusted to allow participants to fill out their information after printing. If 'specific participant' is selected, additional information such as emergency contact and guardian information will be requested

Who is the person participating in the activity?
Participant Name:
Address:
City:
State:
ZIP Code:

Is the Participant a minor?
Select if Participant is a Minor:
- Yes
- No
What is the name of the minor's parent or guardian signing this waiver?:
What is the adult's relationship to the minor?:

Who is the participant's emergency contact?
Emergency Contact Name:
Contact Telephone Number:
Contact Relationship to Participant:

Would you like to include a second emergency contact?
Second Emergency Contact:
- Yes
- No
Second Emergency Contact Name:
Second Telephone Number:
Second Relationship:

Would you like to include a third emergency contact?
Third Emergency Contact:
- Yes
- No
Third Emergency Contact Name:
Third Relationship:
Third Telephone Number:

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