Health and Liability Waiver

Please complete this waiver form before participating in our activities. Your safety is our priority.

First name

Last name

Email address

Phone number

Date of birth

Month

Day

Year

Emergency Contact Information

Emergency contact name

Emergency contact phone

Relationship to emergency contact

Health Information

Do you have any medical conditions that may affect your participation?

Yes

Please describe any medical conditions, allergies, or medications

Are you currently taking any medications?

Yes

Waiver and Release

By signing below, I acknowledge that I understand the risks involved in participating in these activities. I voluntarily assume all risks and release the organization from any liability for injuries or damages that may occur during participation.

I have read and understand the waiver terms and voluntarily agree to participate

I confirm that all information provided is accurate and complete

Participant signature

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Date signed

Month

Day

Year