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LIABILITY WAIVER FORM
First Name
Email
Last Name
Date of Birth
Do you have a doctor's permit to participate in intense activities?
*
Required
Yes
No
Medical Concerns
Emergency Contact Person
Emergency Contact Number
Your Signature
Clear
I declare that the info I've provided is accurate and 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 program. I agree to disclose my physical limitations, disabilities, ailments, or impairments which may affect my ability to participate in this program.
Submit!
Submitted successfully!
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