Indemnity Waiver Form
Please fill out the following form to acknowledge and accept any potential risks involved and release liability.
Full Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Date of Birth
 -
Month
 -
Day
Year
Date
Activity/Event Name
Description of Activity/Event
Acknowledgement
*
I acknowledge that I have read and understand the risks involved in the activity/event.
I understand that participation in the activity/event is voluntary.
I release the organization from any liability for injuries or damages that may occur during the activity/event.
I agree to abide by all rules and instructions provided by the organization.
Signature
*
Submit
Should be Empty: