Educational Program Waiver Form
Please read and complete this waiver form to participate in the educational program.
Participant Full Name
First Name
Last Name
Date of Birth
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Parent/Guardian Full Name (if participant is under 18)
First Name
Last Name
Contact Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Emergency Contact Name
First Name
Last Name
Emergency Contact Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Do you understand and accept the risks involved in this educational program?
Yes
No
Do you agree to release the educational institution and its staff from any liability?
Yes
No
Additional Comments or Concerns
Signature of Participant or Guardian
Submit
Should be Empty: