Positive Vibes Waiver Form
Please complete this waiver form to participate in Positive Vibes activities. Your information will remain confidential and is required for your safety and consent.
Participant Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Emergency Contact Name and Relationship
*
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Do you have any medical conditions or special requirements we should be aware of?
Participant Signature (Please sign below to confirm your agreement)
*
Submit Waiver
Submit Waiver
Should be Empty: