Flotation Device Liability Waiver
Please complete this form to acknowledge and accept the risks associated with the use of flotation devices.
Participant Full Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Email Address
*
example@example.com
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.
Date of Activity
*
-
Month
-
Day
Year
Date
Location of Activity
*
Type of Flotation Device to be Used
*
Please Select
Life Jacket
Tube
Raft
Other
Signature of Participant (or Parent/Guardian if under 18)
*
Submit Waiver
Submit Waiver
Should be Empty: