Canteen Stay Waiver Form
Please complete this form to request permission and consent for staying in the canteen outside regular hours.
Participant's Full Name
*
First Name
Last Name
Affiliation (e.g., Student, Staff, Visitor)
*
Please Select
Student
Staff
Visitor
Other
Contact Email Address
*
example@example.com
Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Date(s) of Canteen Stay
*
-
Month
-
Day
Year
Date
Time Period of Stay (e.g., 6:00 PM - 10:00 PM)
*
Purpose of Stay in the Canteen
*
Emergency Contact Name
*
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Please specify any dietary restrictions, allergies, or medical conditions we should be aware of
Have you read and understood the canteen rules and guidelines?
*
Yes, I have read and understood the rules.
No, I have not read the rules.
Signature of Participant (or Parent/Guardian if under 18)
*
Submit Waiver
Submit Waiver
Should be Empty: