Stunt Participation Consent Form
Please complete this form to provide your consent and vital information before participating in a stunt activity.
Participant Full Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
*
example@example.com
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Relationship to Emergency Contact
*
Do you have any medical conditions or allergies we should be aware of?
*
Date of Stunt Participation
*
-
Month
-
Day
Year
Date
Type of Stunt or Activity
*
Please Select
High fall
Fire stunt
Fight choreography
Vehicle stunt
Water stunt
Other
Have you received and understood the safety briefing and instructions for this stunt?
*
Yes, I have received and understood the safety briefing.
No, I have not received the safety briefing.
Participant Signature
*
Submit Consent Form
Submit Consent Form
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