University Workshop Class Participation Waiver
Please complete this form to participate in the university workshop. Your information will be used to confirm your registration and agreement to the participation waiver.
Participant Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Are you a current student, faculty, or staff member?
*
Student
Faculty
Staff
Visitor
Department or Major (if applicable)
Workshop/Class Title
*
Workshop/Class Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Emergency Contact Name
*
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Please list any allergies, medical conditions, or special needs we should be aware of (if none, write 'None')
Participant Signature
*
Submit Waiver
Submit Waiver
Should be Empty: