Tutoring Liability Waiver Form

Tutoring Liability Waiver Form
Please complete this form to acknowledge and accept the risks associated with tutoring sessions.
Participant Full Name
First NameLast Name
Date of Birth
MonthDayYear
Date
Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Address
Street Address
Street Address Line 2
CityState / ProvincePostal / Zip Code
Are you the participant or a parent/guardian filling this form?
Parent/Guardian Full Name (if participant is under 18)
First NameLast Name
Emergency Contact Name
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Please specify any allergies or medical conditions we should be aware of (write 'None' if not applicable).
Session Details (e.g., subject, date, tutor name)
Signature
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