Kiosk Liability Waiver Form
Please complete this form before using the kiosk to acknowledge and accept the liability waiver.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Date of Kiosk Use
*
-
Month
-
Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
Age
*
Emergency Contact Name
*
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Which kiosk will you be using?
*
Please Select
Information Kiosk
Photo Booth Kiosk
Self-Service Kiosk
Other
Please list any known allergies or medical conditions (if none, write 'None')
*
I have read and understand the rules and safety instructions for kiosk use.
*
Yes, I acknowledge and agree
Signature
*
Submit Waiver
Submit Waiver
Should be Empty: