County Services Liability Waiver Form
Please fill out the form to acknowledge the liability waiver for county services.
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 Service
*
Description of County Service Used
*
I acknowledge that I understand and accept the liability terms associated with county services.
*
1
I Agree
Liability Release and Waiver Acknowledgment
*
Would you like to receive future notifications about county services?
Yes
No
Address of Service Location
Signature (Electronic)
*
Submit
Submit
Should be Empty: