University Seminar Activity Waiver
Complete this form to participate in the upcoming university seminar activity. Your waiver and emergency contact information are required.
Full Name
*
First Name
Last Name
Student ID Number
*
University Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Department or Major
*
Seminar / Activity Title
*
Date of Seminar / Activity
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Emergency Contact Name
*
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Relationship to Emergency Contact
*
Please Select
Parent
Sibling
Spouse
Friend
Other
Signature
*
Additional Comments (optional)
Submit Waiver
Submit Waiver
Should be Empty: