Beach Event Liability Waiver Form

Participant Full Name

First NameMiddle NameLast Name

Date of Birth

Date

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Email Address

example@example.com

Home Address

Street Address

Street Address Line 2

CityState / ProvincePostal / Zip CodeCountry

Event Date

Date

Event Name or Location

Emergency Contact Name

Emergency Contact Relationship

Emergency Contact Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

How would you describe the participant’s swimming ability?

Does the participant have any condition that could affect safe participation in beach activities?

Which beach-related allergies or sensitivities should we be aware of?

Please note any special accommodations, restrictions, or safety considerations for the participant.

Participant or Guardian Signature

Date of Signature

Date