Maritime Academy Insurance Waiver Form
Please complete this form to participate in maritime academy activities. Your responses will help us ensure your safety and compliance with academy requirements.
Full Name
*
First Name
Last Name
Date of Birth
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Activity or Training Session
*
Please Select
Basic Seamanship
Navigation Training
Safety Drills
Water Survival Skills
Boat Handling
Other
Do you have any medical conditions or physical limitations that may affect your participation?
*
No, I have no medical conditions or limitations.
Yes, I will describe below.
If yes, please describe your medical condition or limitation.
Submit Waiver
Should be Empty: