Event Smoking Liability Waiver Form
Please provide your details, acknowledge the smoking rules and waiver, and sign to confirm your agreement.
Participant Information
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Age Confirmation
*
I am 18 years of age or older
I am under 18 years of age
Event and Smoking Acknowledgment
Event Name
*
Event Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Smoking Area Acknowledgment
*
I will smoke only in designated smoking areas and follow posted rules
Emergency Contact and Signature
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Participant Signature
*
Submit
Submit
Should be Empty: