Volunteer Firefighter Waiver And Liability Release Form

Volunteer Firefighter Waiver And Liability Release Form
Please complete this form to acknowledge your understanding of the risks and responsibilities associated with volunteer firefighter participation, and to release the department/organization from liability.
Full Name
First NameLast Name
Date of Birth
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Address
Street Address
Street Address Line 2
CityState / ProvincePostal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Emergency Contact Name
First NameLast Name
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Volunteer Department/Organization Name
Briefly describe your prior firefighting or emergency response experience (if any)
Signature
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