Amusement Ride Informed Consent Form
Complete this form to provide participant details, select the ride, and acknowledge the participation terms before riding.
Participant Information
Participant Full Name
*
First Name
Last Name
Date of Birth
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
*
example@example.com
Parent/Guardian Full Name
First Name
Last Name
Parent/Guardian Contact Number
Please enter a valid phone number.
Format: (000) 000-0000.
Ride Participation Details
Ride or Attraction
*
Please Select
Roller Coaster
Ferris Wheel
Water Slide
Haunted House
Log Flume
Bumper Cars
Other
Desired Participation Date and Time
*
Informed Consent and Acknowledgment
Electronic Signature
*
Submit
Submit
Should be Empty: