Restaurant Arbitration and Class Action Waiver Acknowledgement Form
Please review and acknowledge the arbitration and class action waiver terms below. Complete all fields and provide your signature to confirm your understanding.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Restaurant Location or Branch
*
Date of Acknowledgment
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Role/Relationship to Restaurant
*
Please Select
Customer
Employee
Contractor
Other
I acknowledge that I have read and understand the arbitration agreement terms provided to me.
*
Yes, I acknowledge
I acknowledge that I have read and understand the class action waiver terms provided to me.
*
Yes, I acknowledge
I confirm that I have had the opportunity to review the terms and ask any questions before signing.
*
Yes, I confirm
Signature
*
Submit
Submit
Should be Empty: