Minor Educational Activity Waiver Form
Complete this form to provide participant, guardian, activity, and emergency contact details and to acknowledge the waiver for the minor educational activity.
Participant and Guardian Information
Minor Participant Full Name
*
First Name
Middle Name
Last Name
Date of Birth
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Age
School or Organization Name
*
Parent or Guardian Full Name
*
First Name
Middle Name
Last Name
Parent or Guardian Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Parent or Guardian Email Address
*
example@example.com
Activity Details and Emergency Contact
Educational Activity Name
*
Activity Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Activity Location
*
Emergency Contact Full Name
*
First Name
Middle Name
Last Name
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Waiver Acknowledgment and Signature
Parent/Guardian Signature
*
Submit
Submit
Should be Empty: