Liability Waiver Requirements Checklist Form
Use this form to confirm that the liability waiver package is complete and to provide the details needed for review.
Participant Information
Participant Full Name
*
First Name
Middle Name
Last Name
Organization or Company Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Liability Waiver Details
Waiver or Activity Title
*
Activity/Event Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Location
*
Waiver/Release Acknowledgement
Required Waiver Components Checklist
*
Signed waiver copy
Emergency contact details
Witness/guardian signature if applicable
Insurance acknowledgement if required
Safety acknowledgment completed
Submission Sign-Off
Name of Signer
*
First Name
Last Name
Signature
*
Submit
Submit
Should be Empty: