Hurricane Preparedness Liability Waiver Form
Complete this form to provide your participant details, emergency information, and waiver acknowledgment for hurricane preparedness activities.
Participant Information
Full Name
*
First Name
Middle Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Home City/State or General Location
Emergency and Activity Details
Preferred contact method
*
Email
Phone
Text
Planned activity date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Preparedness activity type
*
Evacuation drill
Home protection setup
Supply distribution
Community cleanup
Other
Emergency contact name
*
First Name
Middle Name
Last Name
Emergency contact phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Waiver Acknowledgment and Signature
Signature
*
Submit
Submit
Should be Empty: