Recreation Center Liability Waiver Form

Recreation Center Liability Waiver Form
Please complete this waiver form before participating in activities at the recreation center. All fields are required for participation.
Participant Name
First NameLast Name
Date of Birth
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Emergency Contact Name
First NameLast Name
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Relationship to Emergency Contact
Should be Empty: