Helium Liability Waiver Form
Please complete this form to provide participant details, helium activity information, and waiver acknowledgment before participating.
Participant Information
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Date of Birth
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Helium Activity Details
Activity Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Activity Type
*
Please Select
Balloon Release
Decor Installation
Demonstration
Workshop
Other
Location / Venue
*
Notes on Role or Planned Involvement
Waiver Agreement
Participant Signature
*
Submit
Submit
Should be Empty: