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Release of Liability PDF
Release of Liability
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What action is the creation of this Waiver and Release of Liability form?
Enter Activity:
Who or what organization is being relieved of liability?
Enter Party Name:
What is the address of the person or group whose liability is being released?
Address:
City:
State:
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
ZIP Code:
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Is this waiver for a particular person, or is it a general waiver form that participants will complete later?
Select:
Specific participant
General form
What is the name of the person participating in the activity?
Participant Name:
Address:
City:
State:
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
ZIP Code:
Are they minor participants?
Select if Participant is a Minor:
Yes
No
What is the name of the minor's parent or guardian signing this waiver?:
What is the adult's relationship to the minor?:
Guardian's Signature
Select
Draw Signature
Upload Signature
Draw Signature
Upload Signature
Drop files here or
Select files
Max. file size: 2 MB, Max. files: 1.
Who should they call in case of an emergency?
Emergency Contact Name:
Contact Telephone Number:
Contact Relationship to Participant:
Do you want to provide an additional emergency contact?
Second Emergency Contact:
Yes
No
Second Emergency Contact Name:
Second Telephone Number:
Second Relationship:
Would you like to add a third contact for emergencies?
Third Emergency Contact:
Yes
No
Third Emergency Contact Name:
Third Relationship:
Third Telephone Number:
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