Participation Waivers | RIW4L

Participation Waivers | RIW4L

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Health Declaration

Please fill out the following forms
in order to participate in our activity.

First name

Last name

Email

Date of Birth

Have you been hospitalized in the last 12 months?

No

Yes

Are you suffering from a medical condition, illness, or injury?

No

Yes

If you answered yes to any question, please elaborate

Initials

I declare that the info I’ve provided is accurate & complete

Thanks for submitting!

Liability Waiver

First name

Email

Last name

Date of Birth

Do you have a doctor’s permit to participate in intense physical activities?

No

Yes

Please specify anything we should know about

Initials

I declare that the info I’ve provided is accurate & complete

I hereby acknowledge this release from liability for accidental injury or illness which I may incur as a result of participating in any physical activity. I hereby assume all risks connected therewith and consent to participate in this program. I agree to disclose my physical limitations, disabilities, ailments, or impairments which may affect my ability to participate in this program.

Thanks for submitting!

Emergency Contact Form

First name

Email

Address

Contact Last Name

Contact Phone Number

Last name

Phone

Contact First Name

This contact is my

Contact Email

Thanks for submitting!
We’ll contact this person only in case of emergency.

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