Waiver Waiver Form First name: * Last name * Email: * Phone: * City * State/Province * AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Full Name of Emergency Contact: Relationship of Emergency Contact: Phone Number of Emergency Contact: Minor’s Name: Parent/Guardian Consent (for Participants Under 18) Parent/Guardian Consent: I am the parent or legal guardian of the minor named above. I have read and understood the waiver and release of liability policy of Everything’s Fine, Inc. DBA Wreck it Room, explained the risks to the minor, and consent to their participation. I agree to be bound by all terms herein on behalf of the minor by typing in my name/signature below. Wavier and Release of Liability Policy: By typing in my name/signature below I acknowledge that I have fully read and understood the waiver and release of liability policy of Everything’s Fine, Inc. DBA Wreck it Room. Participants: -- Please select an options --MyselfNew Person First name * Last name * Message: Captcha Submit If you are human, leave this field blank.
