LIABILITY AND PUBLICITY RELEASE

LIABILITY AND PUBLICITY RELEASE
Participant's Name:

First NameLast Name
DOB:

MonthDayYear
Date
Address:

Street Address

Street Address Line 2

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Postal / Zip Code
Phone Number:
Please enter a valid phone number.Format: (000) 000-0000.
Please take a moment to review the Liability and Publicity Release below. You can print a copy of the document by clicking the print icon at the top right of the window or you may hit the arrow button and download a copy to your computer.
LIABILITY AND PUBLICITY RELEASE

I have read the statements in the document above and understand its terms and agree to all of them. I also certify that I am 18 years of age or older. If I am not 18 years of age or older, this form is also signed by my parent or legal representative; please see below. Further, if I do not understand this Release, I am 18 years of age or older, and I am not under the care of a legal guardian signing on my behalf, I will not sign this Release until after seeking the advice of a legal professional.
Select all that apply:
Signature of Client
Date

MonthDayYear
Date

CONSENT OF LEGAL REPRESENTATIVE