Liability Waiver 2021
If you would like access to OCB's Facility you must fill out this form. This form must be filled out in person at an OCB Facility witnessed by an OCB representative.
Name
*
First Name
Last Name
Suffix
Date of birth
*
-
Month
-
Day
Year
Date
Phone Number
*
-
Area Code
Phone Number
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
OCB Location that you are filling out this form
*
Indiana-01
Alabama-01
California-01
Reason for visit
*
I am Veteran
I am first time Visitor
I am a new Volunteer / Intern
I am a new Board Member
Age group
*
18 - 24
25 - 39
40 - 55
56 - 70
70+
Branch of Service
*
I am not a Veteran
Army
USMC
Air Force
Navy
Coast Guard
Space Force
Under current law, the VA recognizes the following wartime periods to decide eligibility for VA pension benefits: under which time did you serve?
*
World War II (December 7, 1941, to December 31, 1946)
Korean conflict (June 27, 1950, to January 31, 1955)
Vietnam War era (February 28, 1961, to May 7, 1975, for Veterans who served in the Republic of Vietnam during that period. August 5, 1964, to May 7, 1975, for Veterans who served outside the Republic of Vietnam.)
Gulf War (August 2, 1990, through a future date to be set by law or presidential proclamation)
none of the above
Wartime Service?
*
Yes
No
Peacetime Service?
*
Yes
No
Combat Award?
*
Yes
No
Service Connected Disability?
*
Yes
No
In case of an emergency, please call
*
First Name
Last Name
Emergency Contact Phone Number
*
-
Area Code
Phone Number
I HAVE READ THIS DOCUMENT AND UNDERSTAND IT. I FURTHER UNDERSTAND THAT BY SIGNING THIS RELEASE, I VOLUNTARILY SURRENDER CERTAIN LEGAL RIGHTS.
*
YES
OCB regularly takes pictures during shop day and at events. Do you grant us permission to use your likeness on OCB digital and print media?
*
YES
I, the [applicant, requestor, etc.] for this [type of form], warrant the truthfulness of the information provided in this application.
*
YES
OCB'S SHOP STANDARD OPERATING PROCEDURES HAVE BEEN EXPLAINED TO ME
*
YES
Last 4 of your SSN
*
Signature
*
Witness
*
First Name
Last Name
Please verify that you are human
*
Submit
Print Form
Should be Empty: