Liability Waiver 2026
Last update 06 MAR 2026 - JZ
This form must be filled out IN PERSON at our OCB Facility witnessed by an OCB representative in Crown Point Indiana.
Everyone visiting OCB's Facility you must fill out this form.
ANY FORM YOU MAY FILL OUT HERE ON OCB'S WEBSITE IS HIPAA COMPLIANT. YOUR INFORMATION IS PROTECTED AND AVAILABLE TO YOU AT YOUR REQUEST.
Security Clearance Cards
Visitors will be issued a temporary visitor badge. Members regularly visiting our facility will be issued an access card after filling out this waiver. This card must be kept on you at all times and may be spot checked from time to time. Treat this as your membership card. If you lose it at anytime please reach out to staff and we will gladly make you a new one.
Name
*
First Name
Last Name
Suffix “Jr.” or “Sr.”
Date of birth
*
-
Month
-
Day
Year
Date
Gender - We collect this information to understand who is accessing our facility as part of our work to deliver inclusive programs that appeal to everyone in our community. Only intake / communications department / security / administration managers / medical professionals see these forms.
Woman
Man
Other
Phone Number
*
Home Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
County
*
Email
*
example@example.com
Reason for visit
*
I am a Veteran
I am a Visitor
I am a Volunteer / Intern
I am a Board Member
I agree that, anyone under the age of 18 is not permitted in dangerous or restricted areas (the shop). Volunteers / employees may not bring or accept visitors in areas where there are dangerous machines or chemicals, confidential records, or sensitive equipment. Representatives of regulatory bodies, approved visitors, and donors (e.g. investors) may be exempted, if they have received official authorization from management and have first filled out this form prior to entering restricted areas. In these cases, employees / volunteers should provide visitors with the necessary badges and protective equipment to enter premises when needed.
*
Yes
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). For VA benefits eligibility purposes, the Gulf War period is still in effect. This means that anyone who served on active duty from August 2, 1990, to present is considered a Gulf War Veteran.
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
*
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 - this must be an OCB representative
*
First Name
Last Name
Print Form
Submit
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