Atlantic Indemnity Waiver Form
Please fill out the following form to acknowledge and accept any potential risks involved and release liability.
Rider Details
Full Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Date of Birth
*
-
Month
-
Day
Year
Date
Activity/Event Name
*
Surf/Skate/SUP/ Kite Lessons
Any injuries/illness/allergies we need to know of?
Emergency Contact Details
Full Name
*
First Name
Last Name
Email
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Acknowledgement
*
I acknowledge that I have read and understand the risks involved in the activity/event.
I understand that participation in the activity/event is voluntary.
I release Atlantic Surf , its employees or contractors from any liability for injuries or damages that may occur during the activity/event.
I agree to abide by all rules and instructions provided by Atlantic Surf.
Signature
*
Submit
Should be Empty: