Waiver Form
Please fill out one waiver per participant
Participant Full Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Second Participant Full Name from Same Household - if applicable
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Parent/Guardian Full Name (if participant is under 18)
*
First Name
Last Name
Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
*
example@example.com
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Date of Event
*
-
Month
-
Day
Year
Date
Event Host / Location
*
YES, I give my permission for Velocity Games to use photos and/or videos of my child for social media and promotional content.
NO, I do not give my permission for Velocity Games to use photos and/or videos of my child for social media and promotional content.
WRITE FULL NAME of Participant or Parent/Guardian (this will act as a valid signature)
Submit
Should be Empty: