USRowing Waiver
Please read the waiver and complete the form below.
Participant Name
*
First Name
Last Name
Email (copy of form will be emailed to this email)
*
example@example.com
Participant Date of Birth
*
/
Month
/
Day
Year
Date
Phone Number
*
Please enter a valid phone number.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Signature
*
Printed Name:
*
First Name
Last Name
Date of Form Completion
*
-
Month
-
Day
Year
Date
PARENTAL/GUARDIAN NAME & SIGNATURE (IF PARTICIPANT IS UNDER 18 YEARS OF AGE):
Parent Name/Guardian
First Name
Last Name
Parent/Guardian Signature
Submit
Should be Empty: