Updated Liability Release - Playmaker11 / We Outside

Updated Liability Release - Playmaker11 / We Outside

Complete all sections to provide participant, emergency, and consent information for Playmaker 11 and We Outside Foundation events. Parent or legal guardian must sign for participants under 18.
Participant Name

First NameLast Name
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Age
Parent/Guardian Name (if minor)

First NameLast Name
Relationship to Participant
Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
City, State, Zip
Participant Phone
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Emergency Contact Name

First NameLast Name
Emergency Contact Phone
Please enter a valid phone number.Format: (000) 000-0000.
Primary Physician (optional)
Known allergies or medical conditions
Medical and Safety Information (medications, mobility concerns, restrictions, etc.)
Participant Signature
Participant Signature Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Participant Printed Name
Participant Age at Signature
Parent/Guardian Signature (if minor)
Parent/Guardian Signature Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Parent/Guardian Printed Name
Staff/Witness Name or Signature
Should be Empty: