Contractor Liability Waiver and Release Form
Please fill out your details and acknowledge your agreement to the terms to proceed.
Full Name
*
First Name
Last Name
Company Name or Job Title
*
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Services You Are Interested In Providing
Start Date (Today’s Date)
*
-
Month
-
Day
Year
Date
Independent Contractor Acknowledgment
*
Independent Contractor Acknowledgment:
I acknowledge and agree that I am providing services as an independent contractor and not as an employee of the company.
Indemnification and Hold Harmless:
I agree to indemnify and hold harmless the company from any and all claims, liabilities, injuries, damages, or losses arising out of or in connection with the services I provide as a contractor.
If your profession requires its own insurance and/or licensing, I confirm that I hold all proper and current documentation required for my field.
I confirm I hold all required insurance and/or licensing documentation.
Signature
*
Date Signed
*
-
Month
-
Day
Year
Date
Submit Waiver
Submit Waiver
Should be Empty: