FIVE STAR LIFE WAIVER
2026-2027
Participant Information
Participant Name
*
First Name
Last Name
Date of Birth
*
MM/DD/YYYY
Group Name (Use full group name with whom you are associated)
*
Organization
Participant's Allergies (environmental, food, or otherwise)
There are animals and environments that may not be suitable for everyone, but adjustments can be made.
Participant's Limitations (physical, emotional, mental, or otherwise)
The more information we receive, the better we're able to provide a Five Star Experience.
How did you hear about us?
Emergency Contact Information
Emergency Contact #1 Name
*
First Name
Last Name
Emergency Contact #1 Number
*
-
Area Code
Phone Number
Emergency Contact #1 Email
*
example@example.com
Relationship
*
To Participant
Emergency Contact #2 Name
*
First Name
Last Name
Emergency Contact #2 Number
*
-
Area Code
Phone Number
Emergency Contact #2 Email
*
example@example.com
Relationship
*
To Participant
Household Information *OPTIONAL*
This information is used to help us make the most informed decisions to serve our families in the best possible ways.
Household Size
Household Income
Liability Release
Participant Signature OR Parent/Guardian Signature (if under 18 years of age)
*
Parent/Guardian Name (if signing for a minor)
First Name
Last Name
Submit
Should be Empty: