Liability Release for
Who are you filling out this form as?
*
Participant (Minor)
Parent/Guardian
Participant Name
*
Enter participant name
Participant E-mail
*
Guardian email can be used here.
Parent/Guardian 1 Name
*
This person is responsible for supplying medical information for the participant
Guardian 1 Email
*
Add Additional Second Guardian (optional)
Parent/Guardian 2 Name
Guardian 2 Email
Emergency Contact Full Name
Emergency Contact Phone Number
Ministry
aiaEventtrip
Start Date
End Date
Admin Name
Admin Email
Admin Email2
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