Rescue Waiver form

Volunteer Release Waiver of Liability
Today's Date*

MonthDayYear
Date
Your Name*

First NameLast Name
Phone Number*
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Date of Birth*

MonthDayYear
Date
Emergency Contact*

First NameLast Name
Emergency Contact Phone Number*

Area CodePhone Number
YesNo
If under the age of 18 you must have a parent or legal guardian sign this waiver before you may participate in any activities at or for NC Cooperative Extension in Union County.
Name of Guardian*

First NameLast Name
Phone Number*

Area CodePhone Number
Relationship to Volunteer*
Signature of Guardian*

Clear
Signature of Volunteer*

Clear
Should be Empty:

Volunteer Release Waiver of Liability