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Wellness Warriors Waiver and Release of Liability 2019 for GUESTS
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* Indicates required question
Email
*
Your email
Your first name
*
Your answer
Your last name
*
Your answer
I am 18 years of age or older
*
Yes
No (must be 18 or older to participate)
I certify that I am able to swim or tread water for extended periods while wearing a personal flotation device (PFD).
*
Yes
No (You will not be able to join Wellness Warriors for on-water activities.)
Which event are you attending?
*
Friendship Night for Sponsors (August 12)
Family and Friends Night (August 19)
Survivor Guest Paddler
Other:
Please indicate your host's name here. This will be the name of a sponsoring organization (e.g. CRA, SGH), the name of a WW member (your paddler friend's name), or the name of your home dragon boat team.
*
Your answer
INFORMATION FOR BALANCING THE BOAT
Please provide your height and weight. The coaches use this information for seating the boat.
Height (inches)
*
Your answer
Weight (pounds)
*
Your answer
YOUR CONTACT INFORMATION
Street Address
*
Your answer
City/Town
*
Your answer
State
*
Your answer
Zip code
*
Your answer
Phone number (xxx-xxx-xxxx)
*
Your answer
EMERGENCY CONTACT
Name of Emergency Contact
*
Your answer
Best phone # for emergencies (xxx-xxx-xxxx)
*
Your answer
Electronic signature
*
By checking this box I am agreeing to the waiver and release of liability and this constitutes my signature
Required
A copy of your responses will be emailed to the address you provided.
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