Recess Cleveland Liability Release Form

We're sorry. This a link to our old waiver.
***You have reached this waiver via an old link. Please use one of the links below to access the latest version of our injury waiver

For recessROOM: http://recessroom.org/waiver/

For Recess Cleveland: http://recesscleveland.com/waiver/
Name of Participant*

First NameLast Name
Phone Number*

Area CodePhone Number
Event location you're filling out the waiver for*
E-Mail
Email*
example@example.com
Birth Date*

MonthDayYear
Name of Guardian

First NameLast Name
Birth Date of Guardian

MonthDayYear
Would you like to add any additional participants to this waiver?
Would you like to add any children as additional participants to this waiver?
Additional Child 1 Name

First NameLast Name
Additional Child 1 Birthdate

MonthDayYear
Date
Additional Child 2 Name

First NameLast Name
Additional Child 2 Birth Date

MonthDayYear
Date
Additional Child 3 Name

First NameLast Name
Additional Child 3 Birth Date

MonthDayYear
Date
Additional Child 4 Name

First NameLast Name
Additional Child 4 Birth Date

MonthDayYear
Date
Additional Child 5 Name

First NameLast Name
Additional Child 5 Birth Date

MonthDayYear
Date
Additional Child 6 Name

First NameLast Name
Additional Child 6 Birth Date

MonthDayYear
Date
Additional Child 7 Name

First NameLast Name
Additional Child 7 Birth Date

MonthDayYear
Date
Additional Child 8 Name

First NameLast Name
Additional Child 8 Birth Date

MonthDayYear
Date
Additional Child 9 Name

First NameLast Name
Additional Child 9 Birth Date

MonthDayYear
Date
Additional Child 10 Name

First NameLast Name
Additional Child 10 Birth Date

MonthDayYear
Date
I AM THE PARENT OR LEGAL GUARDIAN OF THE CHILD NAMED ABOVE AND HAVE THE LEGAL AUTHORITY TO EXECUTE THIS CONSENT AND RELEASE.

Yes
I/WE HAVE HAD SUFFICIENT OPPORTUNITY TO READ THIS ENTIRE DOCUMENT. I/WE HAVE READ AND UNDERSTOOD IT, AND I/WE AGREE TO BE BOUND BY ITS TERMS. *

Yes
Date

MonthDayYearHourMinutesAM/PM Option
Are you interested in learning more about our youth groups?*

YesNo
Are you interested in church at the Salvation Army?*

YesNo
Would you like to receive FREE event invites from Recess Cleveland (FYI - Recess is a 501(c)(3) nonprofit and most of our events are FREE to attend)?*

Yes, please let me know when you're hosting other eventsNo, I'm not interested in attending any other events
Our nonprofit also specializes in distributing toys to kids in need. Do you have any toys or play equipment, in any condition, that you would consider donating to our organization? (Please check all boxes that apply)*

Yes, I have toys and/or play equipment I'm willing to donateI don't have any toys or play equipment, but I'm interested in becoming donorI have a friend who may be willing to donate itemsI know a business who may be willing to helpNo, not at this time
Address

Street Address

Street Address Line 2

CityState

Zip Code
Would you like to volunteer at an upcoming Recess Cleveland event?*

Yes, looks like a blast. I would like to join the team.No, but I would like to learn how I can help with recess in other ways.No, not interested at this time, but thanks for asking.
Would you like to learn how you could rent our equipment for free and host events in your neighborhood?*

Yes, I would love toNo, but I would like to learn more about the Play Champion programNo, but I know an organization that may be interestedNo, not interested at all
Should be Empty:

We're sorry. This a link to our old waiver.