Recess Cleveland Liability Release Form

Release and Waiver of Liability and Indemnity Agreement

Last edited 6/29/22
***You only have to complete a waiver with us once each calendar year. If you have already filled out this form, then please use our self check-in page to look up your profile in our system using your phone number.

If you have not filled out a wavier with Recess Cleveland before, then please fill out the form below:
Name of Participant *

First Name Last Name
Phone Number *

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

Month Day Year
Name of Guardian

First Name Last Name
Birth Date of Guardian

Month Day Year
Would you like to add any additional participants to this waiver?
I AM THE PARENT OR LEGAL GUARDIAN OF THE CHILD NAMED BELOW 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

Month Day Year Hour Minutes AM/PM Option
Are you interested in learning more about our youth groups? *

Yes No
Are you interested in church at the Salvation Army? *

Yes No
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 events No, I'm not interested in attending any other events
Address

Street Address

Street Address Line 2

City State

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 to No, but I would like to learn more about the Play Champion program No, but I know an organization that may be interested No, not interested at all
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Release and Waiver of Liability and Indemnity Agreement