Emergency Contact & Waiver of Liability Name(Required) First Last Phone(Required)Email(Required) Date of Birth(Required) Month Day Year Free Will Consent(Required) I represent that I am 18 years of age or older and legally capable of entering into this agreement.(Required)Additional Participants?Add Children / Wards To This Waiver For Whom I Am a Parent / Guardian Name Date of Birth Actions Edit Delete There are no Additional Participants. Add Additional Participant Maximum number of additional participants reached. HiddenNumber of Additional ParticipantsFree Will Consent(Required) The additional participant(s) entered above are under 18 years of age and I am hereby providing permission for them to participate in this program, and I agree to be responsible for their behavior and safety during this event.(Required)Emergency ContactEmergency Contact's Name(Required) First Last Emergency Contact's Phone(Required)Emergency Contact's Alternate PhoneEmergency Contact Relationship(Required) Waiver of LiabilityWaiver Document(Required)I acknowledge that participation in activities, events, or programs at the International ALERT Academy (IAA)/Institute in Basic Life Principles (IBLP) may involve risk of injury to my person and/or damage to my property. I acknowledge that I have been informed of the general nature of such risks. By my participation in these activities I agree to assume the risks involved and I agree not to hold IAA or IBLP responsible for any injury or loss that I may experience. I agree that in the event of accident or injury ALERT/IBLP personnel may need to exercise personal judgment regarding what actions should be taken on my behalf, unless I direct otherwise. I agree to follow and to obey any and all instructions/directions given by IAA/IBLP staff regarding the proper use of equipment, facilities, and property for my safety or the safety of others, as well as any and all of IAA’s rules and policies applicable to all activities related to this program/event. I understand that ALERT/IBLP reserves the right to exclude my participation in this program/event if my participation or behavior is deemed detrimental to the safety or welfare of others. In consideration for being permitted to participate in this program/event, and because I have agreed to assume the risks involved, I hereby agree that I am responsible for any resulting personal injury, damage to or loss of my property which may occur as a result of my participation or arising out of my participation in this program/event. I acknowledge that I have read and fully understand this document. Free Will Consent(Required) I further acknowledge that I am accepting these personal risks and conditions of my own free will.(Required)CAPTCHA
