Release Form Question Title * 1. Participant name: Question Title * 2. Phone number: Question Title * 3. Email address: Question Title * 4. Emergency contact name: Question Title * 5. Emergency contact phone: Question Title * 6. Emergency contact email: Question Title * 7. Acknowledgements: INSERT YOUR LIABILITY RELEASE TERMS HERE I confirm that I am of legal age to give my consent. Question Title * 8. I consent to participate in [activity] given the acknowledgements above: I consent Question Title * 9. Signature: Question Title * 10. I acknowledge that by entering my name above I am providing a digital signature. Yes No Question Title * 11. Date: Date Date Done