Liability – Afros In Tech

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Full Name

Phone

Date of Birth

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Emergency Contact Person

Contact Phone Number

Health Conditions or Allergies

Medications Being Taken

Description of the Activity or Event

Location

Date / Time

Date

Time

Email Assumption Conditions

Assumption of Risk

I understand and acknowledge that rock climbing involves risks such as falls, equipment failures, etc.
I understand that my participation in this activity is entirely voluntary.

Release and Waiver

Indemnification

Signature of the Participant

Clear Signature

Date of Signing