Liability Waiver

Print Name

DOB

Phone Number

Address

City

State

Zip

I have read and agree to the terms above

Signature of Participant

Date Signed

Parents' or Guardian's Additional Indemnification

(Must be completed for participants under the age of 18)

In consideration of the following minor(s): (print name(s) and DOB(s))

Being permitted by AUA to participate in its activities and to use its equipment and facilities, I further agree to indemnify and hold harmless AUA from any and all claims which are brought by, or on behalf of, minor(s), and which are in any way connected with such use or participation by minor(s).

Parent or Guardian Signature

Print Name

Parent/Guardian Date of Birth

Date Signed

Thank you, waiver signed

Your signature has been recorded. You may now close this page.