Forms & Waivers

Please complete and send in these forms prior to arriving for your WAO adventure:

Waiver & Liability Release

Medical Form

Personal Information

Name

First Name

Last Name

Date of Birth

MM

DD

YYYY

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Emergency Contact

Name

First Name

Last Name

Relationship to the applicant:

Parent

Sibling

Aunt/Uncle

Friend

Coworker

Primary Phone

(###)

###

####

Secondary Phone

(###)

###

####

Additional Contact Information

Work phone with extension, email, etc.

Medical Information

All information is confidential and will only be used as reference in case of emergency.

Allergies:

If you have any allergies please list them below with any medication you may take for them.

Medications:

If you take any medications please list them below – including the reason for use.

Medical Conditions:

If you have any medical conditions, please list them here – including the length of time you've had the conditions.

Date of last tetanus shot:

MM

DD

YYYY

Any additional information?

Do you have any additional medical information you would like to include not listed above?

Medical Contact

Family Doctor

First Name

Last Name

Doctor's Phone Number

(###)

###

####

Medical Insurance

Please include the policy provider and policy number below:

Confirmation

I confirm that the information given above is accurate and honest:

Yes

No

Printable Medical Form

Acknowledgement of Risk