Participant Agreement and Release of Liability


Please fill in the following information to create your document. For participants under 18, this document must be completed by a Parent or Court-Appointed Legal Guardian. Email verification must be completed before the document can be accepted at Vertical eXcape.





This is the person participating in any activities. If the participant is a minor, the form must be signed by a parent or legal guardian.
Participant Name

First Name *

Middle Name

Last Name *
Date of birth of the participant, not the person signing the waiver.
Participant Date Of Birth *
Participant Address

Address *


City *

State *

Zip/Postal *


Country
Phone Numbers *

Home Phone

Work Phone

Cell Phone
Emergency Contact

Emergency Contact First & Last Name *

Emergency Phone *
Email Address *


Electronic Signature Consent  *
By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.

SAVE INFORMATION FOR ADDITIONAL DOCUMENTS

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Do not print this page. Please complete the form and follow the steps.