Elderly Social Activities Participation Waiver

I, the undersigned, acknowledge that I am voluntarily choosing to participate in the social activities organized by .

I am aware that participation in these activities may involve certain risks. I hereby release and hold harmless , its staff, volunteers, and affiliates from any and all liability, claims, or demands for any injury, illness, loss, or damage which may be incurred as a result of my participation.

I confirm that I have read and understood the information provided and agree to participate at my own risk.

Participant Information

Full Name:
Date of Birth:
Phone Number:
Emergency Contact:
Relationship:
Emergency Contact Phone:
Participant Signature:
Date:
If applicable, Guardian Signature:
Date: