Free Health Disclaimer Template
Health Disclaimer
Please complete this form to acknowledge understanding of the health and safety information provided and to participate in the event.
Participant Information
Name
Date of Birth
Phone Number
Health Information
Do you have any known health conditions we should be aware of?
If yes, please specify:
Are you currently under medical supervision or taking any medication that may affect your participation?
If yes, please specify:
Consent and Acknowledgment
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I acknowledge that participation in this event may involve certain health risks. I confirm that I am in suitable health to participate and have consulted a healthcare professional if needed.
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I accept full responsibility for any potential risks and agree that [Your Company Name] will not be held liable for any health issues arising from participation.
Disclaimer
The information provided in this form is for health and safety purposes only and will be handled in strict confidentiality by [Your Company Name].
Signature
Name:
Date:
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