Media Release Form

Please fill out the following form.

First name

Last name

Date of birth

Month

Day

Year

Do you have any medical conditions, allergies, or physical limitations we should be aware of?

No

Yes

I confirm that I am physically able to participate in this workshop and assume all risks associated with participation.

In case of emergency, I authorize event staff to seek medical treatment on my behalf if necessary.

I release and hold harmless Something 2 Do Gulf Coast, its owners, instructors, employees, volunteers, and venue from any liability related to participation in this event.

Email

Digital Signature

Date

Month

Day

Year

I declare that the info I’ve provided is accurate and complete.