Welcome to the Steubenville Conferences Liability Waiver Generator



Group Information

Please check that the below information is correct and click ‘Next’.


*Select who you are and click ‘Next’ .

Participant Information


Primary Guardian


Secondary Guardian


Emergency Contact


Health Information(please have your insurance card with you at all times)


Food Allergies (select all that apply)
Milk
Egg
Wheat
Soy
Fish
Shell Fish
Peanuts
Tree Nuts
Gluten
Dairy
Diabetic Needs
Low Sodium
Other Food Allergies

This field is required.

Other Information


I understand that, in addition to this Liability Form, I must submit a Letter of Good Standing to the Christian Outreach Office at Franciscan University of Steubenville (for questions regarding the contents and requirements of this letter, please contact your group leader or call 740-284-5888)
I understand that I need to have an Adult Chaperon Application/Verification Form signed by my diocesan official in addition to this liability form in order to attend the Youth Conference.

Note: If you do not have an Adult Chaperon Application/Verification Form, please contact your group leader or youthconferences@franciscan.edu


Review the below information before proceeding.


Attendee Type


Type:

Personal Information


Email:

Title:

First Name:

Last Name:

Birthday:

Sex:

Home Parish:

Address1:

Address2:

City:

State:

Zip:

Home Phone:

Cell Phone:

Primary Guardian


Ttile:

First Name:

Last Name:

Email:

Home phone:

Cell phone:

Guardian Type:

Other:

Secondary Guardian


Ttile:

First Name:

Last Name:

Email:

Home phone:

Cell phone:

Guardian Type:

Other:

Emergency Contact


First Name:

Last Name:

Contact:

Relationship:

Health Information(please have your insurance card with you at all times)


Family Physician:

Physician Phone:

Insurance Co:

Insurance ID#

Insurance Group#

Cardholder's Name:

Food Allergies (select all that apply)
Milk
Egg
Wheat
Soy
Fish
Shell Fish
Peanuts
Tree Nuts
Gluten
Dairy
Diabetic Needs
Low Sodium
Other Food Allergies

Other Food Allergies:

Current Medication and Dosage (prescription and over the counter):

Medical History/Chronic Medical Problems (e.g. diabetes, epilepsy):

Medical Allergies:

To sign,left-click anywhere in the box above and hold down while using your mouse or trackpad to draw your signature.Click the 'Clear Signature' button to start over.