Steubenville Liability Waiver Form Generator

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, Preferences, & Restrictions

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:

T-Shirt Size:

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, Preferences, & Restrictions
None
Dairy
Lactose
Gluten
Nuts
Wheat
Soy
Fish
Shellfish
Eggs
Corn
Diabetic Needs
Gluten-Free
Kosher
Low Sodium
Vegan
Vegetarian
Other Food Allergies

Other Food Allergies:

Medical Allergies:

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

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

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.