ASSUMPTION OF RISK, INFORMED CONSENT, AND WAIVER OF LIABILITY AND INDEMNIFICATION AGREEMENTLiability and Indemnification Agreement • May 3rd, 2021 • Utah
Contract Type FiledMay 3rd, 2021 JurisdictionParticipant (print full name): Date of Birth: / / Address: City: State: Zip: Program/Course (Specify if online): Date(s) of Program/Course: Emergency Contact Name: Relationship: Phone: Participant’s Insurance ID, Carrier, Address, and Phone: