Waiver Form – Good Together Chicago

GTC Participant Consent and Release of Liability Waiver

Event Name & Waiver Form Overview

Please include name of event that you are signing up for. The following form is required to be reviewed, completed and submitted by all participants prior to attendance of any activity – regardless of format – that is organized by Good Together Chicago (“GTC”), a 501(c)(3) nonprofit organization with a mission is to enrich sober lifestyles and strengthen substance-free communities by connecting individuals to peer-based services and resources. We ask that you take a moment to read the mandatory participation terms as outlined below, as they are critical to maintaining the safety and well-being of all GTC activity attendees, staff, and partners.

Participant Name

First

Last

Participant Email

Participant Phone Number

Emergency Contact Name

First

Last

Emergency Contact: Relationship to Participant

Emergency Contact Phone Number

Overview Name Date

Additional Attendees: Name, Phone Number, Email Address

Please include the information for any additional attendees that you have included in your event sign up. If your reservation just includes you, please write “N/A” in the box.

Terms of Participation

Participant Has Reviewed & Agreed to Terms of Participation

Yes, I have Reviewed & Agreed to the Terms (applicable to all participants in my signup)

I hereby acknowledge that I have read and fully understand the contents of this waiver and voluntarily agree to its terms. Please note that each attendee is required to consent to the terms above and when checking “Yes” your consent applies to all applicable attendees you have included in your event sign-up. Agreement to the Terms of Participation is Required to participate in any Good Together Chicago Activity. Please note that each attendee is required to consent to the terms above, and when checking the terms agreement, your consent applies to all applicable attendees included in your event sign-up reservation.

Participant Signature

(First and Last Name)

Effective Date

Current Date Formatted: MM/DD/YYYY