Event Waiver and Consent Form
SALT Conference
December 29, 2024 -January 1, 2025
First Name *
Last Name *
DOB *
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Email *
Address *
Phone number *
List of any Physical Limitations *
Emergency Contact Name:  *
Emergency Contact Phone: *
Emergency Contact Relationship to Participant *

I understand that there are certain risks of injury inherent in participating in this event, including traveling and other related activities incidental to my participation, and I am willing to assume these risks. I hereby certify that I am fully capable of participating in the designated activities and am healthy and have no physical or mental disabilities or conditions that would restrict full participation in associated activities. 

 

In addition to giving my full consent for my participation, I do hereby waive, release and hold harmless Chi Alpha Campus Ministries, UTSA Chi Alpha, its affiliates and representatives for any injury that may be suffered in the normal course of participation in the designated event and the activities incidental thereto, whether the result of negligence or any other cause. 

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