Amtgard, Barony of Solstice, Kingdom of Goldenvale
General Waiver and Informed Consent
To Participate in All
Amtgard Events and Functions
Please print
all information and turn in to the Chancellor:
Persona
Name:___________________________________________________________
Address:_______________________________________________________________
City:___________________________________State:________Zip:________________
Phone Number: (______)_____________
Email:________________
Date of Birth_____________________________o check
if you are under 18
I agree to release and hold harmless Amtgard,
The Kingdom of Goldenvale, Amtgard splinter group chapters, and all members of
all Amtgard Chapters from and against all claims, demands, and actions in
respect to damage to my person of my property arising in connection with my
participation in Amtgard functions. Furthermore,
I accept and understand that neither Amtgard, nor any Amtgard members are
responsible for any injuries received or given at any Amtgard function. I further understand that, as with any
physical sport, participation in Amtgard has an element of risk.
I also authorize by my signature herein
permission for medical treatment by professional means, if necessary, and I am
unable to answer for myself.
Signature of Participant
Date
Signature of Parent of Guardian (if
Participant is under 18)
Relationship
__________________________________ __________________________________
Monarch Chancellor
EMERGENCY
CONTACT LIST (please list two if possible)
Name:_____________________Phone:(H)__________________(W)_______________
If you have any ailments we should know about…please
list them on the back!