Fillable Webster University Statement Of Responsibility

Fill Online, Printable, Fillable, Blank Webster University Statement Of Responsibility Form

Use Fill to complete blank online WEBSTER UNIVERSITY pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

Webster University Statement Of Responsibility

On average this form takes 6 minutes to complete

The Webster University Statement Of Responsibility form is 1 page long and contains:

  • 1 signature
  • 0 check-boxes
  • 21 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Webster University

BROWSE WEBSTER UNIVERSITY FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
ACTIVITY PARTICIPATION CERTIFICATE
SECTION I: Application for on and off-campus participation in curricular and extra-curricular activities.
ACTIVITY NAME:_______________________________Date:_________________
Student’s Name:
Student ID Number:
Pe
rmanent Address, City, State, ZIP:
Ca
mpus Address, City, State, ZIP:
In Case of Emergency Notify
Na
me: Relationship: Work Phone:
Home Phone:
Na
me: Relationship: Work Phone:
Home Phone:
Li
st any medical conditions:
Li
st any allergies:
Insuran
ce Company Name:
Policy # / Member ID #:
Group #:
Contact Number:
SECTION II: Authorization of Treatment and Release
I realize that my voluntary participation in activities either on or off campus could constitute a potential risk.
I acknowledge that even with the best supervision, and strict observance of rules, accidents are still possible.
I will not hold Webster University responsible in case of accident or injury whether en route to or from an activity or during
participation of such an activity. I agree to hold Webster University, its employees, agents, representatives, instructors, and
volunteers harmless from any and all liability, actions, causes of action, debts, claims, or demands of every kind and nature
which may arise by or in connection with participation in any university activity.
In the event of an emergency, I authorize Webster University to make arrangements as reasonably necessary for my welfare.
I authorize the
Hospital/Physician/Dentist
to perform medically necessary procedures.
I UNDERSTAND THAT THE COST OF MEDICAL ATTENTION AND AMBULANCE ARE NOT THE
RESPONSIBILITY OF WEBSTER UNIVERSITY, ITS EMPLOYEES, AGENTS, REPRESENTATIVES,
INSTRUCTORS, AND/OR VOLUNTEERS.
X
Signature of Participant or Parent/Legal Guardian if Participant is a Minor Date
Please return a copy of this form to
Saa Meier
Loretto Hall 260 Email: kitprasu@webster.edu
click to sign
signature
click to edit
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

Webster University Statement Of Responsibility

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 2 February 2021

Message

View Audit Log
Print With Audit Log
Duplicate Document