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Waiver of Liability Statement Fax Number: 14088741962 Waiver of Liability (WOL) only applies to noncontracted providers for Disconnect members. Noncontracted providers must include a signed LOW form

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How to fill out waiver of liability statement

01

Read the waiver of liability statement carefully to understand the terms and conditions.

02

Fill out your personal information accurately including your full name, address, and contact details.

03

Sign and date the waiver of liability statement to acknowledge your agreement with the terms specified.

04

If required, have a witness sign the statement as well to validate the agreement.

05

Make a copy of the signed waiver for your records and submit the original where necessary.

Who needs waiver of liability statement?

01

Anyone participating in activities that pose a risk of injury or damage may need to sign a waiver of liability statement.

02

This includes participants in sports events, recreational activities, fitness classes, and other potentially risky endeavors.

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What is waiver of liability statement?

A waiver of liability statement is a legal document that individuals sign to acknowledge the risks associated with an activity and agree not to hold the organization or individuals responsible for any injuries or damages.

Who is required to file waiver of liability statement?

Typically, organizations or businesses that conduct activities where there are potential risks to participants are required to have individuals file a waiver of liability statement.

How to fill out waiver of liability statement?

To fill out a waiver of liability statement, individuals usually need to provide their name, contact information, and an acknowledgment of understanding the risks involved, along with their signature.

What is the purpose of waiver of liability statement?

The purpose of a waiver of liability statement is to protect the entity conducting the activity from legal claims by participants in case of injury or damage.

What information must be reported on waiver of liability statement?

The information that must be reported typically includes the participant's name, contact information, details of the activity, acknowledgment of risk, and the participant's signature.

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