Sign in & Release of Liability

Thank you for visiting DignitySOS. We are here for you! Please complete the following form to sign in and enact your liability waiver.

Date

Month

Day

Year

First name or Initials

Last name

Phone

Address

Location

If "Other," Enter Location

If Children/Minors (people under age 18) are with you:

For the safety of clients, staff, and volunteers, any child/minor who utilizes DignitySOS services, or who accompanies an adult using DignitySOS services, MUST be accompanied by an adult, parent, relative, or approved guardian. DignitySOS does NOT provide childcare or supervision of children/minors in any way. DignitySOS does not verify or confirm or monitor accompanying adults. As self-determined mandatory reporters, any DignitySOS staff or volunteer will report any concerns they observe in the treatment of children/minors.

By checking this box, I affirm that I have read and understand the DignitySOS policy regarding children/minors.

Please provide the following information about children/minor(s) accompanying you.

Please list the first name and age of each child/minor accompanying you.

Release of Liability

Guests, and all persons accompanying registered guests, who utilize the free shower service of DignitySOS hereby accept responsibility for their personal property and safety and irrevocably release and save and hold harmless DignitySOS, its affiliates, associates, representatives, and parent organization from any cost or liability whatsoever arising from loss, damage, personal injury, illness, weather-related circumstances, or any circumstance beyond their control occurring during or affecting a Guest's use of DignitySOS services or equipment.

With this mark I affirm and understand and agree to this release of liability.

Signature (Your personal information, including your full name is not shared outside of DignitySOS.)

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