HCRA Waiver

You can no longer sign electronically

  • Revise form with correct information. Click Save & Email.
  • Print PDF from email or from Link on next page
  • Take a photo of signed form
  • Follow the link in the email or use next page to upload the photo of the signed form.

Do NOT print this page. Only print the PDF file. In addition to a copy in the email there will be a direct download link to your unsiged form too, in case email fails to work.

Gender: M for Male,
F for Female, X for undisclosed

Please check each field and make any corrections
necessary before saving.