←
Let us do this part
Today's Date:
Sat Nov 9 2024 01:21
RELEASE & LIABILITY WAIVER
Please read and answer
Risks
*
Makerspaces are all sorts of fun but also dangerous with hot soldering irons, sharp pointy things and fast moving power tools.
By signing this agreement, I acknowledge the risks of injury, property damage, or death resulting from the use of potentially dangerous tools or materials, even if the risks are unknown to me.
Release
*
I hold harmless MAKE SOUTH BEND and its respective members, employees, instructors and directors (collectively "MAKE SOUTH BEND") and release MAKE SOUTH BEND from all liability, claims, damage, or demands arising from or related in any way to being a member or guest of MAKE SOUTH BEND or your participation in any MAKE SOUTH BEND activity, whether caused by negligence of MAKE SOUTH BEND or otherwise.
Recording
I agree to let MAKE SOUTH BEND use any recordings of my awesome image and/or voice for any purpose. I release MAKE SOUTH BEND and waive any claims related to or arising by reason of the making and/or use of any such recordings.
*Please alert staff if you do not agree to have your image or voice used so we refrain from recording you. We just like to share photos of real people making cool things in our makerspace.
Responsibility
*
I am of sound body and mind and voluntarily elect to participate in MAKE SOUTH BEND activities with knowledge of the hazards involved. I accept personal responsibility for my safety and actions and will follow all safety instructions and signage while at MAKE SOUTH BEND.
If any provision, section, subsection, clause or phrase of this release is found to be unenforceable or invalid, that portion shall be severed from this contract. The remainder of this contract will then be construed as though the unenforceable portion had never been contained in this document.
Client Information
I hereby declare that I am of legal age (with valid proof of age) and am competent to sign this Agreement or, if not, that my parent or legal guardian shall sign on my behalf, and that my parent or legal guardian is in complete understanding and concurrence with this agreement.
Name:
*
Address:
Postcode:
Date of birth:
*
-Month-
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
-Day-
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
-Year-
1914
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
1919
1918
1917
1916
1915
If you are under
18
your parent/guardian will be required
Phone #:
Email:
*
Sign up for our newsletter
Signature:
*
Sign above or type signature:
Parent/Legal Guardian
I, as custodial parent or legal guardian of the above minor under 18 years of age, hereby consent to the terms and conditions set forth in this release form and I attest that all documentation I have provided is true and accurate.
Parent or Guardian Signature required for minors under 18 years of age.
Guardian's Legal Name:
*
Signature:
*
Photo ID
Please take photo(s) of your government issued photo IDs and related paperwork.
Remove Photo