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MakeICT Liabilty Waiver and Contact Form

In consideration for my being permitted to participate in the activities of MakeICT, I agree to the following waiver and release:

ASSUMPTION OF RISK: I acknowledge that inherent risks, dangers and hazards and such exist when using tools commonly used in a workshop environment. Participation in such activities and/or the use of equipment associated with technology design, manufacture and experimentation may result in injury, illness, death or damage to personal property. These risks and dangers may be caused by other participants, or by accidents, acts of nature or other causes. Risks and dangers may arise from foreseeable or unforeseeable causes including, but not limited to electrocution, burns, impalement, injury from slips or falls, etc.

RELEASE OF LIABILITY: I fully assume all risks associated with participation in events and exempt and release MakeICT, its members, officers, agents, board members, etc. from any action whatsoever arising out of any damage, loss or injury to myself or my property while upon the premises or using any equipment of the organization or while participating in any of the activities contemplated by this agreement whether such loss, damage, or injury results from the negligence of the corporation, its members, agents, or from some other cause.

COVENANT NOT TO SUE: I agree never to institute any suit or action at law or otherwise against MakeICT, its members, officers, board members, agents, etc. nor to initiate or any way assist the prosecution of any claim for damages or course of action which I, my heirs, executors or administrators hereafter may have by reason of injury to my person or property arising from the activities contemplated by this agreement.

THIRD PARTY INDEMNIFICATION: I will indemnify, save and hold harmless MakeICT, its members, officers, board members, agents, etc. from any and all losses, claims, actions, or proceedings of every kind and character which may be presented or initiated by any other persons or organizations and which arise directly or indirectly from the actions of the member while engaged in the activities contemplated by this agreement.

USE OF MEDIA: I hereby consent to the use of quotes and the taking of photographs and video while at the MakeICT makerspace or participating in MakeICT activities. I also grant the right to edit, use, and reuse media for nonprofit purposes including use in print, on the internet, and all other forms of media. I also hereby release MakeICT and its agents and employees from all claims, demands, and liabilities whatsoever in connection with the above.

I hereby acknowledge that I have CAREFULLY read all of the provisions above, fully understand the terms and conditions expressed there, and do freely choose acceptance of the provisions of the foregoing paragraphs relating to assumption of risk, release of liability, covenant not to sue, third party indemnification, and use of media.

Updated: 03/22/18

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First Participant's Name

First Name*

Middle Name

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Signature*
Parent or Guardian's Email Address

Email*

Confirm Email*
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Emergency Contact

First Name*

Last Name*

Emergency Contact's Phone Number*
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the parent or court-appointed legal guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Middle Name

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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