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Talent Maker City

109 Talent Avenue, TALENT, OR 97540

In consideration for the opportunity to participate and learn during Talent Maker City’s (TMC) workshops, I agree as follows:

1. I understand that the TMC workshop activities in which I voluntarily choose to participate may involve certain risks and dangers, which may include, but are not limited to: physical injury or damage to my property; the presence, use, and condition of power and hand tools and equipment; my own actions or inactions; the actions or inactions of other participants; and the negligence of TMC or any of its employees, instructors, volunteers, independent contractors, agents, owners, officers, directors, shareholders, and subsidiaries (the “Released Parties”).

2. To the best of my knowledge, I am in good physical condition and fully able to participate in workshop activities.

3. I voluntarily assume and accept the risks and all responsibility for any losses, liability, damages, claims, demands, or costs that I may incur as a result of or related to my participation in the workshop activities.

4. I hereby release, discharge, hold harmless and covenant not to sue the Released Parties for any losses, liabilities, injuries, including death, damages, claims, demands, expenses, or costs that I may incur and which arise out of or are related to my participation in the workshop activities or any act, omission, or negligence of the Released Parties, while participating in workshop activities.

5. I agree to follow all instructions of TMC’s instructors, volunteers and agents with respect to my participation in the workshop activities. I further agree that I will refrain from conducting the workshop activities in an unlawful or unsafe manner.

6. By signing my name, I acknowledge and represent that I have read the foregoing Release and Waiver of Liability, understand it and freely sign it; no oral representations, statements or inducements, apart from the foregoing written agreements have been made; and I execute this release for full, adequate and complete consideration, fully intending to be bound by it.

7. I acknowledge that TMC has installed security cameras on the premises for the safety and security of all visitors, staff, and property. I understand that my activities may be recorded while on-site, and this footage may be used solely for security purposes. By signing below, I consent to being recorded by these security cameras and understand that the footage will be managed in accordance with the organization's privacy and security policies.

First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Age Acknowledgment*
First Participant's Date of Birth*
I certify that I am 18 years of age or older
First Participant's Signature*
Second Participant's Name

First Name*

Last Name*
Second Participant's Date of Birth*
Third Participant's Name

First Name*

Last Name*
Third Participant's Date of Birth*
Fourth Participant's Name

First Name*

Last Name*
Fourth Participant's Date of Birth*
Fifth Participant's Name

First Name*

Last Name*
Fifth Participant's Date of Birth*
Sixth Participant's Name

First Name*

Last Name*
Sixth Participant's Date of Birth*
Seventh Participant's Name

First Name*

Last Name*
Seventh Participant's Date of Birth*
Eighth Participant's Name

First Name*

Last Name*
Eighth Participant's Date of Birth*
Ninth Participant's Name

First Name*

Last Name*
Ninth Participant's Date of Birth*
Tenth Participant's Name

First Name*

Last Name*
Tenth Participant's Date of Birth*
Parent or Guardian's Email Address

Email*
Check this box to be included in our newsletter.
Your signed waiver will be sent to the email address provided here and is available for download for three days via URL attachment.
Emergency Contact

First Name*

Last Name*

Emergency Contact's Phone Number*

Media Consent: Photos of activities will be taken during TMC Workshops. TMC will be sharing these photos on social media and on our website. Some photos may be put in our newsletter or shared with our collaborators and funders. If you would like to place conditions on your (or your child’s or ward/charge’s) photos or be removed from groups where photos are taken, please comment below.


Comment here to opt out of media

Family Doctor:
1. Does the student have any known allergies to medicines, foods, or bees?*
No
Yes

If yes, to what are they allergic and what happens when exposed?
2. Does the student have seasonal or environmental allergies (such as hay fever?)*
No
Yes

If yes, to what are they allergic and what helps?
3. Does the student take any medications regularly? *
No
Yes

If yes, what medications?
4. Does the student use any emergency medications, such as Epi-pen™ or asthma inhaler?*
No
Yes

If yes, what emergency medications?

** ALL MEDICATIONS BROUGHT TO TALENT MAKER CITY MUST BE LABELED WITH STUDENT  NAME, NAME OF MEDICATION, AND DIRECTIONS FOR USE. Bring only enough for EACH DAY. **


5. Is there anything else we should know about this student so that they can have a positive experience with us at TMC?
By checking this box, I give my permission for my student to attend the Talent Maker City programs. I grant permission for staff to seek necessary emergency medical attention should I be unavailable. We agree to follow all safety precautions and instructor directions. If my student does not comply with safety precautions or directions, they may be removed. We understand these rules and will comply with them.
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*

Last Name*

Phone*
Parent or Guardian's Age Acknowledgment*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
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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