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Personal Injury Release & Photography Consent 

THIS PERSONAL INJURY RELEASE (this "Agreement") dated April 24, 2024.

OF THE FIRST PART 

AND 
Chandell Popik, all employees of the glass studio, and Under the Sun Stained Glass and Glass Art Studio of 4915-50th Avenue Leduc, AB T9E 6W7 (collectively the "Releasee") 

OF THE SECOND PART 

IN CONSIDERATION OF the covenants and agreements contained in this Agreement and other good and valuable consideration, the receipt of which is hereby acknowledged, the parties to this Agreement agree as follows:

Consideration
1.   In consideration of the Damages or personal injury sustained while on the premises attending any classes, workshops or special events held of 4915-50th Avenue Leduc, AB the receipt and sufficiency of which consideration is acknowledged,  the Releasor releases and forever discharges the Releasee the Releasee's spouse, heirs, executors, administrators, legal representatives and assigns from all manner of actions, causes of action, debts, accounts, bonds, contracts, claims and demands for or by reason of any injury to person which has been or may be sustained as a consequence of the incident described below.

Details of Incident
2.   The injury occurred at of #108, 4915-50th Avenue Leduc, AB The injury arose from: walking in or exiting, or while attending any classes, workshops or special events.

Concurrent Release
3.   The Releasor acknowledges that this release is given with the express intention of effecting the extinguishment of certain obligations owed to the Releasor, and with the intention of binding the Releasor's spouse, heirs, executors, administrators, legal representatives and assigns.

Full and Final Settlement
4.   The Releasor further understands and acknowledges that the Releasor may have suffered injuries or complications unknown at the present, that the settlement amount was determined taking into consideration this possibility, and that the Releasor is releasing these unknown claims.

5.   For the above noted consideration, the parties to this Agreement further agree not to make claim or take proceedings against any other person or corporation which might claim contribution or indemnity under the provisions of any statute or otherwise. 

6.   It is declared that the terms of this settlement are fully understood; that the amount or type of consideration stated is the sole consideration for this Agreement and that the sum is accepted voluntarily for the purpose of making a full and final compromise, adjustment and settlement of all claims for injuries, losses and damages resulting or which may result from the above described incident.

7.   This Agreement contains the entire agreement between the parties to this Agreement and the terms of this Agreement are contractual and not a mere recital.

No Admission of Liability
8.   It is agreed that the payment is not deemed to be an admission of liability on the part of the Releasee. 

Governing Law
9.   This Agreement will be construed in accordance with and governed by the laws of the Province of Alberta.

 

SIGNATURE:

First Participant's Name

First Name*

Middle 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*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

Email*

Confirm Email*
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PHOTOGRAPHY CONSENT
I the releaser consent to any photographs taken of students including myself/adolescent while in this studio location to be used for promotional, social media and other marketing materials produced by the Under the Sun Stained Glass and Glass Art Studio*
Yes
No
PERSONAL INJURY RELEASE FORM VALID TIME
At the request of the Releasor this PERSONAL INJURY RELEASE FORM is valid for *
1 month
6 months
1 year
5 years
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 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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