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Class Registration Form This is the form and the Waiver that you must fill out and mail in order to register for a class or workshop sponsored by the Mid-Atlantic Glass Beadmakers. Please read this entire form very carefully. Then fill it out, sign it, and mail it with the appropriate check to the address noted in the workshop announcement. IMPORTANT: You will not be registered for the class until you have received an e-mail confirmation of receipt of your check and this form from the SGB/MA. If you have any questions about the
process, please contact the Board member that has sent out the original
class announcement or contact Feedback. ................................................................................ Name of Workshop Instructor:__________________________________________________________ Dates of Workshop:__________________________________________________________ ................................................................................ Address:___________________________________________________________________
__________________________________________________________________________ Business
Phone:____________________________________________________________________ In case of emergency: ................................................................................ WAIVER
AND RELEASE OF LIABILITY 1.
By this instrument I hereby release Mid-Atlantic Glass Beadmakers. I
recognize and acknowledge that making glass beads is a potential dangerous
activity. I understand that beadmaking may include damage to or destruction of
personal property and serious physical injury. I am 18 year of age or older. 2.
I am submitting this release, waiver of liability, and assumption of risk
declaration voluntarily and of my own free will. 3.
I have had no physical or emotional problems, nor any history thereof, which
will impair my ability to participate in the event. 5.
I understand and EXPRESSLY ASSUME all the dangers incident to beadmaking
and hereby RELEASE ALL CLAIMS, including but not limited to, personal
injury, property damage or destruction, and death, whether caused by NEGLIGENCE,
breach of contract or otherwise, and whether for bodily injury, property damage
or loss or otherwise, which I may ever have against Mid-Atlantic Glass
Beadmakers, their employees, assistants, volunteers, and any other person or
entity who is a participant in or promoter of this event as well as any supplier
of materials and equipment employed in connection with my participation in the
event; 6.
I agree to assume all financial responsibility for any medical, rescue or other
expenses that I may incur or may be incurred on my behalf and agree to defend,
hold harmless and indemnify Mid-Atlantic Glass Beadmakers, employees,
assistants, volunteers, and assigns for any loss or damage, including
attorneys� fees, that they may suffer should I or anyone else on my behalf
pursue an action or claim that is waived or barred by this release or waiver or
any other claim by or on behalf of me arising out of the activity to which this
release relates; 7. This waiver, release and assumption of liability shall be binding upon me, my heirs, executors, and administrators. 8.
I have read and fully understand the written safety and
other rules and precautions that are a part of the requirements for my
participation in the above stated workshop/activity, if any, as well as those explained
to me by representatives of the above listed parties and I agree to strictly
observe them;
Date:______________________________________________ (Signature)_________________________________________
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