Authority to Execute Waiver, Register and/or to Act as Agent. You represent and warrant to Galena Tech Institute and Bridgewire, its affiliates, and related companies and the officers, directors, employees, agents, insurers, servants and attorneys thereof (collectively, hereinafter “GTIB”) that you have full legal authority to enter into and execute this Waiver of Liability, Release and Assumption of Risk (hereinafter “Waiver”) for participation in a class, camp, or workshop using tools and/or equipment (the “Education Event”) provided by GTIB or its agents/representatives on behalf of yourself and/or any party(ies) who will participate in the Education Event with your authority (collectively, “Students”). You represent and warrant that you are over the age of 18. If a child will be participating in the Education Event, you represent and warrant that you are the parent or legal guardian of that party and have the legal authority to execute this Waiver on their behalf.

 

1. Safety Compliance and Rules. Tools and equipment in the Education Event are safe guarded as much as possible. General safety and safe tool use practices are emphasized repeatedly. However, bodily injury can occur through carelessness, misuse of tools, disobedience, or otherwise.

 

The Students make the following pledge:

___ I agree to follow all safety rules in the GTIB building.

___ I agree to not use any tools until I have been given an initial orientation by the instructor, observed the teachers demonstration and have been given approval for tool use by the teacher.

___ I agree not to jeopardize the safety of my classmates by carelessness, indifference to safety or participating in horseplay.

___ I agree to report all accidents, even if they appear to be minor, to the teacher immediately.

___ I agree to show respect and consideration for the tools and equipment used in the GTIB building. I understand that class instructors and teaching assistants will fully train all students to use safe practices and will monitor student usage, when possible, but once trained on safe usage of tools, the student may have the opportunity to use tools without direct supervision and accept responsibility therefore.

 

By Initialing here Parent/Guardian __________Youth __________

 

I confirm I have read and agree to adhere to the safety guidelines as described on the Safety Guidelines and FAQs web page (https://feenx.org/camp-safety-and-q-a/), and also to follow verbal instructions given by class instructors and teaching assistants. I understand that refusal to comply with safety guidelines may result in
dismissal from the class, without refund.

 

2. I hereby release, waive, discharge and covenant not to sue GTIB, building operator, tool owner, member, visitor, any persons in the GTIB, promoters, sponsors, advertisers, owners and lessees of GTIB spaces and each of them, their officers, members and employees (all herein referred to as “Releases”), from all liability to the undersigned, my personal representatives, assigns, heirs, and next of kin for any and all loss or damage, and any claim or demands therefore on account of injury to my person or property or resulting in my injury or death, or risk of injury or death, or damage to my property, whether caused by the negligence of the Releases or otherwise, while I am in GTIB.

 

3. I hereby agree to Indemnify and save and hold harmless the Releases and each of them from any loss, liability, damage, or cost they may incur due to my presence in GTIB, and whether caused by the negligence of the Releases or otherwise. If a member of my family under the age of 18, or a guest of mine uses or occupies GTIB, I make this release and these representations on his or her behalf as well as my own, and I agree to assume responsibility for his or her safety. Further, I agree to indemnify and hold harmless Releases in the event a member of my family or my guest sues them or any one of them. I understand that this means I will pay all fees, costs, and charges incurred by Releases, including all fees, costs and charges incurred by Releases, including attorney fees.

 

4. Health of Students. I certify that to the best of my knowledge and belief I and any Students under 18 years old are physically fit and know of no medical or health reason why the Student(s) should not use the tools and equipment in the Education Event. In case of illness or injury, permission is granted for emergency treatment to be administered. It is further understood that the undersigned will assume full responsibility for any such action, including payment of costs. I hereby advise that the minor has the following allergies, medicine reactions or unusual physical conditions, which should be known to the physician: (If none, please
write the word “none”)

 

5. Risks. I acknowledge that participation in Education Events delivered by GTIB comes with risk. Depending on the class being taken, I understand that I may have an opportunity to use many different types of hand tools and/or power tools and equipment, including but not limited to: power drills and drivers; powered saws such as table saws, chop saws, band saws, and circular saws, nail guns; hand tools such as hammers, chisels, wire cutters, and utility knives.

 

The risks of participating in Education Events include but are not limited to: trips and falls, bruising, foreign objects in skin or eyes, hearing damage, electric shock, cuts, and other injuries including disability and the loss of limbs or life. I further realize that those risks could occur as a result of equipment failure, bad decision-making, and unforeseeable accidents, and I assume all risks associated with such accidents.

 

6. Publicity Release. I understand that program activities of GTIB may occasionally be photographed, videotaped, or audio taped for Education, publicity, or fundraising purposes.

 

By initialing here ___________, I give permission for all Students to appear in videos, photographs, or audio recordings, without compensation (e.g., as part of brochures, presentations, social media, or program websites). Agreement or refusal to this release does not affect ability to participate in the Education Event.

 

7. Severability. If any provision of this Waiver is found to be unenforceable, it shall not affect the enforceability of the remaining portions, which shall be enforced to the extent permitted by law.

 

8. Choice of Law. Any question as to the validity, meaning or application of this document shall be controlled by the laws of the State of Nevada in Washoe County without giving effect to any choice of law rules that may require the application of the laws of another jurisdiction.

 

THE UNDERSIGNED HAS READ AND VOLUNTARILY SIGNS THE WAIVER OF LIABILITY, RELEASE AND ASSUMPTION OF RISK. By my signature, I hereby agree, for myself, my heirs, assigns, executors, and administrators, to release and hold harmless GTIB and all its officers, directors, employees, agents, volunteers, and Education Event Students from all claims, demands and actions for injuries sustained to my person and/or property as a result of my participation. If I am the parent or guardian of a Participant under the age of 18, I make this release and these representations on his or her behalf as well as my own, and I agree to assume responsibility for his or her safety. I hereby state that the Students involvement with GTIB is voluntary; that the Students are participating at their own risk, and that I have read and agree to the foregoing terms and conditions of this release.

 

EDUCATION EVENT PARTICIPATION WILL NOT BE PERMITTED UNLESS THIS STATEMENT IS FULLY SIGNED BELOW AND RETURNED TO GTIB FOR OUR RECORDS Parent/Guardian if the member applicant or guest is a junior (13-17 yrs old)

 

Parent/Guardian

Signature: ____________________

Printed Name: __________________

Date: ___/___ /______

Email:  _______________________

Parent/Guardian Phone ( ___) _____-_______

 

Student

Signature: ____________________

Printed Name: __________________

Date: ___/___ /______

 

Instructor – Witness (final signature)

Signature: ____________________

Printed Name: __________________

Date: ___/___ /______

 

Emergency Contact Information

Contact Name: ___________________

Relationship: ____________________

Address: ______________________________

City: ____________________State: __________ Zip Code: _______

Primary Phone: ( ___) _____-_______

(Optional)Secondary Phone: ( ___) _____-_______