Check In for Fixit Clinic
(OUR MAIN WEBSITE: www.fixitclinic.org, see also https://www.facebook.com/FixitClinic/, https://plus.google.com/+FixitClinic)

It helps us to know in advance what you're bringing and what's wrong with it. And while walk-ins are always welcome, we'll make an effort to give priority to participants who fill out this form in advance.

PLEASE READ: Fixit Clinic is a troubleshooting and discovery workshop staffed by volunteer Fixit Coaches: you are expected to actively participate in the disassembly, troubleshooting, and repair of your item so that you leave fully empowered to share your new-found confidence and insight with your friends, neighbors, and the community at large.

- Bring the broken item with all parts necessary to recreate the symptoms (carry-in only: no oversize items)
- Bring any parts and tools you already own that might be helpful (e.g. hand tools, sewing supplies)
- Come ready to clearly describe what’s wrong and what you’ve tried
- Come eager to learn and to share your skills and knowledge with others

Thanks; and we're looking forward to seeing your smiling face at the Fixit Clinic!

(P.S.: If you'd like to be a Fixit Coach (first timers and fixing families always welcome!) sign up here: http://goo.gl/kwVNlv)

Which Fixit Clinic / Repair Event are you attending? *
Please re-confirm with the venue as the date approaches
Required
What are you bringing?
Add Make and Model in separate fields below if it's a manufactured item. (Fill out this form again if you're bringing multiple items.)
Your answer
Make / Manufacturer
Your answer
Model
Your answer
When was it manufactured?
What's wrong with it?
Provide as much detail as you can as to how it's acting up. Did the symptoms manifest gradually or was there "an event"? Can you reproduce the symptoms reliably or is it intermittent?
Your answer
What have you tried to fix it? (hint: web research)
Your answer
OPTIONAL, BUT HELPFUL: What does the item weigh? (in decimal lbs. please)
(e.g. "3.5 lbs" not "3 lbs. 8 ozs.") This is helps us assess our waste stream diversion impact
Your answer
Can we contact you?
No promises, but someone might contact you to get more information to have a better chance of fixing your item.
Liability Waiver
In consideration for being allowed to participate in the event I hereby waive, release and forever discharge Fixit Clinic, its employees, agents and volunteers, and any others acting on their behalf, from any and all responsibilities or liability from damages or injuries of any kind to my property, anyone else's property, or to me or any other person, in my party or otherwise, as a result of my participation in this event. I hereby grant Fixit Clinic and its agents the absolute and irrevocable right and unrestricted permission to use photographs and video taken at the event.
Email address
Your answer
How did you hear about Fixit Clinic?
Your answer
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