Member ID: _____________     .

                              .     Member Agreement     Please Print Legibly!

First Name ___________________   Middle Name __________________    Last Name _____________________

Existing members enter Member ID and name above, and only changed data below.

New Members if you signed up online, then you need enter only Phone and Email here:

PhotoID type

____________________

e.g “OR Driver’s License”

ID Number

_____________________

e.g Driver’s license number

 Street ________________________

 Apt, etc ______________________

 Zip  __________________________

 Neighborhood  _________________

 Address Proof _________________

e.g. utility bill, rental agreement

 Phone1____________________

 Phone2 ____________________

 Email _____________________

 

                                                                                                                                                                                   [ SEPTL: by ____________ ]

RELEASE, WAIVER AND INDEMNIFICATION

I, ____________________________________ (print name), state that I am at least 18 years of age, capable of using the tools I borrow, and will use them in a proper manner.  I will not allow others to use the tools I borrow.  On behalf of myself, and my  successors and assigns, I agree to release, indemnify and hold harmless, and waive all claims against, the SE Portland Tool Library, SE Uplift, and the City of Portland, and their officers, agents, directors, Board members, employees, and volunteers of and from any and all liability, loss, claims, demands, and actions or causes of action, for the death of or injury to any persons and for any property damage suffered or incurred by any person, including myself, which arises or may arise or be occasioned in any way from the use or transport of tools I borrow from the SE Portland Tool Library, or that arises or may arise within the Tool Library itself or its environs.

I affirm that the above information is current, true and correct; that I have also read and fully understand and agree to the Borrowing Rules and Disclaimer form of the SE Portland Tool Library; and I understand that failure to comply with any of these rules may result in revocation of my borrowing privileges.  I have read and agree to this Release, Waiver and Indemnification form, as well as the Borrowing Rules and Disclaimer form, relinquishing any and all claims against the SE Portland Tool Library, SE Uplift, and the City of Portland.

Signature _________________________________________  

Date __________________________

                                             Revised 7/25/2011   .

with minor edits 2/17/12, 4/16/12, 5/28/12, 4/8/13, 2/12/15, 2/17/16   .