STEMful Liability Waiver
Please review and sign our liability form waiver in order to use our facility.
Parent/Guardian First and Last Name *
Your answer
Email Address *
Your answer
Child #1 First and Last Name *
Your answer
Child #2 First and Last Name
Your answer
Child #3 First and Last Name
Your answer
Child # 1 Gender *
Child # 2 Gender
Child # 3 Gender
Child #1 Birthday Date *
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Child #2 Birthday Date
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Child #3 Birthday Date
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1) I, for myself, my child/children or ward/wards sign this Waiver and Assumption of Risk in consideration of the opportunity to use the facility, or to participate in any parties or activities at/by STEMful/Bricks 4 Kidz. 2) I, for myself, my child/children or ward/wards acknowledge and understand that there are dangers and risks associated with the activities at/by STEMful/Bricks 4 Kidz and agree to assume all risk of personal injury, including the potential for paralysis and death. 3) I, for myself, my child/children or ward/wards agree to follow the safety instructions provided and acknowledge that failure to do so may result in expulsion from STEMful/Bricks 4 Kidz. 4) personal representatives and next of kin, HEREBY HOLD HARMLESS STEMful/Bricks 4 Kidz, its owners, members, officers, employees, equipment manufacturers and sponsoring agencies from all liability for any such personal injury, disability, death or loss or damage to person or property, arising out of my child/children’s participation in the activities at STEMFUL/Bricks 4 Kidz, including but not limited to, any medical procedures, medical tests, Type I Diabetes Blood test and otherwise, to the fullest extent of the law. 5) I, for myself, my child/children or ward/wards understand that my execution of this waiver on the initial visit will authorize STEMful/Bricks 4 Kidz to enter this waiver into its database and use it as a continuous, multi use waiver for my child’s/children’s ongoing participation in the activities or use it as a waiver executed for my other child/children. I hereby expressly authorize STEMful/Bricks 4 Kidz to use this Waiver as a multi use waiver until such time as I revoke it in writing. *
Photo Waiver: I consent to STEMful/Bricks 4 Kidz use of any photographs or video recording that are taken of my child while participating in the program activity for use in STEMful/Bricks 4 Kidz brochures and program materials that are distributed both as printed document and on the internet. No payment will be made for use of these photographs and/or videos. Your child's name would never be used in connection with these images. We will not release any personally identifiable information without prior written consent from you as parent or guardian. Personally identifiable information includes student names, residential addresses, e-mail address, phone numbers. *
Emergency Contact First and Last Name *
Your answer
Emergency Contact Phone Number *
Your answer
How did you hear about us? *
Would you like to sign up for our online mailing list? *
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This form was created inside of STEMful San Francisco.