STEAM Fun LIABILITY WAIVER FORM
Please complete the waiver form if this is the first time that your kid join a class / workshop / party at STEAM Fun.
WAIVER OF LIABILITY & PHOTO RELEASE:
In consideration of participation in a camp, class, workshop, or activity offered by STEAM FUN, I, the undersigned for myself and/or as the parent/guardian of the named Minor, agree to indemnify and hold STEAM FUN harmless and hereby waive, release and discharge any and all claims for damage, for death, personal injury, bodily injury or property damage which I and/or the Minor may have or which hereinafter may accrue to me and/or the Minor against STEAM FUN, its employees, agents, volunteers, independent contractors, and instructors from and against any liability arising our of or connected in any way with my and/or the Minor’s participation in this camp, class, workshop, or activity, even though that liability may arise out of negligence or carelessness on the part of the person or entities mentioned above.
I understand that accidents and injuries can arise from participation in this camp, class, workshop or activity; knowing the risks, nevertheless, I hereby agree to assume those risks on behalf of me and/or the above named Minor and to release and to hold harmless all of the persons or entities mentioned above whom (through negligence or carelessness) might otherwise be liable to me and/or the named Minor (or my/our heirs or assignees) for damages. It is further understood and agreed that this waiver, release and assumption of risks has been freely entered into and is to be binding on my/our heirs and assigns.
I have read and agree to the registration and program policies. Further, I agree to allow use of my image and/or that of the named Minor, which may be captured through video, photo, digital camera or other media, for STEAM FUN and its partners, promotional materials and publications.
By my signature below, I acknowledge that I have read this document and understand its contents.
STEAM Fun
415 N. Mary Ave
#112
Sunnyvale, CA 94085
408-868-2587
https://steamfun.us
* Required
Email address
*
Your email
Parent/Guardian Name (Last, First):
*
Your answer
Street Address (Please include city, state, and zipcode):
Your answer
Phone Number:
*
Your answer
Emergency Contact Name:
*
Your answer
Emergency Contact's Phone Number:
*
Your answer
Child # 1 - Name (Last, First)
*
Your answer
Child #1 - Birth Date:
*
MM
/
DD
/
YYYY
Child #1: Any food allergy?
*
Your answer
Child #1: Gender?
Female
Male
Prefer not to say
Other:
Child # 2 - Name (Last, First)
*
Your answer
Child #2: Gender?
Female
Male
Prefer not to say
Other:
Child #2 - Birth Date:
*
MM
/
DD
/
YYYY
Child #2: Any food allergy?
*
Your answer
Are you a parent or a guardian?
*
Parent
legal guardian
Signature (Signature of a parent or legal guardian is required for youth registrations)
*
Your answer
A Maker Space for Kids and Adults
Send me a copy of my responses.
Submit
Page 1 of 1
Never submit passwords through Google Forms.
reCAPTCHA
Privacy
Terms
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
Forms
