Live Laugh Love Portland Liability Waiver Adult Information Use parent or guardian information if under 18Name* First Last Email* Date of Birth* Month Day Year Are you signing up with a minor?* No Yes, I am registering for a minor Minor 1 Information I am filling this out this liability waiver to include minors. I certify that I am the legal guardian or parent of the included minors. I am including the information for the children for which I am responsible for:Name of Minor 1 First Last Date of Birth of Minor 1 Month Day Year Minor 2 Information Enter the information for the children for which you are responsible for:Name of Minor 2 First Last Date of Birth of Minor 2 Month Day Year Minor 3 Information Enter the information for the children for which you are responsible for:Name of Minor 3 First Last Date of Birth of Minor 3 Month Day Year Consent* I understand, agree and acknowledge the following section:Agreement Any participant enrolled in a workshop or experience in Glass Blowing, Glass Fusing, Torch Working, Welding/Metal Working, or Painting in the studio must complete the liability waiver.If you wish to go in the hot shop as an observer with a registered participant you must be at least 5 years old and complete the liability waiver.Glass Blowing Requirements: • not recommended for expecting mothers. • All participants must be at least 5 years to enter the hot shop • Glass Blowing for Kids (ages 5 to 9) experiences are limited in participation to only the blowing and expanding of the glass. In our Glass Blowing for Kids there will be absolutely no handling of the pipe (such as in our 9+ classes) due to safety precautions • Closed toed shoes requiredWelding/Metal Working Requirements: • Participants must be at least 12 years or older • Closed toed shoes (preferably work boots) and jeans requiredPlease note if you have been to the studio and filed out the online liability waiver within the past 3 years you will not need to do it again. ASSUMPTION OF RISK; RELEASE OF LIABILITY, WAIVER OF CLAIMS, AND INDEMNITY AGREEMENT MUST BE COMPLETED TO ENTER HOT SHOP OR FUSING OR PAINTING STUDIOASSUMPTION OF RISK Live Laugh Love Glass, LLC operates a Glass Blowing, Flame working, Welding/Metal Working, Painting, and Glass Fusing Studio with the use of a furnace, Torch, Welder, and/or Kiln work areas (the “Studio”). The undersigned participant and, where participant is under age 18, the undersigned parent or guardian of participant on behalf of the participant, for himself/herself and his/her respective heirs, next-of-kin, personal representatives, successors and assigns: (1) acknowledges that glassblowing, welding and fusing involves certain inherent risks, dangers, and hazards which can result in personal injury, death, property damage, and other losses; and (2) hereby freely agrees to assume and accept any and all such risks of personal injury, death, property damage and loss associated with the Studio, including risks arising from my conduct (either as a participant or spectator), the design of the features in the Studio, the conduct of Live Laugh Love Glass, LLC and its directors, officers, shareholders, trustees, beneficiaries, employees, agents, representatives, independent contractors, subcontractors, sponsors, successors and assigns, and the conduct of other participants.*Glass Blowing is not recommended for expecting mothers. I acknowledge I am not an expecting mother. All glass blowing or torch working participants or observers in the hot shop must be over the age of 5 years. Glass Blowing for Kids (ages 5 to 9) experiences are limited in participation to only the blowing and expanding of the glass. In our Glass Blowing for Kids there will be absolutely no handling of the pipe (such as in our 9+ classes) due to safety precautions.All welding/metal working participants or observers in the hot shop must be over the age of 12 years. Metal working is not a dangerous occupation, but it does have both risks and dangers associated with it. These dangers and risks include but are not limited to: • Electric shock can kill • Hot parts can burn • Fumes and gases can be hazardous • Arc rays can burn eyes and skin • Welding can cause fire or explosion • Flying metal or dirt can injure eyes • Muscle injuries • Traumatic injury due to inherent dangers of working in a metal shop I the undersigned hereby acknowledge that I understand the dangers and risks inherent to metal working and waive all right to lawsuits or other legal or punitive action against LLLG, its owners, employees, or other associated persons. By signing I take full responsibility for my own actions and any accidental injury that I may experience in the course of my relationship with LLLG.RELEASE OF LIABILITY, WAIVER OF CLAIMS AND INDEMNITY AGREEMENT In consideration of the use of the Studio, the undersigned participant and, where participant is under age 18, the undersigned parent or guardian of participant on behalf of the participant, hereby agrees: 1. To waive any and all claims that participant and any parent or guardian or heirs and assigns has or may in the future have against Live Laugh Love Glass, LLC and their directors, officers, shareholders, trustees, beneficiaries, employees, agents, representatives, independent contractors, subcontractors, sponsors, successors and assigns (all of whom are hereinafter collectively referred to as “the Release-es’”) and to release the Release-es from any and all liability for any loss, damage, expense or injury including death that the participant and any parent or guardian or heirs and assigns may suffer, resulting from or arising out of any aspect of the participant’s use of the Studio, due to any cause whatsoever, including negligence; 2. To hold harmless and indemnify the Release-es from any and all claims and liability arising out of or in connection with the participant’s use of the Studio, and for any damage to property of or personal injury to any third party, resulting from the participant’s use of the Studio.CONSENT TO MEDICAL TREATMENT The undersigned hereby authorizes Live Laugh Love Glass, LLC to obtain emergency medical attention and treatment on behalf of myself or my minor child in case of sickness, accident or injury and to secure such medical attention and treatment at my sole expense. The undersigned recognizes that it may be required to transport my minor child to the nearest medical treatment facility based upon his/her age even though the condition may not warrant it.PERMISSION TO USE IMAGES AND OTHER MEDIA The undersigned also grants Live Laugh Love Glass, LLC and any third party authorized by Live Laugh Love Glass, LLC the right to film, videotape, photograph, record, and/or make any reproductions of me or my minor child’s likeness and voice that are captured within the open and public areas of the Studio. The undersigned further grants Live Laugh Love Glass, LLC the right to use, display, and digitally enhance or alter in any manner, such likeness in any media including but not limited to television, cable, radio or internet, in any motion picture film, videotape, DVD, CD or any published article without giving compensation, attribution, or notice to the participant. CHOICE OF LAW AND VENUE This Agreement and any rights, duties and obligations as between the parties to this Agreement shall be governed by and interpreted solely in accordance with the laws in the state of Oregon and no other jurisdiction. Any litigation involving the parties to this Agreement shall be brought solely within Washington County, Oregon and shall be within the exclusive jurisdiction of the Courts of Washington County, Oregon.I HAVE READ AND UNDERSTAND THIS AGREEMENT AND I AM AWARE THAT BY SIGNING THIS AGREEMENT I AM WAIVING CERTAIN LEGAL RIGHTS, WHICH I OR MY HEIRS, NEXT OF KIN, EXECUTORS, ADMINISTRATORS AND REPRESENTATIVES MAY HAVE AGAINST THE RELEASE-ES.Signature*By entering my name below and clicking the “Submit Waiver” button below, I indicate my acceptance and delivery of this waiver and release. I acknowledge that I have been given an opportunity to prevent or correct any error in connection with this waiver form. If I have submitted this waiver form in error, I will immediately notify you of the error, revoke my signature as instructed, and refrain from participating in any event or activity to which the waiver applies, as provided in Section 204(b) of the Uniform Electronic Transactions Act.PhoneThis field is for validation purposes and should be left unchanged.