PERSONAL INJURY WAIVER, ASSUMPTION of RISK

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					PERSONAL INJURY WAIVER, ASSUMPTION of RISK ACKNOWLEDGMENT,
and RELEASE of LIABILITY AGREEMENT

I hereby agree that I am voluntarily participating in a glass art workshop
(Flameworking/Lampworking/Glassblowing) which has been planned and provided by
Playing with Fire! Glassworks & Gallery, LLC, and Edward Slawson and Virginia Dejewska
Slawson. I am aware that this workshop may include, and is not limited to the use of torches,
flame, kilns, and potentially dangerous tools, equipment, and materials. I recognize and
acknowledge that glass art work may be considered hazardous and that voluntarily
participating involves inherent risk and danger. I fully understand and will apply written and
oral safety rules and precautions that are necessary for the requirement of my participation in
said workshop. I am in good health and have no physical limitations which would impair my
safety or the safety of others at this facility. At any time, if I am uncomfortable with my
knowledge or experience level, I will request personal supervision or assistance.

I understand and EXPRESSLY ASSUME all the risk incident to activities associated with the
aforementioned workshop, and I hereby release and forever discharge Playing with Fire!
Glassworks & Gallery, LLC, and the aforementioned artists and studios and any of their
affiliated entities, including but not limited to their officers, representatives, employees,
administrators and assigns, from any and all claims, complaints, liabilities, obligations,
promises, damages, costs, losses (“claims”), medical, rescue, and attorneys’ fees which may
arise out of my participation or election to participate in the aforementioned activities,
including but not limited to claims for delays, cancellations, injuries or death, or for the loss of
or damage to my property occurring during any portion of, or relating to, this workshop
including my post-workshop use of the techniques taught in the workshop. I agree that this
release shall bind my heirs, executors, other legal representatives, insurance companies,
guardians, and all members of my family.

— I am 18 years of age or older.
— I am the Parent/Legal Guardian of workshop participant who is under the age of 18.

Signature:                                                    Date:
Print Name:
Address:
Phone/s:                                                      Email:
Class/Workshop:
Emergency Contact:                                            Relationship:
Phone/s:                                                      Address:
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ACKNOWLEDGMENT of PARTICIPATION in SAFETY INSTRUCTION
Please sign after you have participated in the Safety Instruction portion of the workshop.
I hereby acknowledge that I have participated in a discussion of Safety Procedures and
Precautions to be employed in the aforementioned art glass workshop, including but not limited
to proper use of the equipment, and use of eye protection. I acknowledge that working with
flame and glass is potentially dangerous, and hereby assume that risk.

Signature of workshop participant:
Print Name:                                                                   Date: