Student Forms Workshop Title(Required) Today's Date(Required) MM slash DD slash YYYY Name(Required) First Last I, ____________________________, the undersigned, am a registrant and willing participant in a workshop offered by Sanborn Mills, Inc. (SMI) a nonprofit organization. In consideration of admission of the undersigned to the event offered by Sanborn Mills, Inc., plus other good and valuable consideration, and being fully aware of the inherent risks and dangers associated with working with fire, hand tools and other equipment, I hereby RELEASE, WAIVE, DISCHARGE and HOLD HARMLESS for myself and my heirs, executors, administrators and assigns, Sanborn Mills, Inc., Sanborn Mills Farm, their employees, instructors, directors and subcontractors in their corporate capacity and individually, and any owners of premises which are used as sites of instruction and activity during said workshop, of and from any and all claims, demands, rights, and causes of action of whatsoever kind and nature, arising from, and by reason of any and all known and unknown, foreseen and unforeseen bodily and personal injury, damage to property, and the consequences thereof, resulting, and to result, from said course of instruction and my attendance at same, and any other circumstance incidental thereto. By signing this form, I give permission for photographs & video to be taken while engaged in a workshop at SMI and my image to be used at the discretion of SMI in SMI printing and online publications. Signature(Required)Parent or Guardian Signature (for minors under 18)Parent or Guardian Printed Name (First, Last) Date(Required) MM slash DD slash YYYY Photo Consent I would prefer that Sanborn Mills Farm does NOT use images of me in SMI Printing and online publications. Smoking Policy(Required) I agree not to smoke while on the premises. Smoking is not permitted on the premises. This also applies to electronic cigarettes or other imitation cigarette devices.Emergency Contact(Required) Relationship(Required) Emergency Contact Phone Number(Required)Alternative Contact(Required) Relationship(Required) Alternative Contact Phone Number(Required)Allergies(Required) Please list any allergies that may require intervention.Other Medical Conditions(Required) Please list any other serious medical conditions you would like us to be aware of.
