RELEASE, WAIVER OF RIGHTS, AND AUTHORIZATION FOR USE OF IMAGE

Failure to present a properly executed form will result in denial of use of facilities and services by Tulsa Glass Blowing Studio, Inc.

Student

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Tulsa Glassblowing Studio, Inc., an Oklahoma non-profit corporation under 42 U.S.C. Section 501(c)(3) (hereinafter “Sponsor”), sponsors and conducts classes and seminars to instruct or enhance the abilities of individuals to work with hot, molten glass and objects that are heated, sharp and may cause injury. In connection with such activities, Sponsor provides a location, facilities, instruction, and equipment used or useful in creating or making glass items and for the advancement of education in the use and manipulation of glass.

In consideration for the execution of this Release, Waiver of Rights, and Authorization for Use of Image (hereinafter “Agreement”), Sponsor agrees to permit you or the minor on whose behalf this Agreement is executed (hereinafter “Student”), to avail himself or herself of the use and enjoyment of the equipment and/or instructional services of the agents or employees of Sponsor.

In order to use and enjoy the equipment and services you acknowledge and agree for yourself and/or on behalf of Student that:

1. Working with or exposure to molten glass and glass is dangerous and could result in serious bodily harm, temporary or permanent physical impairment or disability, and/ or possibly death to Student.

2. The equipment utilized in preparing and working with molten glass is subject to malfunction, failure of components or improper use by the undersigned, other students, visitors, or third persons over which Sponsor has no control.

3. In consideration of the right and authority license to use and access to Sponsor’s equipment and facilities, Student or you on behalf of Student:

  1. Assumes all risk of injury or death to Student or any injury or damage to Student’s property
  2. Waives and release every claim or cause of action of Student against TGS, its officers, directors, employees, and guests that exist or arise at or on the Sponsor’s premises, INCLUDING, BUT NOT LIMITED TO ANY CONSEQUENCE OF THE ACT OR OMISSION OF SPONSOR, ITS MEMBERS, AGENTS, EMPLOYEES, CUSTOMERS, INVITEES, OR ANY OTHER PERSON OR ENTITY REQUIRED OR PERMITTED TO BE ON THE SPONSOR’S PREMISES OR UTILIZE ANY OF THE EQUIPMENT OR SERVICES PROVIDED BY SPONSOR.

4. You further agree and authorize Sponsor to use the image of Student in any manner or format deemed appropriate by Sponsor, including but not limited to posting such images on the worldwide web, in video, photographs, advertising, promotional material, educational material, magazine articles, etc...

5. You further represent that you:

  1. are more than 18 years of age OR, if signing on behalf of a student who is under 18 years of age, are the parent or legal guardian and have full legal authority to sign this Agreement;
  2. understand written English;
  3. have read, understand, and agree to the terms and conditions set forth in this Agreement; and
  4. sign and deliver this Agreement to Sponsor freely, voluntarily, and without compulsion or pressure.

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Date: 1/26/2022

Time: 1:58 AM

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Date: 1/26/2022

Time: 1:58 AM


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