MakeHaven Parent Waiver and Release for Partner Program or Supervised Youth

THIS AGREEMENT made this between MakeHaven, Inc. (770 Chapel Street, New Haven, CT) and the Parent or Legal Guardian (Guardian) and on behalf of a minor participating (Particpant) in partner program (Program).

Parent or Legal Guardian's Printed Name (Guardian) *

Minor’s Name (Participant) *

For activities in program *

Teacher and School

Name the entity or person who you assign as responsible for the minor

Guardian agrees to the following:

1. Assumption of Risk.
Guardian and Participant acknowledges risks from the use of tools, equipment, devices, and hazardous materials of any kind commonly used in constructing, fabricating, developing, crafting, inventing, prototyping, metalworking, woodworking, software design and other technology related activities. Participant’s participation in such activities, and/or use of such tools may result in injury, illness, death or damage to Participant or Participants’s personal property. Such injury, illness, death or damage to Participant or Participants personal property, may arise from foreseeable or unforeseeable causes and may be caused by Participant, other Participants, Members, or Force Majeure. Guardian and Participant hereby fully acknowledges all such risks and any others which arise because of Participant’s association with MakeHaven, Inc.

2. Release of Liability.
Guardian and Participant releases MakeHaven, Inc., its Officers, Agents, Board, Members, Guests and Assigns from any and all liability arising out of any and all damage, loss or injury to Participant or Participant’s property while participating in any and all activities related to MakeHaven, Inc. and/or using any equipment owned by MakeHaven, Inc. or another Participant, Guest or Member of MakeHaven, Inc. regardless of whether such loss or injury is as a result of negligence of MakeHaven, Inc. or its Members, Guests, Agents, Board Members and Assigns, or is a result of some other cause.

3. Covenant Not to Sue.
Guardian and Participant agrees that Guardian or Participant will not, under any circumstances, initiate any legal action against MakeHaven, Inc., its Members, Guests, Agents, Board Members and Assigns, nor will Participant assist in the prosecution of any such legal action filed by another, arising out of an injury to the person or property of Participant while participating in the activities related to MakeHaven, Inc.. This covenant extends to include the Heirs, Executors, Administrators or Assigns of Participant and Guardian.

4. Third Party Indemnification.
Guardian and Participant indemnifies, saves and holds harmless MakeHaven, Inc., its Members, Participants, Agents, Board Members and Assigns from any and all losses, claims, actions or proceedings of every kind and character which may be initiated by any other persons or organizations and which arise directly or indirectly from the actions of Participating while engaged in the activities related to MakeHaven, Inc..

By signing below, I acknowledge that I am eighteen (18) years of age or older, and am the Parent, or Legal Guardian, or otherwise responsible person of Participant with full authority under the law to sign and enter into this Agreement for Participant. I have read, understand and agree to the terms outlined above and am voluntarily surrendering and releasing certain legal rights described herein. I am mentally competent to sign this release.

Full authority *

I hereby acknowledge that I have carefully read and understood all of the above provisions and voluntarily sign this document as a condition of Participant participating in activities at MakeHaven, Inc.

Voluntarily signature *

I understand and acknowledge that if I proceed to sign the waiver electronically, that, under the Electronic Transactions Act, such electronically signed Waiver document will be valid and enforced in the same manner as a hand-signed document that exists in physical form and that a record or signature may not be denied legal effect or enforceability under law solely because it is in electronic form.

Electronic Signature *

This Agreement and General Release shall be governed and conformed in accordance with the laws of the State of Connecticut. Should any provision of this Agreement and General Release be declared illegal or unenforceable and cannot be modified to be enforceable, excluding the general release language, such provisions shall immediately become null and void, leaving the remainder of this Agreement and General Release in full force and effect.

Signature

Sign with finger, stylus or mouse in box bellow.

Signer Name *

Signer Title *

Email Address (optional)

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