Please provide for recording purposes

Emergency Contact Details:

Please provide a contact person in the event of an emergency.

I hereby assume all of the risks of participating, volunteering and/or working in this event and on behalf of myself, my spouse, children, wards, relatives, heirs, executors, personal agents, personal representatives, administrators, successors and assigns, hereby unconditionally waive, release, discharge, and indemnify Me.reka or its directors, officers, partners, employees, volunteers, representatives, agents, suppliers, sponsors, or event volunteers from any liability of, from and for all and any manner of action or actions, cause and causes of action, claims, demands, costs, loss of services, expenses, attorney’s fees, compensation and all consequential, compensatory, general, special, and/or punitive damages or liabilities, known or unknown, which may result directly or indirectly or in any way related to or growing out of participating, coming to, being on, or departing the premises, including on account of any and all injuries, illnesses and other damages, including death; provided, that this waiver of liability does not apply to any acts of gross negligence, or intentional, willful or wanton misconduct.

I hereby consent to receive medical treatment that may be deemed advisable in the event of an injury, accident, and/or illness during this event by the Paramedics or Ambulance or other medical personnel arranged by Me.reka. *If the participant is less than 18 years of age, the parents having legal custody and/or the legal guardians of the participant also hereby release and forever discharge Me.reka or its directors, officers, partners, employees, volunteers, representatives, agents, suppliers, sponsors, or event volunteers from any claim whatsoever which arises or may hereafter arise on account of the decision by any representative or agent of Me.reka to exercise the power to consent to medical treatment as such power may be granted and authorized in a Parental Authorization for Treatment of a Minor Child.

Photography on the program, we would like to take photograph(s) of you and capture the content of the work that you do at Me.reka Makerspace to be used for our social media platform.

By signing this form, you will give permission to be photographed for all the purposes mentioned above.

Participants will be responsible for damage and/or loss of equipment, while at any and/or all labs.

I have read and fully understand the Terms & Conditions of Participation (“Agreement”) and that I agreed to all terms specified in this Agreement freely and voluntarily with the intention to completely and unconditionally release all liability to the greatest extent allowed by law.