“MELISSA’S SEWING & QUILTING” CLASSES

Waiver and Release of All Claims and Assumption of Risk

Please read carefully before signing.

By signing below, you will be expressly assuming all risks arising from your child’s participation in this program and/or any activities associated with this program.  You will also be waiving and releasing all claims for injuries, damages or loss which you and/or your minor child might sustain or incur as a result of participating in this program and/or any activities associated with this program. 

I recognize and acknowledge that there are certain risks of physical injury to participants in this program.  I voluntarily agree to assume the full risk of any and all injuries, damages or loss, regardless of severity, that my minor child may sustain as a result of participation in this program and/or any activities associated with this program.  I further agree to waive and relinquish all claims that I and/or my minor child may have or which may in the future accrue to me and/or my minor child against Melissa Kristufek d/b/a Melissa’s Sewing & Quilting, her agents and employees, including, but not limited to, claims for negligence.  I do hereby fully release and forever discharge Melissa Kristufek d/b/a Melissa’s Sewing & Quilting, her agents and employees, from any and all claims for injuries, damages or loss that I and/or my minor child may have or which may in the future accrue to me and/or to my minor child as a result of my child’s participation in this program and/or any activities associated with this program.  This release includes, but is not limited to, claims for negligence.

Photo Authorization:  I hereby give consent for Melissa Kristufek d/b/a Melissa’s Sewing & Quilting to use photos of my minor child in future program guides and fliers.

Child’s Name:____________________________  Child’s Birth Date: __________________

Phone Number: _____________________________________________________________

Address: __________________________________________________________________

E-mail ____________________________________________________________________

Allergies or Medical Conditions _________________________________________________
___________________________________________________________________________

____________________________

Name of Parent or Guardian (Printed)

____________________________                      Date: _________________

Signature