Burnt Glassworks Waiver and Release of Liability

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Participant (Releasor) Info Required fields indicated with *

Date*

Full Name*

E-mail

Address*

This Release is executed on the date provided, by the individual(s) whose name and address are indicated (hereinafter, “Releasor”) who agrees to use the facilities operated by Burnt Ventures, LLC, doing business as Burnt Glassworks (hereinafter, “Burnt Glassworks”), located at 5105 – 201 Philips Highway Jacksonville, FL 32217 (hereinafter, the “Premises”), or participate in activities sponsored by Burnt Glassworks, upon the express agreement, understanding, and condition that:

*In consideration of being permitted to participate in (i) activities, including but not limited to, the construction of glass art production equipment and the production of glass art (hereinafter, “Activities”) that take place at the facilities operated at Burnt Glassworks, whether located on the Premises or elsewhere, or (ii) Activities sponsored by Burnt Glassworks, Releasor, individually and on behalf of Releasor’s personal representatives, heirs, and next of kin, releases, waives, discharges and covenants not to sue Burnt Glassworks, its officers and members, promoters, sponsors, advertisers, owners and lessees of the premises and as to each of them, their officers and employees, (all hereinafter, “Releasees”), from all liability to the Releasor, Releasor’s personal representatives, assigns, heirs and next of kin for all loss or damage, and any claim or damage therefor, on account of injury to the person or property or resulting in death of the Releasor, whether caused by the negligence of Releasees or otherwise while the Releasor is (i) participating in the Activities or (ii) on the Premises.

*Releasor agrees to follow all rules and regulations promulgated by Burnt Glassworks (i) for the use of the Burnt Glassworks facilities, (ii) while present on the Premises or(iii) in connection with Activities sponsored by Burnt Glassworks.

*Releasor represents that Releasor is physically capable of participating in the Activities and that to the extent necessary in light of Releasor’s prior medical history, weight, and general physical condition, Releasor has consulted Releasor’s personal physician or other medical authority before making such representation

* Releasor agrees to indemnify the Releasees and each of them from any loss, liability, damage or cost Releasees may incur due to the presence of Releasor in or on the Premises whether caused by the negligence of the Releasees or otherwise.

*Releasor assumes full responsibility for and risk of bodily injury, death or property damage due to negligence of Releasees or otherwise while present on the Premises, and/or while participating in the Activities.

*Releasor agrees that this release, waiver, and indemnity agreement is intended to be as broad and inclusive as permitted by the laws of the State of Florida and that if any portion of the agreement is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect.

*Releasor, being of lawful age, in consideration of being permitted to participate in the Activities and/or being present on the Premises, does for Releasor and Releasor’s heirs, executors, administrators, and assigns, now release and forever discharge Releasees, their heirs, administrators, and executors of and from any and every claim, demand, action or right of action, of whatsoever kind or nature, either in law or in equity arising from or by reason of any bodily injury or personal injuries known or unknown, death and/or property damage resulting or to result from any accident which may occur as a result of Releasor’s participation in the Activities or Releasor’s presence on the Premises, whether by negligence or not.

Covid-19 Liability Waiver and Risk Acknowledgement

*Covid19 Release

Releasor acknowledges the contagious nature of the Coronavirus/COVID-19 and that the CDC and many other public health authorities still recommend practicing social distancing and proper mask wearing. Releasor further acknowledges that Burnt Glassworks has put in place preventative measures to reduce the spread of the Coronavirus/COVID-19 and that Burnt Glassworks can not guarantee that releasor will not become infected with the Coronavirus/Covid-19. Releasor understands that the risk of becoming exposed to and/or infected by the Coronavirus/COVID-19 may result from the actions, omissions, or negligence of releasor and others, including, but not limited to, Burnt Glassworks owners, contractors, employees, clients, students, guests and their families. Releasor voluntarily seeks services provided by Burnt Glassworks and acknowledges the increased risk to exposure to the Coronavirus/COVID-19. Releasor will comply with all set procedures to reduce the spread while participating in any activites or event hosted by Burnt Glassworks.

Releasor attests that:

* Releasor is not experiencing any symptom of illness such as cough, shortness of breath or difficulty breathing, fever, chills, repeated shaking with chills, muscle pain, headache, sore throat, or new loss of taste or smell.

* Releasor has not traveled internationally within the last 14 days.

* Releasor has not traveled to a highly impacted area within the United States of America in the last 14 days.

* Releasor is confident there has been no exposure to someone with a suspected and/or confirmed case of the Coronavirus/COVID-19.

* Releasor has not been diagnosed with Coronavirus/Covid-19 and not yet cleared as non contagious by state or local public health authorities.

* Releasor is following all CDC recommended guidelines as much as possible and limiting my exposure to the Coronavirus/COVID-19.

Releasor, individually and on behalf of Releasor’s personal representatives, heirs, and next of kin, releases, waives, discharges and covenants not to sue Burnt Glassworks or Releasees, from all liability to the Releasor, Releasor’s personal representatives, assigns, heirs and next of kin for all loss or damage, and any claim or damage therefor, on account of injury or illness to the person or property or resulting in death of the Releasor, whether caused by the negligence of Releasees or otherwise while the Releasor is (i) participating in the Activities or (ii) on the Premises.

* Releasor further states that Releasor has carefully read the above release and knows the contents of the release and signs this release as Releasor’s own free act.

*This release contains the entire agreement between the parties to this agreement and the terms of this release are contractual and not a mere recital.

Electronic Signature and Acknowledgement If participant is under 18 years of age, a parent or legal guardian must sign below.

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Participant (Releasor) or Guardian Signature*

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