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CAREFULLY READ THE ENTIRE AGREEMENT.
“GENERAL RELEASE OF LIABILITY, WAIVER OF CLAIMS, ASSUMPTION OF RISKS
INDEMNITY AGREEMENT , WAIVER OF RIGHT TO TRIAL and SELECTION OF MEDIATION”
I, _________________________________________________________________, am at least 18 years
(clearly print your full legal name)
I understand, acknowledge, and agree that I may suffer severe, catastrophic, physical, emotional, and/or
financial damage and/or loss, including, but not limited to laceration, blood loss, mutilation, amputation,
blinding, disfigurement, electrocution, burns, crushing injury, toxic injury and death as a result of operating
and/or being in the presence of the tools, equipment, facilities, processes, and/or chemicals at Hacker Lab. I
understand that the tools, equipment, facilities, processes, and/or chemicals at Hacker Lab may not be safe and
that using or being in the presence of the tools, equipment, facilities, processes, and/or chemicals at Hacker
Lab present serious, substantial and significant risk(s). __________(Initial here)
Having in mind these risks and other substantial and serious risks, not stated above, to the fullest extent
permitted by law, I hereby expressly assume all risks and waive all claims which may be associated with
and/or arise either directly or indirectly from my presence at Hacker Lab and/or from my use of the tools,
equipment, facilities, processes, and/or chemicals at Hacker Lab. I hereby hold harmless, release, agree to
indemnify and agree to defend Hacker Lab, its owners, officers, instructors, teachers, facilitators, volunteers,
investors, contributors, agents, members, suppliers, and employees (hereinafter collectively referred to as "the
released parties") from any and all liability, claims, demands, damages, actions and causes of action
whatsoever arising out of, or related to, any loss, damage or injury, including death, that may be sustained by
me and/or my unborn offspring and/or caused directly or indirectly by me while using the tools, equipment,
facilities, processes, and/or chemicals at Hacker Lab, including, but not limited to, those injuries and damages
caused by negligence and/or breach of warranty, express or implied, on the part of the released parties. In
addition, by execution of this release, the released parties shall be indemnified by me for any injury to other
person(s) or property which I may intentionally or negligently cause. __________(Initial here)
Having in mind these risks and other substantial and serious risks, not stated above or referred to herein, in
relation to all claims, causes of action, or other legal action, civil or criminal, arising from my membership or
presence at any Hacker Lab, I knowingly and voluntarily agree to waive and release my right to Trial by Judge,
Trial by Jury, Judicial Determination of any kind, Judicial Arbitration, Non-Binding Arbitration, Binding
Arbitration, Administrative ruling and/or my Right to Appeal, if any. Instead, I agree to submit all disputes
solely and exclusively to Mediation by a Neutral Private Non-Recommending Mediator and I agree to pay fifty
percent of any Mediation costs associated with said dispute(s). __________(Initial here)
I understand the legal consequences of signing this document. I understand that this document is written to be
as broad and inclusive as legally permitted by the State of California. I agree that if any portion is held invalid
or unenforceable, I will continue to be bound by the remaining terms. I declare under penalty of perjury under
the laws of the State of California, that the foregoing is true and correct.
_____________________________________________________________________ ________________
(sign your full legal name here )
(date)
Drivers licence number or California ID Number_______________________________________________
Accepted By: ___________________________________________________________________________
CAREFULLY READ THE ENTIRE AGREEMENT.
CAREFULLY READ THE ENTIRE AGREEMENT.
CAREFULLY READ THE ENTIRE AGREEMENT.
of age. I am of sound mind. I may enter into a legally binding agreement. I have been given adequate time to
carefully read and understand this agreement. I have been given adequate opportunity to consult with an
attorney regarding this agreement and I have been strongly encouraged to do so. I knowingly and voluntarily
agree to be bound by all of the following terms and conditions: __________(Initial here)