Burnt Glassworks Waiver and Release of Liability

Participant (Releasor) Info Required fields indicated with *

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:

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*
Image Use Burnt Glassworks may use my image for promotional purposes unless otherwise indicated