Burnt Glassworks Waiver and Release of Liability

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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:

Covid-19 Liability Waiver and Risk Acknowledgement

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.

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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