Name *

First Name

Last Name

Phone *

(###)

###

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Guardian Completing Form (if member is under 18)

First Name

Last Name

Person to contact in case of an emergency *

First Name

Last Name

Emergency Contact Primary Phone # *

(###)

###

####

Emergency Contact Secondary Phone #

(###)

###

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Waiver of Liability *

By checking "I agree," I waive, release, absolve, indemnify and agree to hold harmless Building Bridges to Careers, organizers, supervisors, officers, and directors of any claims or demands for injury to person or property resulting directly or indirectly by reason of participation in activities in the Makerspace. I hereby assume full responsibility for all risk of injury to person or property by reason thereof. I am aware of all safety concerns and agree to adhere to all safety guidelines.

I agree

Membership Agreement *

By checking "I agree," I recognize that I am assuming fincancial responsibility for any incurring costs associated with the person listed in the "Member Name" field of this form. I understand these charges may incur as a result of damage to property or person due to equipment misuse, or may incur as a result of using BB2C Makerspace or other makerspace member supplies. Furthermore, I understand that failure to follow membership rules and regulations may result in membership being revoked without refund.

I agree