Health & Indemnity Waiver-Black Phlox Candles

Health & Indemnity Waiver

Please complete the following Health & Indemnity waiver prior to attending your session. Please note that one form must be submitted per participant. You must agree to all fields to attend any Black Phlox Candle Co activity or session.

First Name

Last Name

Phone Number

Waiver and Release: In consideration of being permitted to participate in a candle or perfume making class (the “Experience”) offered by Black Phlox Candle Co. (the “company”), I, for and behalf of myself, personal representatives and all persons claiming by or through me, hereby release, waive and discharge the Company and its officers, directors, contractors and agents ( the “Released Parties”) from all existing and future claims and/or causes of action arising from, or relating to, the Experience, my presence on the Company’s premises (the “Premises”) or my use of the Company’s tools, equipment or facilities (the “Equipment”), including, without limitation, injury, illness, death, or property loss, regardless of whether arising, in whole or in part, from the action or inaction of any Released Parties.

Please initial below

Minors: With the exception of specific Black Phlox Candle Event Built for Children: I understand that I cannot bring any children under the age 12 to the Premises during the class, and that all Experience participants must be at least 12 years old. I will ensure that 1 adult will remain present on the Premises during the entire Experience for (a) every 3 Experience participants ages 12-16; or (b) 1 parent for every 2 children in any group of Experience participants booked for specific Black Phlox events built for children 6-11 years old. I understand that each Experience participant who is under age 18 must have a parent or guardian sign this waiver on behalf of the Experience participant. No alcohol will be served or may be consumed on the Premises by any person who does not present a valid ID indicating such person is at least age 21.

I acknowledge that I do not have participants under the age of 12

Yes

I acknowledge that if I am under the age of 21 years old, I will not be allowed to consume alcoholic beverages during any Black Phlox events or activities

Yes

N/A

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Assumption of Risks: The Company may, but is not obligated to, permit the consumption of alcoholic beverages on the Premises. I understand that participation in both candle/perfume making and drinking alcohol carries certain known and unknown risks that cannot be eliminated regardless of the care taken to avoid injuries. I acknowledge that I am aware and voluntarily expose myself to risks inherent in candle making, including, but not limited to, physical and emotional injury or death resulting from serious burns/scalding and other heat related injuries; slippery surfaces; lacerations; allergic reactions; and eye injuries. I further acknowledge that if I choose to consume alcohol on the Premises, I am aware of and voluntarily expose myself to many risks of alcohol consumption, and the risk that alcohol consumption might exacerbate the risks inherent in candle making. I hereby knowingly assume full and sole responsibility for all the foregoing risks and acknowledge that my participation in the Experience is fully voluntary.

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Use of Likeness: I hereby grant to the Company the right to use my likeness and recorded actions during my participation in the Experience, without charge, in Company marketing and promotional materials.

I agree to use of my likeness for Black Phlox Candle Company marketing /promotional materials

I DO NOT agree to use of my likeness for Black Phlox Candle Company marketing/ promotional materials

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Indemnification and Hold Harmless: I agree to indemnify, defend and hold harmless the Released Parties from any and all existing and future claims, actions, suits, procedures, costs, expenses, damages and liabilities (including, without limitation, reasonable attorney’s fees and court costs) brought, asserted, incurred or arising from or as a result of my participation on the Experience, my presence on the Premises or my use of the Equipment.

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Policies and Procedures: I understand the Company may impose certain policies and procedures in connection with the Experience, including without limitation the right to exclude intoxicated parties from the Premises or participation in the Experience. I agree to abide by any and all such policies and procedures and understand that if I violate them, I may be asked to leave the Premises without refund of any fees or other costs I may have incurred in connection with the Experience.

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Severability: In the event that any court of competent jurisdiction shall declare any part of this agreement provision to be invalid, prohibited, or unenforceable, the remaining portions of this agreement shall remain enforceable. To the fullest extent allowed by the law, any invalid, unenforceable or prohibited portion of this agreement shall be modified by a court of law so as to allow the same to be interpreted in such a manner as to be enforceable.

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By signing below,

I agree to the terms and conditions stated therein

I agree to receive emails, SMS notifications, text notifications. Carrier/data rates may apply

Your Signature

Date