Juggernaut Glass Liability Waiver
Please take a minute to fill in the following info:
First Name
Last Name
Email
Phone Number
Are you 18 years of age or older?
Yes
No
Are you a legal parent/guardian of a minor granting them permission to participate in glass art activities with Juggernaut Glass?
Yes
No
N/A
-I am submitting this release, waiver of liability, and assumption of risk declaration voluntarily and of my own free will.
Yes
No
I have had no physical or emotional problems, nor any history thereof, which would impair my ability to participate in the event.
Agree
Disagree
By this instrument I hereby release Mark Todd Wurtzel, & Juggernaut Glass. I recognize and acknowledge that making glass art is a potentially dangerous activity.
Agree
Disagree
I understand that glassblowing, lampworking, fusing & slumping may include damage to or destruction of personal property and serious physical injury.
Yes
No
I agree to the terms & conditions
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