Filling Out the Safety Questionnaire

If someone purchased this for you or you are participating in an event or workshop, please add the event sponsor’s name.
If someone younger than 18 years old is participating, the parent or legal guardian must fill out the safety waiver and give their consent to participate. It is best if they accompany them to the studio.

Everyone who makes glass must read and sign this waiver and release. If you have any issues that might inhibit you inform inform your glassmaker so they can assist you. Waivers for participants under 18 should be filed out in their name and signed by their parent or legal guardian.

Participant's Full Name *

Please write in full name

Phone *

Email *

Organizer's Name, if Different

Complete the following for the person listed above.

Visually Impaired

Yes

No

Sensitive to Heat/ Prone to Heat Stroke

Yes

No

Disabilities That Affect Working With Glass

Yes

No

Lift 10 lb Object

Yes

No

Hearing Impaired

Yes

No

Mobility Issues

Yes

No

Difficulty Standing or Sitting

Yes

No

All Appendages

Yes

No

Emergency Contact Name

Emergency Contact Phone

Today's Date *

If participant under the age of 18 this must be signed by parent or guardian. *

Paticipant or Parent/Guardian Signature *

Clear

Filling Out the Safety Questionnaire​

Filling Out the Safety Questionnaire