This is an old revision of the document!

Between _ (print your first and last name) and Lansing Makers Network, NFP, [insert address here] (“LMN”).

By signing this statement, I acknowledge that LMN is a dangerous place and I agree to HOLD HARMLESS LMN, its officers, and its directors.

Initials:

I understand that I am responsible for properly monitoring and labeling anything I bring to LMN and that LMN is not responsible for any lost, damaged, or stolen property.

Initials:

I affirm that I am 18 years of age or older, and that I am mentally competent to sign this release.

Initials:

Name: _ Address: _ Phone number: _ Email address: _ Emergency contact name: _ Emergency contact phone: _ Emergency contact relationship: _ Signature: _ Date: ___

Based on a form used by i3Detroit.