This is an old revision of the document!

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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.