Form Liability Release Form

Adult's Information

Name*

First Last

Address*

Street Address City State ZIP Code

Email*

Cell Phone*

Secondary Phone

Medical Information/Permission to Treat

Do you have any food allergies?*

No
Yes

Please list any allergies

Emergency Contact Name*

Emergency Contact Relationship*

Emergency Contact Primary Phone*

Emergency Contact Secondary Phone

Assumption of Risk, Release of Liability and Waiver

Privacy and Consent*

Please read and agree to the terms below:
By signing this Assumption of Risk, Release of Liability and Waiver, I participate in the activities of Kitchen House, specifically including the cooking class(es). I acknowledge that the participation in Kitchen House Classes & Events, which includes participating in activities related to preparing and eating food, involves known and unknown risks, including the risk of physical injury, death and other damage. I expressly and voluntarily assume any and all risks associated with participation in Kitchen House events and eating the food prepared. I understand that there are risks inherent in cooking and eating the food prepared, including but not limited to, slips, falls, cuts, burns, cooking, food, allergy reactions, and other accidents and injuries that may arise from the activity of cooking and eating the food prepared in class.

I am permitted to attend and participate in Kitchen House’s classes.
I release and further agree to indemnify, defend and hold harmless Kitchen House, including members, manager, officers, owners, employees, agents, contractors, representatives, volunteers, interns, and insurers, from any and all claims, demands, actions, causes of action, lawsuits, expenses or losses (including attorneys’ fees) whatsoever that could be brought by me, my child or a third party acting on behalf of my child or me for acts of omissions related in any way to, or arising out of, Kitchen House's classes and the preparation of food in that class for consumption.

I understand that this is the entire agreement between Kitchen House, their agents or employees, and me, and that it cannot be modified or changed in any way by the representations or statements of any employee, agent, volunteer or intern of Kitchen House’s and I agree that this agreement shall be governed and interpreted under Texas Law. I acknowledge that I have read and understand this document, which affects my legal rights, and I will be bound by all of its terms.

I agree to the privacy and consent policy.

Waiver for Photo/Video/Audio Release:*

I give my consent for any photos, video and/or audio take of my myself involved in Kitchen House's programs to be used for Kids Kitchen’s promotions, trainings, or displays.

Yes
No

Date of Consent

Signature

Phone

This field is for validation purposes and should be left unchanged.