Kids Kitchen Contact Form No. 1 Child's Name* First Last Age of Child* Parent's Name* First Last Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email* Phone*Does your child have any food allergies?* Yes No List of Food Allergies Who will be picking up your child?* Is there anything else you would like to share with us?Privacy and Consent* I agree to the privacy and consent policy.Please read and agree to the terms below By signing this Assumption of Risk, Release of Liability and Waiver, I represent that it is my desire and intent that the child identified below (“my child”) participate in the activities of Kitchen House Cooking Classes, specifically including the cooking class(es) described below. I also represent that I have the authority to enter into this agreement on behalf of my Child as the Child’s parent or legal guardian. I acknowledge that the participation of my child in Kitchen House Cooking Classes, 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. On behalf of my Child, I expressly and voluntarily assume any and all risks associated with participation in Kitchen House's cooking classes 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. In consideration for my child being permitted to attend and participate in Kitchen House’s Cooking class and any and all of the activities that are or might be associated with Kitchen House’s Cooking Classes, on my child’s behalf, I release and further agree to indemnify, defend and hold harmless Kitchen House's, 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 cooking classes and the preparation of food in that class for consumption. I understand that Kitchen House does not allow any returns or refunds. For our full Refund Policy: https://kitchenhouseaustin.com/refund_returns/ 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 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 child’s and my legal rights, and I am signing it on behalf of the child, as well as his/her heirs and assigns, who will be bound by all of its terms.Waiver for Photo/Video/Audio Release:* Yes No Date* MM slash DD slash YYYY Signature 40827