Course Registration Form Mail with payment to: The Darkroom - 821 Escobar Street #101 - Martinez CA 94553 Class______________________________________ Date____________ Fee$______ Class______________________________________ Date____________ Fee$______ Name______________________________________ Total Enclosed $________ Address__________________________________City__________________Zip______ Phone ____________________________day   _________________________evening Email__________________________________________________________ Other classes I would take if you offered them:______________________________ I found out about your classes from:____________Camera Model_______________ Assumption of Risk, Waiver and Release of Liability, Including Negligence I, the undersigned agree to each and all of the following in connection with my participation in the photography class(es), workshop(s) and/or field outing(s) conducted by J. Michael (Jerry) Ott or by others on behalf of The Darkroom, for which I have registered above:  1) I am a healthy adult, voluntarily participating in said class(es), workshop(s) and/or field outing(s) and I assume all risks of illness, injury, death, damage and/or loss to myself or my property that might result.  2) On behalf of myself and my personal representatives, heirs, executors, administrators, agents and assigns, I hereby release and discharge in advance The Darkroom (and its owners, employees, instructors, agents, representatives and assigns) from any and all liability, even if that liability arises out of negligence and/or carelessness on the part of the persons or entities mentioned above.  3) My assumption of risk, waiver and release of liability, including negligence, encompasses, but is not limited to: death, bodily injury, illness, damage, theft and/or loss of personal property during said class(es), workshop(s) and/or field outing(s) which occurs as a result of anything during participation in the entire activity. The following are some, but not all of the possibilities: a) negligent instruction and/or supervision by any of the persons involved in any of the courses on behalf of The Darkroom, b) exposure to photographic chemicals, c) traversing uneven ground with or without photographic equipment in order to access photography sites, d) natural hazards, such as, but not limited to, busy roadways and/or poison oak. Consent of Parent or Legal Guardian (if registrant is under 18 years of age): I certify 1) that I am the parent or legal guardian of (minor child)_______________________________, 2) that my child is healthy and in adequate physical condition to participate in the activities involved in the class(es), workshop(s) and/or field outing(s) named on this course registration, 3) that my child is a voluntary participant in said activities, 4) that I give my permission for him/her to participate in said class(es), workshop(s) and/or field outing(s), 5) that my child and I assume all risks of illness, bodily injury, death, damage, theft and/or loss to my child/ward or personal property that might result and 6) that I hereby execute on his/her behalf the Assumption of Risk, Waiver and Release of Liability, Including Negligence. I have carefully read this Assumption of Risk, Waiver and Release of Liability, Including Negligence. I am aware that both predictable and unpredictable risks are involved during the classes, workshops and field outings conducted on behalf of The Darkroom. I hereby agree to assume all of those risks and to release and hold harmless all of the persons or entities mentioned above who through negligence or carelessness would otherwise be liable to me or to my heirs or assigns for damages, or to my minor child or to my child's heirs or assigns. Signature_____________________________________ Date______________ Print Name____________________________ Class(es)__________________________________