** Camp Contraption Registration deadline: May 8** See Lil 'Traption workshops deadlines on schedule Participant info: Participant's Name:

Grade Level:

Workshop:

Session date/time:

Contact information: Main contact name:

Main contact Address:

Main contact phone#:

Main contact email:

Emergency contact Name:

Emergency contact Phone#:

Please read and sign the rules and safty agreement on back of this form.

Payment: * Please make check payable to: Proto, Inc. Mail Check & this form to: Proto, Inc. 515 Pine St. Green Bay, WI 54301 * Forms mailed with payment will be prioritized above those mailed without. Class will be considered "FULL" with max number of paid registrations. * Payment must be received one week before classes begin. * Refunds for cancellations will be made up to one week before the workshop start date.

Proto Camp Contraption Rules and Safety Agreement For the Parent/Guardian: Assumption of Risk and Release You agree that you are voluntarily participating in Proto, Inc. with knowledge of the risks of doing so, such as the risks of injury, property damage, or death resulting from the use of potentially dangerous tools or materials, and/or the active or passive negligence of Proto, Inc. sponsors and suppliers, including the Brown County Central Library(BCCL) and their respective officers, directors, employees, agents, and exhibitors (collectively, "we" or "us"). You release us from all liability, claims, damage, or demands arising from or related to your participation in the Proto, Inc. Recordings You acknowledge that Proto, Inc. events may be recorded in audio, visual, and/or audiovisual media and you consent to the making and use of such recordings by Proto, Inc., BCCL and/or its licensees for any purpose. You release Proto, Inc. and its licensees from and waive any claims related to or arising by reason of the making and/or use of any such recordings. You grant Proto, Inc. the right to use your name and likeness in connection with the use of the recordings. Acknowledgment You acknowledge that you have read this Agreement and understand that it includes an assumption of the risk and a release of liability. We are relying on this waiver to allow you to participate in Proto, Inc. Participation You agree to use the facilities, tools, and materials in a safe way, and to alert fellow Proto, Inc. mentors, staff and/or program leaders when facilities, tools, and materials are being used in a way that could cause harm to themselves or others.

For Parent/Guardian & Participant: ** Disruptive behavior that is considered directly unsafe to self or others or that could cause distraction that would lead to an unsafe situation - will be given one warning only - at the discretion of Proto staff. Further disruptive actions diminishing the quality of the class for self others will result in a phone call for the participant to be picked up and immediate dismissal from the space. This is important for the safety of everyone and for a positive experience overall. Signing below acknowledges that you have read, understand and agree to the terms listed above.

Name of Legal Parent or Guardian (printed )

Signature of Legal Parent / Guardian

Today's Date

Name of Participant (printed )

Signature of Participant:

Today's Date

Proto Camp Contraption Sign Up Sheet.pdf

May 8, 2017 - Signature of Participant: Today's Date. Page 2 of 2. Proto Camp Contraption Sign Up Sheet.pdf. Proto Camp Contraption Sign Up Sheet.pdf.

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