Thank You – WHEELHOUSE MAKERSPACE

New Member Form

All new members are required to Fill this out

Name *

Email Address *

Phone *

Preferred method of contact *

Street Address *

Apartment, suite, etc

ZIP / Postal Code

Your Website

Emergency Contact Information:

Emergency Contact

Contact Number

Relationship

Skills

(This section helps to understand the diversity of skills within our community.)

Professional Background: (Optional)Current Occupation/Field of Study

Please check areas where you possess skills and experience (check all that apply)(This section helps to understand the diversity of skills within your community.)

OtherIf other selected

For the skills identified above, please indicate your level of expertise (Beginner, Intermediate, Expert) in the space provided

OtherIf other is selected

What skills do you wat to learn? (check all that apply)

Other SkillIf other Selected

Additional Comments/InformationPlease share any other skills, interests, or relevant information that you’d like us to know

Volunteer

(This section informs us what member's are willing to participate in various activities and help others.)

Are you willing to volunteer and help others?yesno

Please indicate any areas you're interested in (check all that apply)

What days are you available?

What times are you available

Hours

Minutes

Preferred types of projects or tasks

Any restrictions or limitations (physical, time-related, etc.)

OtherIf other Selected

Rules & Procedures

Waiver Of Liability

At WheelHouse, we use a variety of tools and materials. Some projects require tools that can pose a moderate risk (for example, 3D-printers, laser cutters, etc.), and others pose much greater risk (welders, drill presses, belt sanders, etc.). Some tools can cause serious injury or death. Many of the tools are designed to re-arrange atoms. You are made of atoms! So, treat every tool with cautious respect. Regardless of the tool or project, at WheelHouse, you must always be alert, use common sense, and treat every space and tool with caution and respect. Safety is our greatest concern and number one priority. And, as a member, we require you to prioritize safety too. You must have comprehensive training on a tool before you may use it. You must be diligent in your use of every space and/or tool. If you feel uncomfortable or think you may not be using something properly, ask someone. If you see someone else being unsafe, speak up. ALWAYS WEAR EYE PROTECTION! This waiver is designed to protect WheelHouse, but it is also designed to protect you. This document is a contract between you (the member) and WheelHouse in which you acknowledge and promise that you will always, always be cautious, careful, and safe. ALWAYS! This is your legally-binding contractual promise and obligation

Please fill in your name:

promise to prioritize safety and understand that the tools at Wheelhouse can be extremely dangerous (and even deadly!) if not operated properly. I acknowledge that every space and every tool at WheelHouse is safe, as long as it is (they are) used properly and with extreme caution. *

I understand that there are extreme risks at Wheelhouse that carry potentially severe consequences. I acknowledge that my misuse of any space or tool at WheelHouse could result in injury (to myself or others) or death. I UNDERSTAND THESE RISKS AND I AGREE THAT IT IS MY RESPONSIBILITY TO REMAIN SAFE.: *

I agree that every person, whether a member or guest, must understand the rules of Wheelhouse and must sign a waiver before using any space or tool. Therefore, guests are not permitted to use the facilities or tools unless properly trained, protected, and legally permitted by Wheelhouse. I understand and agree that children cannot comprehend the gravity of the danger posed at WheelHouse, and that anyone under the age of 18 is not permitted at Wheelhouse; no person may use the facilities or tools unless that person can sign a copy of this legally-binding waiver for himself/herself.: *

I understand the risks, my responsibilities, and the expectations of me while a member of WheelHouse. I swear that I have read this document in its entirety and agree with all of the provisions. I agree to hold WheelHouse Inc. and/or Nor'wood Limited, Inc. harmless of any liability, and I waive all legal claims against Wheelhouse Inc. and/or Nor'wood Limited, Inc for any injuries or damages that I may incur.: *

Full Name *

Date Of Birth *

Todays Date *

Filling Out for Minor? *noyesAnyone under 18 requires a guardian with them to be in the space

Consent for minor

Name Of Guardian *

Name Of Minor *

Date Of Birth Of Minor *

Date Of Birth Of Minor

Signature *