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DAVIDE BIGAZZI STUDIO & GALLERY 75 Arbor Rd Suite K. Menlo Park, CA 94025 tel/fax 650.323.1923

_________________________________________________________ WORKSHOP & CLASS REGISTRATION FORM Name: ____________________________________________________________________________ Address: __________________________________________________________________________ City: _______________________________________ State: _______ Zip: _____________________ Tel #: ______________________________E-mail: ________________________________________

How did you hear about our classes?___________________________________________________ Workshop Date ____________________________________________________________________ 3 Day Art of Chasing & Repoussé $575 3 Day Cuff Bracelet Workshop $575 3 Day Embellish with Gold $575 1 Day of Tools + 2 days of Chasing & Repoussé $600 5 Day Intensive: The Art of Chasing & Repoussé $1200 5 Day Intensive: Chasing & Repoussé Jewelry Project $1200 12 Hour Class Package $350 2 Day Two Chains / Two Bracelets (instructor Alev Ozten) $280 Payments are due upon registration. (A $450 deposit will secure your spot in the 5 Day Intensive. The final balance ($750) is due 3 wks prior to the workshop.) Payment Our preferred payment method is by check. Please make checks payable to Davide Bigazzi Studio. (*except ‘Two Chains / Two Bracelets’ workshop, payable to ‘Alev Ozten’) □ Check □ Credit Card - If you would like to pay by credit card a PayPal Payment Request will be emailed to you so that you can pay online securely. □ Gift Certificate (expiration date: ________) Cancellation Policy Workshops: For cancellations 21 days or more prior to the workshop, tuition paid may be transferred to another scheduled workshop or refunded less a $50 cancellation fee. Cancellations made 21 days or less prior to the workshop, will result in the loss of all monies paid. Tuition paid will be honored for up to 2 months when applied to another workshop. Once a workshop has started, no refunds will be given. Drop-In Studio Classes: Your class time is reserved specifically for you. A 24 hour cancellation notice is required to cancel, otherwise, when and if the class is full, your class hours will be forfeited. Davide Bigazzi Studio reserves the right to cancel any workshops prior to its start, in which case all fees paid will be refunded. Signed: ______________________________________________

Please read and sign the waiver on page 2.

Date: ________________

RELEASE AND WAIVER OF RESPONSIBILITY Agreement Not to Sue, Indemnification, and Hold Harmless Agreement METALSMITHING AND JEWELRY MAKING ARE INHERENTLY DANGEROUS ACTIVITIES AND, AS SUCH, DAVIDE BIGAZZI REQUIRES ALL PERSONS ATTENDING DAVIDE BIGAZZI STUDIO CLASSES, WORKSHOPS, AND PRIVATE LESSONS, OR USING ANY DAVIDE BIGAZZI STUDIO EQUIPMENT OR FACILITIES TO SIGN THIS RELEASE AND WAIVER OF RESPONSIBILITY. I, _________________________________ on behalf of myself, understand that metalsmithing and jewelry making are inherently dangerous activities and acknowledge that the following inherent risks are associated with such activities, including without limitation: (1) the use of and exposure to superheated gases and torches; (2) handling hot metals and solder; (3) exposure to sharp objects; (4) exposure to power tools, and (5) latent risks associated with exposure to potentially dangerous chemicals and other hazardous materials. I understand that my negligence or failure to act within my abilities may contribute to or result in an injury and that Davide Bigazzi Studio, its instructors, founders and monitors will not provide me with any medical treatment or pay for any medical or other treatment expenses should I become sick or injured.�. Davide Bigazzi Studio and its instructors, founders and monitors hereby specifically disclaims any and all responsibility or liability for, and I, on behalf of myself and my heirs, next of kin, spouse, guardians, legal representative, executors, administrators, successors, and assigns hereby knowingly and intelligently release Davide Bigazzi Studio, and its instructors, founders and monitors, from, any and all claims, whether known or unknown, which I may have relating to: (i) any and all damages to the student or any personal property of the student, including without limitation, indirect and consequential damages or injuries as a direct or indirect result of the inherent risks of metalsmithing and jewelry making; (ii) any liability relating to instruction, construction, design, or use of any Davide Bigazzi Studio equipment or facilities, manufacture of any product, or any other activity undertaken in conjunction with classes, workshops, and private lessons offered by Davide Bigazzi Studio or as a result of the use or application of information given or contained in any class, workshop, and private lessons offered by Davide Bigazzi Studio or contained in any writing given to me by Davide Bigazzi Studio or (iii) any actions taken by me while on the Davide Bigazzi Studio premises with respect to construction, design, use of equipment or facilities or manufacture of any product. I HEREBY REPRESENT AND WARRANT UNDER NO DURESS AND ON MY OWN FREE WILL THAT I UNDERSTAND THAT BY SIGNING THIS DOCUMENT, I MAY BE WAIVING CERTAIN LEGAL RIGHTS. I UNDERSTAND THAT I WILL BE RESPONSIBLE FOR ALL ACTIONS TAKEN AT THE DANACA DESIGN FACILITIES, INCLUDING WITHOUT LIMITATION, USE OF EQUIPMENT AND FACILITIES. I UNDERSTAND THAT I AM SOLELY RESPONSIBLE FOR ANY AND ALL DAMAGES, WHETHER DIRECT OR CONSEQUENTIAL, FOR THE USE AND APPLICATION OF INFORMATION GIVEN AT ANY CLASS, WORKSHOP, OR PRIVATE LESSON, OR CONTAINED IN ANY WRITING DISTRIBUTED BY DAVIDE BIGAZZI STUDIO. _______________________________ Signature

_____________________________ Print Name

_____________________________ Date

_____________________________ Address

Emergency Contact (name, relationship, phone) _____________________________________________________________________________

Registration10 2013  

Workshop and class registration

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