🔒 STEM CAMP LIABILITY WAIVER & ASSUMPTION OF RISK (DRAFT)

Program Name: __________________________________________
Location: ________________________________________________
Dates: _________________________________________________
Student Name: __________________________________________
Parent/Guardian Name: ____________________________________

1. Acknowledgment of Inherent Risks

I, the undersigned parent or legal guardian, understand and acknowledge that participation in this STEM program involves activities that may present inherent risks. These activities include, but are not limited to:

• Handling electronic components such as LEDs, microcontrollers (ESP8266), wires, motors, servos, and batteries
  
  

• Using soldering irons, hot glue guns, cutting tools, pliers, screwdrivers, and other equipment
  
  

• Working with basic electrical circuits
  
  

• Using laptops, Chromebooks, or internet-enabled devices
  
  

• Constructing student-designed or student-built devices
  
  

I understand that these activities may involve risks including, but not limited to:

• Minor or moderate burns (e.g., soldering iron, hot glue, heated components)
  
  

• Scrapes, cuts, or pinches
  
  

• Eye irritation or exposure to bright LEDs
  
  

• Electrical shock from improper handling of components (low-voltage but still a risk)
  
  

• Trip hazards or workspace hazards
  
  

• Unintended behavior of robots or electronic devices
  
  

I voluntarily assume all risks associated with my child’s participation in these activities.

2. Safety Compliance

I acknowledge that staff will provide safety instruction and supervision but cannot guarantee prevention of all injuries. My child agrees to:

• Follow all safety rules and instructions
  
  

• Use tools and equipment responsibly
  
  

• Wear safety equipment when required
  
  

• Report hazardous behavior to staff
  
  

Failure to follow safety procedures may result in removal from activities without refund.

3. Release of Liability

In consideration for my child’s participation in this program, I hereby release, waive, discharge, and hold harmless:

[Your Name / Your Organization], its officers, employees, assistants, volunteers, partners, sponsors, and agents

from any and all liability, claims, demands, actions, or causes of action arising out of or related to:

• Accidental injury
  
  

• Property damage
  
  

• Exposure to materials, tools, or equipment
  
  

• Use or misuse of instruction, tools, or devices
  
  

This waiver includes injuries that may result from ordinary negligence, but not from gross negligence or intentional misconduct.

4. Waiver of Liability for Student Actions Outside the Program

I acknowledge and understand that the skills and knowledge gained in this program may enable my child to work independently with:

• Soldering irons
  
  

• Batteries and circuits
  
  

• Microcontrollers (e.g., ESP8266)
  
  

• Coding and robotics systems
  
  

• Motorized or electronic devices
  
  

I agree that Lumenate Labs Education is not responsible for:

• My child’s use or misuse of skills, knowledge, tools, or devices outside the program
  
  

• Any injury, property damage, or legal consequences that occur after the program ends
  
  

• Any modifications or constructions my child attempts at home
  
  

• Any replication of projects, devices, or activities taught during the program
  
  

This includes, but is not limited to:
unintended burns, electrical hazards, personal injuries, fire hazards, misuse of code or WiFi-connected devices, or damage to personal or household property.

5. Media Release (Optional)

I grant permission (optional) for the program to take photos or videos of my child during activities and use them for promotional or educational purposes.

☐ Yes
☐ No

6. Medical Authorization

In the event of a medical emergency, I authorize program staff to seek appropriate medical care for my child. I understand I am responsible for any resulting medical expenses.

7. Parent/Guardian Certification

I certify that:

• I have read and understood this waiver
  
  

• I am the legal guardian of the minor named above
  
  

• I voluntarily sign this document without coercion
  
  

• I understand this waiver is binding to the fullest extent permitted by California law
  
  

Parent/Guardian Signature: ____________________________
Date: ___________________

Printed Name: _______________________________________

Emergency Contact Name & Phone: ______________________