Hot Glass Safety Questionnaire

Hot Glass strives to make all classes, workshops, and community activities accessible for people with all types of physical restrictions or limitations. In our effort to ensure your safety and the safety of other students, we require all students to fill out a safety questionnaire. Answering “yes” to any of these questions does not disqualify you from taking classes at Hot Glass; using this information, we will do our best to accommodate each student. Hot Glass reserves the right to deny access to Hot Glass’s studios or to remove any student from a class at Hot Glass’s discretion based on our assessment of an individual’s potential risk of injury.

Student Safety Questionnaire


            Your Full Name:

            Email:

            Are you visually impaired in either eye or have any vision problems? Yes No

            Do you have any hearing impairments? Yes No

            Do you have any mobility issues? Yes No

            Do you have trouble going from a seated position to standing?

            Yes No

            Do you have all your appendages (arms, legs, hands, feet, fingers)?

            Yes No

            Are you sensitive to extreme heat/heat stroke?

           (We work with high temperatures and want to make sure you stay hydrated and safe!)

           Yes No

            Can you lift a 10 pound object with ease? Yes No

            Do you have any other disabilities that we should know about that may affect your ability to work with glass? Yes No

            Please list any prescription medications you are currently taking:

           





HOT GLASS WAIVER AND RELEASE AGREEMENT

            I realize that there are dangers inherent in glassblowing, glass working, and other related activities, and that mortal or serious personal injuries and property damage, including (but not limited to) physical effort, cuts, burns, inhalation of hazardous substances, and/or exposure to UV light, may occur from my participation in such activities. I assume full responsibility for the risk of personal injury, death, and property damage due to the negligence and/or fault of the parties released by this document, and/or due to the condition of the premises on which the activities will take place, whether such negligence, fault, and/or condition of the premises is present at the signing of this agreement or takes place in the future. On my own behalf and on behalf of my heirs, personal representatives, and assigns, I hereby release Hot Glass and all of their officers, directors, members, managers, partners, employees, and volunteers (collectively, "the parties released by this document") from all claims, demands, actions, rights of action, or other legal rights to claim compensation for any loss or injury which I may sustain as a result of their negligence or fault, or the condition of the premises, or any other cause whatsoever, whether loss or injury occurs while participating in, going to, or coming from such activity. Further, I agree to indemnify and hold all parties released by this document harmless from any such claims or demands. I expressly agree that this waiver and release agreement is intended to be as broad and inclusive as permitted by the Laws of the State of Iowa and of any other state wherein such activities may occur, and that if any portion hereof is held invalid, the remainder hereof shall continue in full force and effect.

This Agreement contains and embodies the entire agreement and understandings between the parties concerning the subject matter hereof.

YOUR SIGNATURE INDICATES THAT YOU HAVE READ AND AGREE TO THE ABOVE.

Signature:_________________________________________________ Date:______________

Address: ____________________________________Zip___________ Phone:______________

Print name:_________________________________

Age: under 18 19-40 41-60 60+

Optional Email (Please!!): _______________________________________________________

If participant is under the age of 18, parent or guardian must sign as well.

Signature:_________________________________________________ Date:______________

Print name:________________________________________________

Safety and Waiver Form

Hot Glass Inc. Student Safety Information

All students are required to wear closed toed shoes; no exceptions will be made and refunds will not be given. Anyone suspected to be under the influence of drugs or alcohol will be dismissed immediately and without refund. Hot Glass reserves the right to require the withdrawal of any student whose conduct is deemed detrimental, without refund. Many glass art classes involve working around high heat environments and students who have certain health considerations may not be eligible to take every class at Hot Glass. In our effort to ensure your safety and the safety of others, we require all students to fill out a safety questionnaire.  Hot Glass reserves the right to deny access or to remove any student from a class at Hot Glass’ discretion based on our assessment of an individual’s potential risk of injury. Hot Glass will issue a partial refund for any remaining class sessions upon receipt of a doctor’s notice if it is determined you should not participate

Clothing: It is recommended that glassblowers wear cotton or wool clothing rather than nylon or polyester. Part of the reason is the way that natural fibers hold sweat. But nylon can melt in the heat and if it sticks to the skin is very painful. Many glassblowers work in short sleeves and short pants and pull on a cotton sock with the toe cut out to protect the arm when working bigger pieces. Long sleeved cotton tee's and blue jeans are recommended as good year-round glassblowing wardrobe.