Louisiana Workshop Application

Please read carefully and fill out completely the application and the liability release. Sign both and mail them back to Clark Crenshaw Photography. Include the $450 workshop fee or click on the thumbnail at the top of the previous page and pay with credit card.

Workshop: Lake Martin and Southern Louisiana
Date of Workshop: April 11-14, 2012
Name: .................................................................................... Age: .............................
Address: ......................................................................................................................
City: ............................................................................................................................
State: ......................................................Zip: ..............................................................
E-mail: .........................................................................................................................
Phone (home): ........................................ Phone (work): ...............................................
Occupation: ..........................................................................
Birthdate: ........../........../..........
Person to notify in case of an emergency: ....................................................................................................................................
Name: ................................................................................
Relationship: .......................................................................
Address: .............................................................................
City: ...................................................................................
State: .......... Zip: ...............................................................
E-mail: ..........................................................................................................................
Phone (home): ........................................ Phone (work):.................................................
Do you have any special medical conditions: Yes: ................ No: ..................
If yes, please explain: ........................................................................................................................................................
........................................................................................................................................................
Acknowledgement I have read the participant agreement, release and acknowledgement of risk, and understand its terms in full, especially cancellations, refunds and responsibility.

 


Signature of Participant: .......................................................... Date: ............/............/..................

 

 

 

 

 

 

 

Participant Agreement, Release & Assumption of Risk

 


In consideration of the services of Clark Crenshaw Photography, their agents, owners, officers, volunteers, participants, employees, and all other persons or entities acting in any capacity on their behalf (hereinafter collectively referred to as
“Clark Crenshaw Photography”), I hereby agree to release, indemnify, and discharge Pixelchrome, on behalf of myself, my children, my parents, my heirs, assigns, personal representative and estate as follows:
1. I acknowledge that participating in this workshop entails certain unanticipated risks which could result in physical or emotional injury, damage to myself, to property, or to third parties. I understand that such risks simply cannot be eliminated without jeopardizing the essential qualities of the activity. The risks include, among other things: the hazards of walking on uneven terrain, slips and falls, food poisoning, and my own physical condition.
2. I expressly agree and promise to accept and assume all of the risk existing in this activity. My participation in this activity is purely voluntary, and I elect to participate in spite of the risks.
3. I hereby voluntarily release, forever discharge, and agree to indemnify and hold harmless Clark Crenshaw Photography from any and all claims, demands, or causes of actions, which are in any way connected with my participation in this activity, including any such claims which allege negligent acts of omissions by Clark Crenshaw Photography.
4. Should Clark Crenshaw Photography or anyone acting on their behalf, be required to incur attorney’s fees and costs to enforce this agreement, I agree to indemnify and hold them harmless for all such fees and costs.
5. In the event that I file a lawsuit against Clark Crenshaw Photography, I agree to do so solely in the state of Texas, and I further agree that the substantive law of Texas shall apply in that action without regard to the conflict of law rules of that state. I agree that if any portion of this agreement is found to be void or unenforceable, the remaining document shall remain in full force and effect.
Are there any physical or mental conditions for which you have received medical treatment or for which you are currently receiving medical treatment? Please include RECENT SURGERIES, PROBLEMATIC OLD INJURIES, any MEDICATIONS you are currently taking and all ALLERGIES.

By signing this document, I acknowledge that if anyone is hurt or property is damaged during my participation in this activity, I may be found by a court of law to have waived my right to maintain a lawsuit against Pixelchrome on the basis of any claim from which I have released them herein. I have had sufficient opportunity to read this entire document. I have read and understood it, and I agree to be bound by its terms.


Signature of Participant: .......................................................................................
Print Name: ........................................................................................................
Address: ............................................................................................................
City: ..................................................................................................................
State: .......... Zip: .................................... Date: ............/............/......................
E-mail: ..............................................................................................................
Phone (home): .......................................... Phone (work): ...................................................

PARENT’S OR GUARDIAN’S ADDITIONAL INDEMNIFICATION
(Must be completed for participants under the age of 18)
In consideration of ................................................................... (print minor’s name) (“Minor”) being permitted by Clark Crenshaw Photography to participate in its activities and to use its equipment and facilities, I further agree to indemnify and hold harmless Clark Crenshaw Photography from any and all claims which are brought by, or on behalf of Minor, and which are in any way connected with such use or participation by Minor.
Parent or Guardian:...............................................................
Print Name: .........................................................................
Date: ............/............/..................

 

 

Workshop Costs and Cancellation Policy
Price of the Workshop $450


What is included!

  • Knowledge of the shooting locations. 
  • Instruction and guidance while at the shooting locations. 
  • There will also be computer instruction held during mid-day and in the evenings after dinner.

What is not included!

  • Room and board, meals, and transportation. 
  • Participants must reserve their own rooms. 
  • There will be some carpooling each day to drive to the different photography locations, however, you will need your own transportation to and from Lafayette, Louisiana.
  • Camera equipment is not included. Please bring your cameras manual.
  • Entrance fees.

If a workshop participant wishes to cancel they must send notification in writing to:

Clark Crenshaw Photography
4014 Upland Way
Garland, Texas 75042
214-769-4533
Email: clark@clarkcrenshawphotography.com

At the time we receive your notification, the following per person charges will apply:


• More than 30 days until the workshop. Full Refund.

• 30 days or less before the workshop. $50 cancellation fee.

Refunds for services that are voluntarily not used by you cannot be made.

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