Portland State University
Maseeh College of Engineering and Computer Science

Activity: Participation in any Manufacturing Lab Activity

I hereby assume full responsibility for all damage or risk of injury or loss that may result from my participation in any Manufacturing Lab activity, whether it be through a course, an independent study or research, or any project offered by the Maseeh College of Engineering and Computer Science at Portland State University (PSU). As a condition of my participation in Manufacturing Lab Activity, I will be required to safely operate machine tools, hand tools and other equipment that may have the potential to cause personal injuries or even death while operated by myself or others.

I understand that all physical activity inherently carries some risk of injury, and certain types of activity are not appropriate for persons with limiting medical/health conditions. I knowingly and voluntarily assume the risk of these injuries, regardless of severity, which may occur because of participation in physical activities. I understand that Portland State University recommends that each student or participant obtain a medical examination by a qualified medical doctor and be covered by an adequate accident and hospital insurance policy before participating in any program or activity requiring physical activity or exertion.

I will not participate in any Manufacturing Lab activity nor operate any PSU shop tools of any kind if (1) I am not physically or mentally able to operate tools safely, and (2) I have not received the required orientation and training as evidenced by MME Department’s written acknowledgement sufficient to comply with the department’s Level One, Level Two, and Level Three shop access standards described on the back of this form.

I am either insured by a licensed provider of accident or health care insurance, or I assume personal risk of not being insured.

In case of an emergency, I authorize the PSU staff to obtain whatever medical treatment deemed necessary for my welfare.  I further understand and agree that I will be financially responsible for all charges and fees incurred in the rendering of said emergency treatment, regardless of what my medical insurance would cover for such fees and damages.
I understand that PSU reserves the right to remove me from the courses stated above at any time should my actions or behavior, in the sole discretion of PSU, impede or obstruct the activities of other participants in those courses, or if my actions or behavior endanger me, other participants, faculty, staff or students.

I, the undersigned, am at least eighteen (18) years of age and have read this release form and understand all its terms.  If I, the undersigned, am under the age of eighteen (18) years, in addition to my signature, my parent or legal guardian also shall state their having read, signed, and understand this release form and all its terms.

I hereby release Portland State University, its Board of Trustees, officers, employees, agents, affiliates or representatives from any and all liability, claims, cost, expenses, injuries, illness, or loss resulting from, in whole or part, including attorney fees, for my participation in the Portland State University activity shown above.