Lasko School of Log Building Application
SEND TO: Lasko School of Log Building, Inc 18831 Hilltop Road Sparta WI 54656
I, ____________________________________________________________________________________, (Please Print) Do hereby apply to attend a scheduled hands-on course in log construction, course number ________________, at the William M. Lasko School of Log Building, beginning on the __________day of _____________________ 2011.
Enrollment / Registration Agreement
If I am accepted into enrollment for the above selected course at the William M. Lasko School of Log Building, Inc. (hereinafter referred to as; school) I fully understand and accept that while I am a participant of the school, all of my personal needs or requirements are my own responsibility, including accommodation, care and protection of belongings and equipment, mail pick-up, telephone calls/messages, personal safety, personal insurance coverage, and any other matters or issues concerning my trip and participation / experience , any and all needs while I am attending, and my trip home & unless stipulated otherwise, this will be a Standard for all that attend. If for any reason I am not accepted I expect my Deposit and full Fee to be returned promptly.
I am aware of all the dangers and risks in a construction setting and associated with operating power equipment, including but not limited to cranes, ladders and chainsaws and accept as my personal risk the hazards of such participation, and will not hold William M. Lasko, the Lasko School of Log Building, Inc. , its agents, Leasers, hosts, clients, representatives, responsible or liable for any injuries, mishaps, loss or damage to personal property, or any other eventualities in regards to participation in any school functions I freely choose to attend. In consideration of the school accepting my application, I hereby Release and forever Discharge the school, its officers, directors, employees, hosts, Leasers, clients, volunteers and agents from any Liability whatsoever arising as direct or indirect results in the participation in this course. Further, I Release the School of Log Building, Inc, William M. Lasko , their directors, officers, Leasers, hosts, clients, volunteers, instructors, employees, successors, and assigns, from any and all claims, action, and demands I say I have now or at anytime in the future for use of film, video and still photos of me while participating in any type of web, print, recorded or broadcast media or promotional endeavors with the signing of this Agreement.
Further, I declare that this release is binding upon, my heir's, executors, administrators, assigns, and myself, I understand and agree that my fee in "non-refundable". If I am not to meet the registration deadlines, or if I fail to show up for the course applied for, I have only one option, namely to apply the fee to another scheduled course, provided the school receives a written notification of your intent to do so prior to the original registration deadline date. I do understand and agree that the full fee, as set out in the school literature, (which forms a part of the agreement), must be received not less than six (6) weeks prior to the starting date of the course on the date confirmed by the school. No violations of rules of participation will be tolerated/allowed by the school and that any such problems may be cause for dismissal from the group and school. I expect my application to be confirmed in writing before I prepare to attend.
With this signed and witnessed application; I enclose my deposit of $450.00 (US) in a certified check or money order. If for any reason, my application shall be denied or cannot be accepted, I expect my deposit to be returned to me promptly. Then accepted, I will remit the balance (tuition) of $______________ no later then (6) six weeks prior to the start date of the course I have selected.
My birth date is_________________. My state of health is_________________________________________________________________________________________________________________________________________________________________.
I have the following disabilities__________________________________________________________. I have the following work related juries:_________________________________________________________________________________.
To help the school better serve you and understand your needs, please complete the following: During my work experience and schooling, I have developed the following skills to a workman manner:____________________________________________________________________________________________________________________________________________________________________________________________________________________.
Signed this ______day of _____________________, 2011 in city or town of _______________________________________________________. State of ________________________________ _____ Zip Code _______________________________.
Student Name Printed ________________________________________________________. Signature ________________________________________________________________. Date _________________________________________________.
Witness Name Printed _______________ _________________________________________. Signature ________________________________________________________________. Date ___________________________________________________.
My permanent address where I may be reached (6) six weeks prior to a scheduled session I have chosen, is;_______________________________________________________________________________________________________.
My Telephone Number : Home (_______) ____________________ Work : (_______) ____________________ Cell : (_______) _________________________ E-mail address : _______________________________________________________.
I, ____________________________________in consideration of my being accepted by The William M. Lasko School of Log Building, Inc. for enrolling into log construction Session # ______beginning on the ______day of __________, and continuing for ______days, receipt of which consideration is hereby acknowledged for myself, my heirs, executors and administrators, do hereby release and forever discharge the William M. Lasko School of Log Building, William M. Lasko, their directors, officers, Leasers, hosts, clients, volunteers, instructors, employees, successors, and assigns, from any and all claims, action, and demands I say I have now or at anytime in the future for damages, loss, costs, expenses, or legal fees resulting from death, injury, damages, loss, due to or in anyway connected with my participation in the aforesaid Log Construction Course whether or not such loss or damage results from the negligence of Lasko School of Log Building, Inc. I further agree for myself, my heirs, executors, Leasers, hosts, clients and assigns, to indemnity and Save Harmless Lasko School of Log Building, Inc. from any and all claims, actions, or demands, by any person who might be enrolled participating in the said Log Construction Course.
Signed, Sealed and Delivered - In the presence of: Signature of Participant (Printed) __________________________________________________________ . Signed __________________________________________________________.
Name, address, and phone number of Witness. (Printed)_____ ___________________________________________________________________________________________________________________________________________________________.
In Witness whereof I have hereunto set my hand this____ ________day of __________________. 2011 Signature of witness ______________________________________________________________________________________________.
Make a copy of the form, fill out and mail to the address shown. Don't forget a Certified Check or Money Order for each student's tuition deposit!
Incomplete forms can not be accepted
