Fix It Clinic Registration - New Mexico Recycling Coalition

Fix It Clinic Attendee Registration

Name*
First Last
How did you hear about this Fix-It Clinic?
Email*
Enter Email Confirm Email
Phone
Address*
City State / Province / Region ZIP / Postal Code
Which virtual Fix It Clinic would you like to attend?
Please select the event you’d like to attend based on your location.
You will need a laptop, tablet or phone, and Internet connection that allows for video conferencing.*
- Yes
- No
For this virtual Fix It Clinic we will be hosting the event via Zoom. It’s helpful to have a second person in your household helping you aim the camera and help with disassembly and repairs.
Please include an image of your item
Accepted file types: jpg, gif, pdf, Max. file size: 10 MB.
Please include an image of the broken area of your item
Accepted file types: jpg, gif, pdf, Max. file size: 32 MB.
What is the brand name?*
What is the model number? (look on the back or bottom)*
Please describe the item to be repaired in detail and what is wrong with it. For example if it is a broken toaster, note the make and model if possible and the exact problem like, "toast won't pop up when done."*
Describe the problem in detail, including information such as if the problem has been gradual or if there was an event that broke it, and if the problem is constant or intermittent
Do you have any guesses about the underlying problem? What have you already attempted to do to fix it, if anything?*
Do you have access to tools (either your own or through borrowing or buying)?*
Additional Image
Accepted file types: jpg, gif, pdf, Max. file size: 32 MB.
FIXIT CLINIC Waiver and Release of Liability In consideration of the risk of injury or property damage while participating in the Fixit Clinic being held online, and in order to induce New Mexico Recycling Coalition to allow me to participate in the Fixit Clinic, I hereby, for myself, my heirs, administrators, assigns, or personal representatives, knowingly enter into this release and waiver and hereby waive any and all rights, claims or causes of action of any kind arising out of my participation in the Fixit Clinic, and do hereby release and forever discharge Santa Fe County, its departments, employees and volunteers for any physical or property damage that I may suffer as a result of my participation in the Fixit Clinic. I am voluntarily participating in the Fixit Clinic and I am participating entirely at my own risk. I am aware of the risks associated with the Fixit Clinic, which may include physical injury, pain, suffering, illness, disfigurement, temporary or permanent disability, economic or emotional loss, and death, injury or loss caused by use of tools, condition of equipment and actions of others, including the acts or omissions of other participants, volunteers, coaches, and Fixit Clinic staff. I understand that these injuries or outcomes may arise from my own or others’ negligence, conditions related to the Fixit Clinic. Nonetheless, I assume all related risks, both known or unknown to me, of my participation in the Fixit Clinic. I agree to indemnify and hold harmless New Mexico Recycling Coalition, its employees, agents and volunteers against any and all claims, suits or actions of any kind whatsoever for liability, damages, compensation, or otherwise brought by third parties against New Mexico Recycling Coalition, including attorney’s fees and any related costs. I acknowledge that New Mexico Recycling Coalition, its employees, officers, representatives, agents and volunteers are not responsible for errors, omissions, acts or failures to act of any party or entity conducting, co-sponsoring, or providing services for the Fixit Clinic. To the extent that state law or case law does not prohibit releases for negligence, this release is also for negligence on the part New Mexico Recycling Coalition and its employees, agents and volunteers. In the event that I should require medical care or treatment, I agree to be financially responsible for any costs incurred as a result of such treatment. In the event that any damage to equipment or facilities occurs as a result of my willful actions, neglect or recklessness, I acknowledge and agree to be held liable for any and all costs associated with any such actions, neglect or recklessness. In the event that any provision contained within this release shall be deemed to be severable or invalid, or of any term, condition, phrase or portion of this release shall be determined to be unlawful or otherwise unenforceable, the remainder of this release shall remain in full force and effect, so long as that clause severed does not affect the intent of the parties. New Mexico Recycling Coalition and its “public employees” as defined in the NM Tort Claims Act, §41-4-1, NMSA 1978, et seq., do not waive any sovereign immunity, do not waive any defense and do not waive any limitation of liability under the NM Tort Claims Act. No provision of this waiver and release modifies or waives any provision of the NM Tort Claims Act.*
- I agree to the following statement
FIXIT CLINIC Waiver and Release of Liability In consideration of the risk of injury or property damage while participating in the Fixit Clinic being held online, and in order to induce New Mexico Recycling Coalition to allow me to participate in the Fixit Clinic, I hereby, for myself, my heirs, administrators, assigns, or personal representatives, knowingly enter into this release and waiver and hereby waive any and all rights, claims or causes of action of any kind arising out of my participation in the Fixit Clinic, and do hereby release and forever discharge Santa Fe County, its departments, employees and volunteers for any physical or property damage that I may suffer as a result of my participation in the Fixit Clinic. I am voluntarily participating in the Fixit Clinic and I am participating entirely at my own risk. I am aware of the risks associated with the Fixit Clinic, which may include physical injury, pain, suffering, illness, disfigurement, temporary or permanent disability, economic or emotional loss, and death, injury or loss caused by use of tools, condition of equipment and actions of others, including the acts or omissions of other participants, volunteers, coaches, and Fixit Clinic staff. I understand that these injuries or outcomes may arise from my own or others’ negligence, conditions related to the Fixit Clinic. Nonetheless, I assume all related risks, both known or unknown to me, of my participation in the Fixit Clinic. I agree to indemnify and hold harmless New Mexico Recycling Coalition, its employees, agents and volunteers against any and all claims, suits or actions of any kind whatsoever for liability, damages, compensation, or otherwise brought by third parties against New Mexico Recycling Coalition, including attorney’s fees and any related costs. I acknowledge that New Mexico Recycling Coalition, its employees, officers, representatives, agents and volunteers are not responsible for errors, omissions, acts or failures to act of any party or entity conducting, co-sponsoring, or providing services for the Fixit Clinic. To the extent that state law or case law does not prohibit releases for negligence, this release is also for negligence on the part New Mexico Recycling Coalition and its employees, agents and volunteers. In the event that I should require medical care or treatment, I agree to be financially responsible for any costs incurred as a result of such treatment. In the event that any damage to equipment or facilities occurs as a result of my willful actions, neglect or recklessness, I acknowledge and agree to be held liable for any and all costs associated with any such actions, neglect or recklessness. In the event that any provision contained within this release shall be deemed to be severable or invalid, or of any term, condition, phrase or portion of this release shall be determined to be unlawful or otherwise unenforceable, the remainder of this release shall remain in full force and effect, so long as that clause severed does not affect the intent of the parties. New Mexico Recycling Coalition and its “public employees” as defined in the NM Tort Claims Act, §41-4-1, NMSA 1978, et seq., do not waive any sovereign immunity, do not waive any defense and do not waive any limitation of liability under the NM Tort Claims Act. No provision of this waiver and release modifies or waives any provision of the NM Tort Claims Act.