If you go by Tom but your Drivers License says Thomas, please enter "Thomas."

(If so, we may need to secure special approval from the warden for your visit.)

Have you ever served time in a TDCJ Facility? (Select NO if you only served time in TYC and/or county jail).

For example, if the name on your driver's license is Robert Smith but you go by "Bob," please write "Bob Smith."

We need your email address for us to reach you back.

Cell phone is preferable. Required for event-related communications, such as an emergency that requires an event rescheduling.

Please read and indicate your agreement. IN CONSIDERATION for being permitted to participate in activities of the Prison Entrepreneurship Program ("the Program"), THE UNDERSIGNED, for himself/herself, his/her personal representatives, heirs and next of kin: 1. Agrees that he/she appreciates the risk of injury during his/her participation in the Program and further agrees that he/she assumes full responsibility for his/her own safety and for determining that no dangerous conditions exist that could affect his/her own safety at any of the sites; 2. Agrees that his/her participation in the Program acknowledges that he/she finds the sites as being reasonably safe for the purpose of his/her use, and further agrees that if, at any time he/she feels anything to be unsafe, he/she will immediately withdraw from the dangerous area; 3. Acknowledges that in the course of his/her participation during in-prison events or other PEP sponsored activities, video or photographs may be taken or illustrations may be made of him/her and further agrees to allow, without compensation, his/her likeness to appear in material, regardless of media form, promoting the Program, its events and activities, including those of its representatives and licensees; 4. Releases, waives, discharges and covenants not to sue Prison Entrepreneurship Program or any subdivision thereof, and each of them, their officers and employees, (hereinafter as "Releasees") from all liability to the undersigned, his/her personal representatives, assigns, heirs and next of kin for any and all loss or damage and any claim or demands therefrom on account of injury to the person or property or resulting in death of the undersigned en route to/from the site, in or upon the site or while observing, working for or participating in the Program; 5. Agrees to hold harmless and to indemnify the Releasees from and against all claims, actions, damages and expenses, including but not limited to reasonable attorney's fees for any alleged injury and/or death to any person or damage to any property arising or alleged to have arisen out of any negligent, reckless or intentional act of the undersigned or failure to act on the part of the undersigned, his/her heirs, successors or assigns; and 6. Agrees that the foregoing release, waiver and indemnity agreement is intended to be as broad and inclusive as is permitted by laws of the State of Texas and that if any portion thereof is held invalid, the balance shall continue in full legal force and effect. I have read and voluntarily signed this Waiver of Liability and Media Release Agreement and further guarantee that no additional oral representations, statements or inducements have been made.