Terms

WAIVER AND RELEASE OF LIABILITY AND PHOTO USE RELEASE FORM

 

In consideration of the risk of injury while participating in Neuroplastic Functional Training classes (the “Activity”), and as consideration for the right to participate in the Activity, I _______________________ __________hereby, for myself, my heirs, executors, administrators, assigns or personal representatives, knowingly and voluntarily enter into this waiver and release of liability and hereby waive any and all rights, claims or causes of action of any kind whatsoever arising out of my participation in the Activity, and do hereby release and forever discharge Neuroplastic Functional Institute (NFI) and/or Healing Out Loud Institute (HOLI), located at PO Box 1654, Carbondale, CO 81623, their affiliates, managers, members, agents, attorneys, staff, volunteers, heirs, representatives, predecessors, successors and assigns, for any physical or psychological injury, including but not limited illness, paralysis, death, damages, economical or emotional loss, that I may suffer as a direct result of my participation in the aforementioned Activity, including traveling to and from an event related to this Activity.

 

I_____________________________________ also hereby grant and authorize NFI and HOLI the right to take, edit, alter, copy, exhibit, publish, distribute and make use of any and all pictures or videos taken of me to be used in and/or for legally promotional materials including, but not limited to, newsletters, flyers, posters, brochures, blogs, advertisements, fundraising, letters, annual reports, press kits and submissions to journalists, websites, training manuals and videos, documentaries, clinical research publications, social networking sites and other print and digital communications, without payment or any other consideration. This authorization extends to all languages, media, formats and markets now known or hereafter devised. This authorization shall continue indefinitely, unless I otherwise revoke said authorization in writing. I understand that a revocation is not effective to the extent that any person or entity has already acted in reliance on my authorization or information personal to me has been used in above listed uses. I further understand that video or still photographs may reveal visual and/or auditory information about my current or past health issues and/or movement dysfunctions in the process of filming, recording or photographing NFT classes, and I authorize a full release of this personal information without compensation, should it occur. I understand that information used or disclosed pursuant to this authorization may be disclosed by the recipient and may no longer be protected by federal or state law.

 

I am voluntarily participating in the aforementioned activity entirely at my own risk. I am aware of the risks associated with traveling to and from as well as participating in the activity, which may include, but are not limited to, physical or psychological injury, pain, suffering, illness, disfigurement, temporary or permanent disability (including paralysis), economic or emotional loss, and death. I understand that these injuries or outcomes may arise from my own or others’ negligence, conditions related to travel, or the condition of the activity locations(s). Nonetheless, I assume all related risks, both known or unknown to me, of my participation in this activity, including travel to, from and during this activity.

 

I agree to indemnify and hold harmless NFI and/or HOLI against any and all claims, suits or actions of any kind whatsoever for liability, damages, compensation or otherwise brought by me or anyone on my behalf, including attorney’s fees and any related costs, if litigation arises pursuant to any claims made by me or by anyone else acting on my behalf. If NFI and/or HOLI incurs any of these types of expenses, I agree to reimburse NFI and/or HOLI. I acknowledge that NFI and HOLI and their directors, officers, volunteers, representatives and agents are not responsible for errors, omissions, acts or failures to act of any party or entity conducting a specific event or activity on behalf of NFI and/or HOLI.  I understand that this activity may involve a test of a person’s physical and mental limits and may carry with it the potential for death, serious injury, and property loss. The risks may include, but are not limited to, those caused by terrain, facilities, temperature, weather, lack of hydration, condition of participants, equipment, vehicular traffic and actions of others, including but not limited to, participants, volunteers, spectators, coaches, event officials and event monitors, filmmakers, photographers and/or producers of the event.

 

I acknowledge that I have carefully read this “Waiver and Release” and fully understand that it is a release of liability as well as a photo use release. I expressly agree to release and discharge NFI, HOLI and all of its affiliates, managers, members, agents, attorneys, staff, volunteers, heirs, representatives, predecessors, successors and assigns, from any and all claims and causes of action and I agree to voluntarily give up or waive any right that I otherwise have to bring a legal action against NFI and/or HOLI for personal injury or property damage.

 

To the extent that state or case law does not prohibit release for negligence, this release is also for negligence on the part of NFI, HOLI, its agents and employees.

 

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. I am aware and understand that I should carry my own health insurance.

 

In the event that any damage to equipment or facilities occurs as a result of my or my family’s willful actions, neglect or recklessness, I acknowledge and agree to be held liable for any and all costs associated with any actions of neglect or recklessness.

 

This Agreement was entered into at arm’s length, without duress or coercion, and is to be interpreted as an agreement between two parties of equal bargaining strength. Both the Participant, _____________________________, and NFI and/or HOLI agree that this Agreement is clear and unambiguous as to its terms, and that no other evidence will be used or admitted to alter or explain the terms of this Agreement, but that it will be interpreted based on the language in accordance with the purposes for which it is entered into.

 

In the event that any provision contained within this Release of Liability and Photo Use Release shall be deemed to be severable or invalid, or if any term, condition, phrase or portion of this agreement shall be determined to be unlawful or otherwise unenforceable, the remainder of this agreement shall remain in full force and effect, so long as the clause severed does not affect the intent of the parties. If a court should find that any provision of this agreement to be invalid or unenforceable, but that by limiting said provision it would become valid and enforceable, then said provision shall be deemed to be written, construed and enforced as so limited.

 

In the event of an emergency, please contact the following person(s) in the order presented:

 

____________________________________________________________________________________________________________________

 

____________________________________________________________________________________________________________________

 

____________________________________________________________________________________________________________________

 

I, the undersigned participant, affirm that I am of the age of 18 years or older, and that I am freely signing this agreement. I certify that I have read this agreement, that I fully understand its content and that this release cannot be modified orally. I am aware that this is a release of liability, a photo use release and a contract, and that I am signing it of my own free will.

 

 

Participant’s Name:____________________________________________________________________________________________

 

Participant’s Address:_________________________________________________________________________________________

 

 

 

Signature:________________________________________________________________________________________________________

 

Date:_________________________________________

WPGrow