Health Care Provider Registration & Consent
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STEP 1Email & Password
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STEP 2Home Address
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STEP 3Personal Info
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STEP 4Consent
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STEP 5Questions
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STEP 6Fees & Payment
1. Enter Email & Password
2. Enter Home Address
3. Personal Info
Name | Age | Actions |
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5. Questions
ASSUMPTION OF RISK, RELEASE, WAIVER AND INDEMNITY AGREEMENT
We are pleased to have you join us for ITK's Hospital & Community Programs where you and your family ("Participants") will have the opportunity to receive Integrative Touch™ therapy, wellness education and to participate in a variety of therapies that include, but are not limited to, massage, meditation, counseling, sound/music and energy therapies. You will also have the opportunity to participate in a variety of activities that include mindfulness activities, movement, martial arts, dance, music, yoga, arts and crafts, free play, games, food and nutrition, support groups and other activities. Some or all of these activities and therapies may carry an above-normal risk of personal injury and may have some other associated risks.
Each Participant assumes all risk for loss or damage and injury, direct or indirect, from participation in these activities and therapies, whether occurring prior to, during, or subsequent to the activity or therapy. Participants agree that Integrative Touch for Kids ("ITK") is not responsible for any injury to the Participant. Participants assume all liability for the participation in therapies and activities and understand there may be some dangers.
In consideration of each Participant's participation or the participation of such Participant's children, each Participant, on behalf of himself or herself and on behalf of such Participant's children, hereby expressly forever discharges and releases (and hereby covenants not to sue) ITK and its officers, directors, employees, agents and "volunteers" (collectively, the "Released Parties"), from and with respect to any and all present and future claims (including, without limitation, resulting from the active or passive negligence or other actions or omissions on the part of the Released Parties or others) for property damage, personal injury or wrongful death, that such Participant or such Participant's children may have or may hereafter have or acquire, arising as a result of or in connection with engaging or participating in the activities and therapies described above or any other activity incidental to such activities and therapies. The term "volunteers" shall have its generally understood meaning, and includes (without limitation) persons performing services for or at the direction of ITK, without compensation.
Furthermore, each Participant, on behalf of himself or herself and on behalf of such Participant's children, hereby voluntarily and expressly forever waives, as against the Released Parties, any and all present and future claims resulting from active or passive negligence or otherwise, that that such Participant or such Participant's children may have or may hereafter have or acquire against the Released Parties, arising in connection with the aforesaid activities and therapies or any other activity incidental to such activities and therapies.
Each Participant further agrees to indemnify, defend and hold harmless the Released Parties from and against any and all claims arising as a result of or in connection with the aforesaid activities and therapies or any other activity incidental to such activities and therapies.
Each Participant understands that this Assumption, Release, Waiver and Indemnity is intended to be as broad and as inclusive as permitted by the laws of the State of Arizona, and agrees that if any portion is held invalid, the remainder of this Assumption, Release, Waiver and Indemnity will continue in full legal force and effect.
Participants acknowledge that in executing this Assumption, Release, Waiver and Indemnity, they are not relying on any inducements, promises, or representations made by Integrative Touch for Kids.
Each Participant affirms that such Participant is of legal age and is freely signing this agreement. Each Participant further affirms that such Participant has read this form and understands that by signing this form, such Participant is giving up legal rights and/or remedies which may be available to such Participant and such Participant's children against the Released Parties.
Each Participant (over the age of 18) has read the above and agrees therewith.
In consideration of my participation, and/or the participation of my minor children listed below, in one or more programs of Integrative Touch For Kids ("ITK"), I (on behalf of myself and my minor children listed below) hereby grant ITK permission to use my likeness and the likeness of my minor children listed below in all photographs, videos, or other digital media (collectively "Photos/Videos") in any and all of its publications, including (without limitation) web-based publications, without payment or other consideration. ITK shall also have the absolute right to copyright, publish, use, sell or assign any and all Photos/Videos of me and/or my minor children listed below (including, without limitation, photographic portraits or pictures, television spots, movie films, video tapes, and/or sound recordings) made in connection with my participation, and/or the participation of my minor children listed below, in ITK programs.
I understand and agree (on behalf of myself and my minor children listed below) that all Photos/Videos will become the property of ITK. I agree (on behalf of myself and my minor children listed below) that neither I nor my minor children listed below shall own or claim rights to such Photos/Videos, and I (on behalf of myself and my minor children listed below) waive any right to royalties or other compensation arising or related to the use of the Photos/Videos. I hereby irrevocably authorize (on behalf of myself and my minor children listed below) ITK to edit, alter, copy, exhibit, publish, or distribute these Photos/Videos for any lawful purpose. In addition, I waive (on behalf of myself and my minor children listed below) any right to inspect or approve the finished product wherein my likeness and/or the likeness of my minor children listed below appears. I (on behalf of myself and my minor children listed below) hereby hold harmless, release, and forever discharge (and covenant not to sue) ITK from all claims, demands, and causes of action which I and/or my minor children listed below have or may have by reason of this authorization, consent and release.