RELEASE OF LIABILITY, WAIVER OF RIGHT TO SUE, ASSUMPTION OF RISK AND AGREEMENT TO PAY CLAIMS
A legal disclaimer
Activity: Teletherapy
In consideration for being allowed to participate in this activity, I release from liability and waive my right to sue Blair Carsone, who owns and operates STARS Therapy Inc and their employees, officers, volunteers, and agents (collectively “Clinic”) from any and all claims, including the Clinic’s negligence, resulting in any physical injury, illness (including death) or economic loss that I may suffer because of my participation in this activity, including any travel to and from the activity. I am voluntarily participating in this activity. I understand that there are risks, such as physical and/or psychological injury, pain, suffering, illness, disfigurement, temporary or permanent disability, or even death, that may occur from my participation in this activity. These injuries or outcomes may arise from my own or other’s actions, inactions, negligence, or from the condition of the activity location(s) or facility(ies). Nonetheless, I assume all related risks, whether known or unknown to me, of my participation in this activity, including travel to and from the activity. I agree to hold the Clinic harmless from any and all claims, loss, or damage to my personal property, liabilities, and costs, including attorney’s fees, as a result of my participation in this activity, including travel to and from the activity. If the Clinic incurs any of these types of expenses, I agree to reimburse the Clinic. If I need medical treatment, the Clinic is authorized to obtain medical treatment for me. I will be financially responsible for any cost of such treatment. I agree that I will not hold the Clinic responsible for any claims resulting from any medical treatment. I am 18 years or older and the parent of the child listed below. I have read this document, and I am signing it freely. I understand the legal consequences of signing this document, including (a) releasing the Clinic from all liability, (b) waiver of my right to sue the Clinic, (c) and assumption of all risks of participating in this activity, including travel to and from the activity. I understand that this document is written to be as broad and inclusive as legally permitted by the State of Florida. I agree that if any portion is held invalid or unenforceable, I will continue to be bound by the remaining terms.