Integrative Services LLC

RELEASE OF LIABILITY, ASSUMPTION OF RISK AND INDEMNITY AGREEMENT

In consideration of the services provided by Integrative Services LLC (“IC”) the undersigned, whether the individual receiving services (“Client”) or the Client’s guardian, agrees to the following terms and conditions and understands that this document affects their legal rights and that by signing below, the undersigned acknowledges that they have carefully read and understood the disclosure of risks, voluntarily accepts those risks, and agrees to be bound by all terms and conditions of this agreement.

1.  General Release and Waiver of Liability. IN CONSIDERATION OF THE SERVICES PROVIDED BY IC, THE UNDERSIGNED FOR THEMSELVES AND ON BEHALF OF THE CLIENT, THEIR HEIRS, ASSIGNS, PERSONAL REPRESENTATIVES AND NEXT OF KIN (THE “RELEASING PARTIES”), VOLUNTARILY RELEASES, WAIVES, AND FOREVER DISCHARGES IC, ITS OWNERS, EMPLOYEES, MANAGERS, OFFICERS, DIRECTORS, PRINCIPALS, OR AGENTS  (HEREINAFTER COLLECTIVELY REFERRED TO AS THE “PROTECTED PARTIES”) FROM ANY LIABILITY NOW OR IN THE FUTURE  FOR ANY CLAIMS CONNECTED WITH OR ARISING FROM SERVICES RECEIVED BY CLIENT, TO THE FULLEST EXTENT ALLOWED BY LAW, ANY SUCH CLAIMS WHICH ALLEGE NEGLIGENT ACTS OR OMISSIONS OF ANY OF THE PROTECTED PARTIES.

THE UNDERSIGNED UNDERSTANDS THAT THIS RELEASE OF LIABILITY WILL PREVENT ANY OF THE RELEASING PARTIES, INCLUDING THEMSELVES, FROM BRINGING ANY LAWSUIT OR MAKING ANY CLAIM FOR ANY TYPE OF DIRECT, INDIRECT, SPECIAL, INCIDENTAL, EQUITABLE, OR CONSEQUENTIAL DAMAGES FOR DELAYS, BREACH OF CONTRACT, PROPERTY DAMAGE OR LOSS, PERSONAL INJURY, DAMAGES OR DEATH CONNECTED WITH THE SERVICES UNLESS CAUSED BY THE RECKLESS DISREGARD OR GROSS NEGLIGENCE OF THE PROTECTED PARTIES.

2. Acknowledgement of Risks. The undersigned understands that the Services may involve IC staff touching or moving the Client which may involve some risk of injury. The undersigned understands that Client’s participation in the Services may involve known and unanticipated risks (the “Risks”) that could result in physical or emotional injury, paralysis, death, or physical or property damage.

3. Assumption of Risks. After being fully informed of the above Risks, the undersigned accepts complete sole responsibility for Client’s health and well-being in these voluntary Services.  The undersigned, on their own behalf and, to the fullest extent allowed by law, on behalf of all Releasing Parties expressly agrees and promises to accept and assume all known and unanticipated Risks associated with participation in the Services.

THE UNDERSIGNED AGREES THAT BY SIGNING THIS FORM, THE UNDERSIGNED IS GIVING UP THEIR AND THE RIGHT OF THE RELEASING PARTIES TO RECOVER FROM THE PROTECTED PARTIES IN A LAWSUIT OR OTHER PROCEEDING FOR ANY DAMAGES, INCLUDING PERSONAL INJURY OR DEATH TO CLIENT THAT RESULTS FROM SUCH RISKS TO THE FULLEST EXTENT ALLOWED BY LAW.  THE UNDERSIGNED UNDERSTAND THAT THEY HAVE THE RIGHT TO REFUSE TO SIGN THIS FORM, AND IC HAS THE RIGHT TO REFUSE TO LET CLIENT PARTICIPATE IN THE SERVICES, IF CLIENT OR THEIR GUARDIAN DO NOT SIGN AND AGREE TO THESE TERMS.

4. Indemnification. The undersigned hereby agrees to hold harmless, indemnify and defend the Protected Parties from and against any and all claims, losses, actions, proceedings, costs, expenses, damages, penalties, settlement amounts and liabilities (including claims brought by any of the Releasing Parties) and any and all costs and expenses in connection therewith, including reasonable attorneys' fees and costs of investigation (collectively the “Claims”), arising out of or related to the Services, regardless of whether the Claims are the result of the negligent acts or omissions of myself, the Protected Parties, or third parties. This indemnification clause will survive the termination of this agreement.

5. Representations. To assist the Company in effectively providing for Client’s safety during the Services, The undersigned represents that:

●       They and/or Client have no knowledge of any health problems, including but not limited to, orthopedic problems, heart problems, respiratory problems, or any pre-existing physical or medical conditions, that would cause participation in the Services to negatively impact Client’s health.

●       They and/or Client acknowledge that IC encourages each Client to obtain medical clearance prior to participating in the Services.

●       They and/or Client authorize IC’s employees to secure emergency medical care for the Client, including but not limited to the administration of emergency first aid and CPR, or ambulance transportation if deemed necessary by IC’s employees. The undersigned agrees to assume all costs of emergency medical care and transportation.

6. Effect of Agreement. The undersigned has read the above and fully understands and agrees to the terms herein. THE UNDERSIGNED IS AWARE THAT BY SIGNING THIS AGREEMENT, THEY HEREBY KNOWINGLY AND VOLUNTARILY, WITHOUT ANY THREAT OF DURESS, INDUCEMENT, PROMISE OR guarantee COMMUNICATED TO THEM, RELEASES THE PROTECTED PARTIES FROM ANY LIABILITY NOW OR IN THE FUTURE TO THE FULLEST EXTENT ALLOWED BY LAW.

THE UNDERSIGNED UNDERSTANDS AND AGREES THAT THEY ARE GIVING UP RIGHTS THAT THEY OR THE CLIENT MAY HAVE TO BRING A LEGAL ACTION OR ASSERT A CLAIM AGAINST THE PROTECTED PARTIES ON THE BASIS OF THE PROTECTED PARTIES’ NEGLIGENT ACTS OR OMISSIONS.  BY SIGNING THIS, THE UNDERSIGNED MAY BE FOUND BY A COURT OF LAW TO HAVE FOREVER WAIVED THEIR RIGHTS AND THE RIGHTS OF THE RELEASING PARTIES TO MAINTAIN ANY ACTION AGAINST THE PROTECTED PARTIES.