General Trialist Waiver

GENERAL TRIALIST WAIVER

This General Trialist Waiver (the "Waiver") is entered into as of by and between Provider Name: with a principal place of business at Provider Address: ("Provider") and Trialist Name: of Trialist Address: ("Trialist"). Trialist Email: Phone: Date of Birth:

RECITALS

WHEREAS, Provider operates facilities and programs where individuals may participate on a trial basis to evaluate services and facilities (the "Activities");

WHEREAS, Trialist desires to participate in the Activities on the terms set forth in this Waiver and acknowledges that participation may involve physical exertion and inherent risks;

WHEREAS, Provider requires execution of this Waiver as a condition to permitting Trialist to engage in any trial Activities at Provider's premises or under Provider's supervision.

NOW, THEREFORE, in consideration of the mutual covenants and promises contained herein and other good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, the parties agree as follows:

1. DEFINITIONS

For purposes of this Waiver: "Premises" means the real property, facilities and equipment where the Activities occur; "Representatives" means the Provider's officers, directors, employees, agents, contractors and volunteers; and "Claims" means any claim, demand, cause of action, loss, liability, damage or expense including attorneys' fees and costs.

2. ASSUMPTION OF RISK

Trialist acknowledges and agrees that participation in the Activities involves risks, including but not limited to bodily injury, permanent disability, paralysis and death, and damage to property. Trialist VOLUNTARILY ASSUMES ALL RISKS associated with participation in the Activities, whether known or unknown, inherent or arising from Provider's negligence.

3. WAIVER AND RELEASE

Trialist, on behalf of themselves and their heirs, assigns, personal representatives and next of kin, HEREBY RELEASES, WAIVES, DISCHARGES AND COVENANTS NOT TO SUE Provider and its Representatives from any and all Claims arising out of or related in any way to Trialist's participation in the Activities, including Claims arising from the NEGLIGENCE OF PROVIDER, to the fullest extent permitted by law.

4. INDEMNIFICATION

Trialist agrees to indemnify, defend and hold harmless Provider and its Representatives from and against any and all Claims, liabilities, damages and expenses (including reasonable attorneys' fees and costs) arising out of or resulting from Trialist's acts or omissions in connection with participation in the Activities, including breach of this Waiver.

5. MEDICAL AUTHORIZATION AND HEALTH REPRESENTATIONS

Trialist represents that they are physically able to participate in the Activities and have disclosed any medical conditions that could affect safe participation. In the event of injury or medical emergency, Trialist expressly authorizes Provider to obtain or provide medical treatment as deemed necessary. Trialist shall be responsible for all medical and related expenses.

6. MEDIA RELEASE

Trialist grants Provider the right to take and use photographs, video and audio recordings of Trialist during participation in the Activities for promotional, instructional or other business purposes, without compensation. Provider shall own such recordings and may use them in its discretion.

7. COMPLIANCE WITH RULES; REMOVAL

Trialist agrees to comply with all rules, instructions and safety protocols established by Provider. Provider retains the right to deny, suspend or terminate Trialist's participation for noncompliance, unsafe behavior or other reasonable cause.

8. NO WORKERS' COMPENSATION; INSURANCE

Trialist understands that Provider does not carry medical or disability insurance for Trialist and that Trialist is solely responsible for procuring any personal insurance coverage. Trialist waives any claim to workers' compensation benefits in connection with the Activities to the extent permitted by law.

9. TERM; TERMINATION

This Waiver is effective on the Effective Date set forth above and shall remain in force for the duration of Trialist's participation in any trial Activities unless earlier terminated in writing by Provider. Termination shall not extinguish any rights or obligations that accrued prior to termination.

10. NOTICES

All notices required or permitted under this Waiver shall be in writing and delivered to the addresses below by hand, nationally recognized overnight carrier, or certified mail (return receipt requested). Notice is effective upon receipt.

11. AMENDMENTS; WAIVER

No amendment or modification of this Waiver shall be effective unless in writing and signed by both parties. Failure to enforce any provision shall not constitute a waiver of that provision or any other provision.

12. GOVERNING LAW

This Waiver shall be governed by and construed in accordance with the laws of the state specified for governing law: , without regard to conflict of laws principles.

13. ENTIRE AGREEMENT; SEVERABILITY

This Waiver constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior agreements and understandings. If any provision of this Waiver is determined to be invalid or unenforceable, the remaining provisions shall remain in full force and effect.

14. COUNTERPARTS

This Waiver may be executed in counterparts, each of which shall be deemed an original, and all of which together shall constitute one and the same instrument. Signatures delivered by electronic means shall be valid and binding.

I have read, understand, and voluntarily agree to all terms of this Waiver and acknowledge that I am executing it voluntarily and for valuable consideration.

If Trialist is under 18 years of age, parent or legal guardian must complete the following:

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