LiftRight Client Intake Form

LIFTRIGHT CLIENT INTAKE FORM

Parties and Recitals

This Client Intake and Service Agreement (the Agreement) is entered into between Client Name: and Service Provider Name: (collectively, the Parties).

WHEREAS, Service Provider operates a business offering specialized lifting, logistics, and physical performance services and agrees to provide services to Client under the terms set forth herein;

WHEREAS, Client seeks to engage Service Provider to perform the Scope of Work described below and represents that Client has disclosed all material medical, physical, and situational information necessary to perform the services safely;

WHEREAS, the Parties intend this Agreement to set forth the full terms of the relationship, payment, confidentiality, and allocation of risk between them.

Client Information

Emergency Contact

Services Requested / Scope of Work

Select requested services (select all that apply):

Payment Terms

Fee Amount: $ payable as set forth below.

Late Payment: Payments not received within days of the due date shall incur a late fee of per month or the maximum permitted by law, whichever is less.

Term and Termination

Term Commencement Date:    Term End Date:

Either Party may terminate this Agreement for convenience upon written notice to the other Party delivered at least days prior to termination. Termination for cause may occur immediately upon written notice if the non‑breaching Party reasonably believes the other Party has materially breached any obligation hereunder and fails to cure such breach within 14 days following receipt of written notice.

Confidentiality

Each Party shall keep confidential and not disclose to any third party proprietary or confidential information of the other Party disclosed in connection with this Agreement ("Confidential Information"), except as required by law or to the extent necessary to perform the services. Confidential Information does not include information that is or becomes publicly available through no fault of the receiving Party or is independently developed by the receiving Party without use of the disclosing Party's Confidential Information. The obligations in this section shall survive termination of this Agreement for a period of two (2) years.

Insurance and Compliance

Service Provider shall maintain general liability insurance sufficient to cover its obligations under this Agreement. Client shall notify Service Provider of any site-specific safety or compliance requirements prior to commencement of services. Client agrees to comply with reasonable safety directions from Service Provider personnel during on-site work.

Liability and Indemnification

Except to the extent caused by gross negligence or willful misconduct, Service Provider's liability for claims arising out of or related to this Agreement shall be limited to direct damages not to exceed the total fees paid by Client under this Agreement. Client shall indemnify and hold harmless Service Provider from and against third-party claims arising from Client's negligence or breach of this Agreement.

Governing Law; Dispute Resolution

This Agreement shall be governed by and construed in accordance with the laws of the State of . Any dispute arising out of this Agreement shall first be referred to senior representatives of the Parties for negotiation. If the Parties cannot resolve the dispute within 30 days, the dispute may be submitted to binding arbitration under applicable rules.

Entire Agreement; Amendments

This Agreement, including any attachments and the Scope of Work, constitutes the entire agreement between the Parties regarding the subject matter hereof and supersedes all prior agreements, understandings, and negotiations. No modification or waiver of any provision shall be effective unless in writing and signed by both Parties.

Client Representations

Client represents and warrants that it has the authority to enter into this Agreement and that all information provided to Service Provider is true and complete to the best of Client's knowledge. Client acknowledges that Client will disclose any medical or physical limitations that may affect the performance of services.

Additional Notes / Client Disclosures

Acknowledgment and Certification

By signing below, Client certifies that the information provided in this intake form is accurate and complete, that Client has read and understands this Agreement, and that Client agrees to be bound by its terms. Client acknowledges that Service Provider has the right to refuse or suspend services if Client fails to comply with safety requirements or payment obligations.

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