Participant Rights Agreement Form

Participant Rights Agreement Form

Parties and Identification

Effective Date:

Recitals

WHEREAS, the Organization provides services, programs, or activities as described in this Agreement, and the Participant seeks to participate in such program; and

WHEREAS, the Organization requires acknowledgment of the Participant's rights and responsibilities, including confidentiality protections, data handling, and the scope of services to be provided; and

NOW, THEREFORE, in consideration of the mutual promises contained herein, the parties agree as follows.

Scope of Services

Payment Terms

Participant acknowledges the fees for participation and agrees to pay according to the schedule below.

All sums not paid within the specified due period shall accrue the late fee above and may be subject to suspension of services until cured. The Organization may offset payments against any amounts due from Participant to the Organization.

Term and Termination

This Agreement commences on and continues until unless earlier terminated as provided below.

Either party may terminate this Agreement for material breach by the other party if the breaching party fails to cure the breach within the notice period specified above. Termination for convenience by either party requires written notice in accordance with the notice provisions set forth herein.

Confidentiality

The parties acknowledge that in the course of performance they may receive or have access to confidential information, including but not limited to personal data, medical or behavioral records, financial information, and proprietary materials ("Confidential Information"). Each party shall:

1. Maintain Confidential Information in strict confidence and use it solely to perform obligations under this Agreement;
2. Limit disclosure to employees, contractors, or agents who have a need to know and who are bound by confidentiality obligations at least as protective as those in this Agreement;
3. Implement reasonable administrative, technical, and physical safeguards to protect Confidential Information from unauthorized access or disclosure;
4. Promptly notify the other party of any unauthorized disclosure or security incident involving Confidential Information.

The confidentiality obligations shall survive termination of this Agreement for a period of five (5) years, except as required by applicable law which may require longer retention.

Participant Acknowledgments and Rights

Participant expressly acknowledges the following rights and confirms understanding by checking the applicable boxes:

I understand the scope of services and that I may ask questions about how services will be delivered.

I understand how my confidential information will be used, stored, and disclosed as described in this Agreement.

I understand that I may withdraw consent to participate, subject to the termination provisions herein, without penalty for previously rendered services.

Notices

All notices required or permitted under this Agreement shall be in writing and delivered to the addresses stated above or to such other address as a party may designate in writing. Notice is effective upon personal delivery, delivery by nationally recognized overnight courier, or three (3) business days after deposit in the mail with first-class postage prepaid.

Governing Law

This Agreement shall be governed by and construed in accordance with the laws of the state of without regard to its conflict of laws principles.

Limitation of Liability

Except for willful misconduct or gross negligence, neither party shall be liable for consequential, incidental, special, or punitive damages arising out of or related to this Agreement. The aggregate liability of the Organization for any claim arising under this Agreement shall not exceed the total fees paid by the Participant to the Organization under this Agreement during the six (6) month period preceding the claim.

Entire Agreement

This Agreement, including any attachments or written schedules expressly incorporated herein, constitutes the entire agreement between the parties with respect to its subject matter and supersedes all prior and contemporaneous agreements, proposals, and communications, whether oral or written. Any amendment or modification must be in writing and signed by both parties.

Acknowledgment

By signing below, Participant confirms that they have read and understand this Participant Rights Agreement Form, that they have had an opportunity to ask questions, and that they voluntarily agree to the terms set forth herein.

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