Release Of Liability And Assumption Of Risk – Physical Therapy Services

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RUNYOGATHERAPY, PLLC

Release Of Liability And Assumption Of Risk – Physical Therapy Services

The individual named below (referred to as “I” or “me”) desires to participate in and receive telemedicine physical therapy services, care and treatment (the “Treatment”) provided by RunYogaTherapy, PLLC (the “Company”).  In consideration of the benefits I will gain from the receipt of Treatment and in recognition of the Company’s reliance hereon, I agree to all the terms and conditions set forth in this agreement (this “Release”).

  1. I am fully aware and understand that the activities I will engage in as part of the  Treatment provided by the Company have inherent risks, dangers and hazards, such as the risk of serious injury, disability, death and/or property damage.  I further understand that my participation in such activities may result in injury, illness or death, including but not limited to bodily injury, disease, strains, factures and other ailments that may cause serious disability or death.  I acknowledge that these risks may result from or be compounded by the actions, omissions, or negligence of the Company, its employees or others.  I understand that while the Company has implemented measures to reduce the risk of injury from the Treatment, the Company cannot guarantee that I will not be injured due to my participation in Treatment activities.  NOTWITHSTANDING THESE RISKS, I ACKNOWLEDGE THAT I AM VOLUNTARILY PARTICIPATING IN THE TREATMENT WITH KNOWLEDGE OF THE DANGERS INVOLVED.  I HEREBY AGREE TO ACCEPT AND ASSUME ALL RISKS OF INJURY, ILLNESS, DISABILITY, DEATH, AND/OR PROPERTY DAMAGE ARISING FROM MY ENGAGING IN THE TREATMENT ACTIVITIES, WHETHER CAUSED BY THE ORDINARY NEGLIGENCE OF THE COMPANY OR OTHERWISE. 
  2. I, on behalf of myself and my personal representativies and heirs, hereby expressly waive and release any and all claims, now known or hereafter known, against the Company, and its officers, directors, managers, employees, agents, affiliates, members, successors, and assigns (collectively, “Releasees”), on account of injury, illness, disability, death, or property damage arising out of or attributable to my participation in the Treatment activities, whether arising out of the ordinary negligence of the Company or any Releasees or otherwise.  I covenant not to make or bring any such claim against the Company or any other Releasee, and forever release and discharge the Company and all other Releasees from liability under such claims.  This waiver and release does not extend to claims for gross negligence, willful misconduct, or any other liabilities that Vermont law does not permit to be released by agreement.
  3. Excepting any injury thtat I am seeking Treatment for and have disclosed to the Company, I confirm that I am in good health, in proper physical condition, and do not have any medical or other conditions that would impair my ability to participate in the Treatment activities.  I will also follow all instructions, recommendations, and cautions of the Company at all times with respect to my Treatment.  If at any time I believe conditions to be unsafe or that I am no longer in proper physical condition to participate in the Treatment, I will immediately discontinue further participation in the Treatment activities.
  4. I shall defend, indemnify, and hold harmless the Company and all other Releasees against any and all losses, damages, liabilities, deficiencies, claims, actions, judgments, settlements, interest, awards, penalties, fines, costs, or expenses of whatever kind, including reasonable attorney fees, fees, the costs of enforcing any right to indemnification under this Release, and the cost of pursuing any insurance providers, incurred by the Company or any other Releasees, arising out or resulting from any claim of a third party related to my participation in the Treatment.
  5. This Release constitutes the sole and entire agreement of the Company and me with respect to the subject matter contained herein and supersedes all prior and contemporaneous understandings, agreements, representations, and warranties, both written and oral, with respect to such subject matter.  If any term or provision of this Release is invalid, illegal, or unenforceable in any jurisdiction, such invalidity, illegality, or unenforceability shall not affect any other term or provision of this Release or invalidate or render unenforceable such term or provision in any other jurisdiction.  This Release is binding on and shall inure to the benefit of the Company and me and our respective successors and assigns.  All matters arising out of or relating to this Release shall be governed by and construed in accordance with the internal laws of the State of Vermont without giving effect to any choice or conflict of law provision or rule (whether of the State of Vermont or any other jurisdiction).  Any claim or cause of action arising under this Release may be brought only in the federal and state courts located in Chittenden County, Vermont and I hereby consent to the exclusive jurisdiction of such courts.

BY SIGNING, I ACKNOWLEDGE THAT I HAVE READ AND UNDERSTOOD ALL OF THE TERMS OF THIS RELEASE AND THAT I AM VOLUNTARILY GIVING UP SUBSTANTIAL LEGAL RIGHTS, INCLUDING THE RIGHT TO SUE THE COMPANY. 

(This acts as your legal and binding signature.)
(This acts as your legal and binding signature.)