Preconceive Education Class - Waiver, Agreement, and Release Form
Effective June 6th, 2018
I, the undersigned have enrolled in a Preconceive Education Class (the “Class”) which may include, but is not limited to instruction, training, education, and minor physical activity, offered by Preconceive, Inc. and their contractors. I fully understand that the physical location where the Class takes place (the “Facility”), is owned and operated by an affiliate of Preconceive, Inc. As such, Preconceive, Inc. is not liable for the condition, maintenance, or any liabilities of the Facility. At all times, I agree to comply with all stated and customary terms, posted safety signs, rules, and verbal instructions given to me by the Class Instructor. If in the subjective opinion of the Class Instructor, I would be at physical risk participating in the Class, I understand and agree that I may be denied access to the Class and the Facility.
I hereby acknowledge that there are certain inherent risks and dangers in participating in physical activities during pregnancy. In consideration of being allowed to participate in the Class and access to the Facility, I, the undersigned, hereby (1) agree to assume full responsibility for any and all injuries, conditions, or damages which are sustained or aggravated by me in relation to the Class or occur while at the Facility, (2) waive, release, indemnify, discharge, and hold harmless Preconceive, Inc. its direct and indirect parent, affiliate entities, and each of their respective officers, directors, members, employees, representatives, and agents, and each of their respective successors and assigns and all others, from any and all responsibility, claims, actions, suits, procedures, costs, expenses, damages, and liabilities to the fullest extent allowed by law arising out of or in any way related to (a) my participation in the Class, (b) my use of the Facility, or (c) my reliance upon the information, recommendations, or suggestions presented by the Class Instructor, and (3) represent that I (a) have no medical or physical condition that would prevent me from properly participating in any Class, (b) do not have a physical or mental condition that would put me in any physical or medical danger, and (c) have not been instructed by a physician to not participate in such physical activity. I acknowledge that if I have any chronic disabilities or conditions, I may be at risk in participating in the Class and should not participate.
I understand that the Class is provided for informational and educational purposes only and will not serve to diagnose or treat any of my medical conditions or symptoms. I understand that the Class Instructor is an independent contractor, not an employee or agent, of Preconceive, Inc. The Class does not create a doctor-patient or nurse-patient relationship between me and the Class Instructor. As such, the Class Instructor does not have any responsibility for my current or on-going medical care or treatment. I understand that, although the Class Instructor may suggest, recommend, or educate me regarding certain medications, treatments, or procedures applicable to conception, pregnancy, childbirth, or newborn care, I am responsible for discussing any treatments, medications, or procedures presented by the Class Instructor with a physician.
THE PRECONCEIVE EDUCATION CLASSES PROVIDE GENERAL HEALTH AND WELLNESS INFORMATION. THE PRECONCEIVE EDUCATION CLASSES DO NOT REPLACE MY RELATIONSHIP WITH ANY PRACTITIONER OR SERVICE, AND PRECONCEIVE, INC. ITSELF OR THROUGH ITS SERVICES, DOES NOT PROVIDE MEDICAL OR HEALTH ADVICE, CARE, DIAGNOSIS, OR TREATMENT.
I hereby give Preconceive, Inc. the irrevocable right to use my name (or any fictional name), picture, portrait, image or photograph in all forms and in all media and in all manners, without any restriction for advertising, trade, promotion, exhibition, or any other lawful purposes, and I waive any right to inspect or approve the photograph(s) and/or videos or works. I hereby release and agree to hold harmless Preconceive, Inc. its direct and indirect parent, affiliate entities, and each of their respective officers, directors, members, employees, representatives, and agents, and each of their respective successors and assigns and all others from any liability resulting from my appearance in any photograph(s) and/or videos or works, unless it can be shown that Preconceive, Inc. maliciously caused, produced, and published solely for the purpose of subjecting me to conspicuous ridicule, scandal, reproach, scorn, and indignity. I agree that Preconceive, Inc. owns the copyright in these photographs and/or videos or works and I hereby waive any claims I may have based on any usage of the photographs and/or videos or works derived there from, including but not limited to claims for either invasion of privacy or libel.
I affirm that I am of full age and competent to sign this release. I agree that this release shall be binding on me, my legal representatives, heirs, and assigns.
I hereby affirm by enrolling in this class through the Preconceive website or in person, that I have read, understand and agree to all of the above in its complete entirety.
Please contact us at: email@example.com with any questions regarding this Class Release Form.