This agreement releases KMF Consulting LLC. dba Mealtime Connection from all liability, claims, demands, and causes of action now or in the future, relating to injuries that may occur during or after my child’s participation in therapy or other activities, at 14503 Houghton St. Chesterfield VA 23832 or at the child’s home or other setting. By signing this agreement, I agree to hold KMF Consulting LLC. dba Mealtime Connection entirely free from any liability, including financial responsibility for illnesses or injuries incurred, regardless of whether illnesses or injuries are caused by negligence. If other dependents accompany the patient the health and safety of those individuals are solely the responsibility of the individual (if 18 years of age or older) or the parent/guardian. I also acknowledge the risks involved in speech/language/feeding/swallowing therapy. I swear that I am participating voluntarily, and that all risks have been made clear to me. Additionally, I do not have any conditions that will increase my likelihood of experiencing injuries while engaging in this activity. I acknowledge that no guarantees or assurances have been made to me/my child concerning the results intended from treatment. By signing below I forfeit all right to bring a suit against KMF Consulting LLC. dba Mealtime Connection for any reason. In return, I will receive services. I will also make every effort to obey safety precautions as listed in writing or as explained to me verbally. I will ask for clarification when needed. *