Please read and agree by checking the yes box below:We at Bikur Cholim of Greater Washington are privileged to provide you with the use of our equipment during the period of your need. Please understand that we are required to inform you of the following, in order to continue the service we provide. RELEASE OF LIABILITY & PARTICIPANT AGREEMENTBy signing this document you will waive certain legal rights including the right to sue. Please read carefully:In consideration of being allowed to participate in Bikur Cholim of Greater Washington’s Medical Equipment Loaner Program, I, _________________________________ (“Participant”), the undersigned, acknowledge, appreciate, and agree that:1. The risk of injury from using medical equipment and the activities involved in this program is significant, including the potential for permanent paralysis and death, and while particular skills, equipment, and personal discipline may reduce this risk, the risk of serious injury does exist; and,2. I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for my participation; and,3. I willingly agree to comply with the stated and customary terms and conditions for participation. If, however, I observe any unusual significant hazard during my participation, I will remove myself from participation and bring such to the attention of Bikur Cholim of Greater Washington; and,4. I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE, INDEMNIFY, AND HOLD HARMLESS BIKUR CHOLIM OF GREATER WASHINGTON, its Board members, officers, officials, agents and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and, if applicable, owners and lessors of premises used for the activity (“Releasees”), WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss or damage to person or property associated with my presence or participation, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by law.I fully understand and agree that using borrowed medical equipment, which has been used by other participants, has inherent risks, dangers and hazards and that my using such equipment may result in injury or illness including, but not limited to, bodily injury, disease, strains, fractures, partial and/or total paralysis, death or other ailments that could cause serious disability. These risks and dangers may be caused by the negligence of the employees, officers or agents of BIKUR CHOLIM OF GREATER WASHINGTON, the negligence of the participants, the negligence of others, accidents, breaches of contract, the unpredictable forces of nature or other causes. Risks and dangers may arise from foreseeable or unforeseeable causes.I confirm that I am eighteen (18) years of age or older. I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT _____ *
