WAIVER OF LIABILITY, INDEMNIFICATION, AND MEDICAL RELEASE

Acknowledgment and Assumption of Risk

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I am aware of the dangers and the risks to my person and property involved in participating in receiving treatment, consulting, and/or educational services from Healthy Feet Medical Services of Idaho. I understand that this activity involves certain risks for physical injury. I also understand that there are potential risks of which I may not presently be aware. Because of the dangers of receiving medical services, I recognize the importance and agree to fully comply with the applicable laws, policies, rules, and regulations, and any provided instructions regarding my care. I understand that Healthy Feet Medical Services of Idaho does not insure clients, that any coverage would be through personal insurance, and Healthy Feet Medical Services of Idaho has no responsibility or liability for injury resulting from the services provided. I voluntarily elect to receive services with knowledge of the danger involved, and I hereby agree to accept and assume any and all risks of property damage, personal injury, or death.

 

Waiver of Liability and Indemnification: In consideration for being allowed to voluntarily receive treatment, on behalf of myself, my personal representatives, heirs, next of kin, successors and assigns, I forever: a) waive, release, and discharge Healthy Feet Medical Services of Idaho and its owner, Brenda Bauscher Fries from any and all negligence and liability for my death, disability, personal injury, property damages, or claims of any nature which may hereafter accrue to me, and my estate as a direct or indirect result of my participation in the above referenced activity or event; and b) agree to defend, indemnify, and hold harmless Healthy Feet Medical Services of Idaho, its agencies, officers and employees, from and against any and all claims of any nature including all costs, expenses and attorneys’ fees, which in any manner result from participant’s actions during this activity or event. I hereby consent to receive medical treatment which may be deemed advisable in the event of injury, accident or illness during this activity or event. This release, indemnification, and waiver shall be construed broadly to provide a release, indemnification, and waiver to the maximum extent permissible under applicable law.

 

I, the undersigned participant, affirm that I am at least 18 years of age and am freely signing this agreement. I have read this form and fully understand that by signing this form I am giving up legal rights and/or remedies which may otherwise be available to me regarding any losses I may sustain as a result of my participation. I agree that if any portion is held invalid, the remainder will continue in full legal force and effect