Consent, Waiver and Release of Liability for Chrysalis
I, _________________________________, (Chrysalis Participant) hereby agree to the following:
- I voluntarily consent to participate in the Chrysalis Method offered by DPT Associates, LLC d/b/a Chrysalis (“Chrysalis”).
- I understand that Chrysalis is not providing medical or health services. Rather, the Chrysalis Method is a 12-week, post-operative program designed to help anyone undergoing breast surgery thrive during their recovery by providing exercises, nutritional guidance, and support.
- I understand that it is my full responsibility to consult with a physician prior to and regarding my participation in any fitness program or changes in diet. I represent and warrant that I am physically fit and have no medical condition that would prevent my full participation in the Chrysalis Method.
- I understand that Chrysalis may need to communicate with my surgeon as necessary and will sign an authorization form allowing my surgeon and Chrysalis to communicate.
- I understand and acknowledge that because the bulk of the content of the Chrysalis Method and training are delivered upfront electronically, there is no refund once payment is received.
- As a participant in the Chrysalis Method, I agree not to share, duplicate, or post the information provided to me in this program. I understand that my participation in the Chrysalis Method is by membership and memberships cannot be shared. I understand that the content provided to me in this program is protected by the US copyright laws.
- I fully understand and acknowledge that my participation in the Chrysalis Method may result in injury or illness, or, in extreme cases, in death. Some risks and dangers may arise from foreseeable or unforeseeable causes. In consideration of my participation in the Chrysalis Method:
- I WAIVE, RELEASE, AND DISCHARGE Chrysalis and its employees, agents, owners, creators, and insurers, as well as physicians, and dietitians associated with program development (referred to collectively herein as the “Releasees”) from any and all liability, including but not limited to, liability arising from the negligence or fault of the entities or persons released, for my death, disability, personal injury, property damage, property theft, or actions of any kind, in contract or tort, which may hereafter occur to me;
- I HEREBY AGREE TO INDEMNIFY, HOLD HARMLESS, AND PROMISE NOT TO SUE the entities or persons mentioned in this paragraph from any and all liabilities or claims made as a result of participation in this activity, whether caused by the negligence of release or otherwise.
- I hereby consent to seek and receive immediate medical treatment for any injury, accident, and/or illness that may occur as a result of my voluntary participation in the Chrysalis Method.
- This Waiver and Release of Liability in all components of the Chrysalis Method, shall not be in any way constructed as an admission by the Releasee that it has acted wrongfully with respect to me or any other person, that it admits liability or responsibility at any time for any purpose, or that I have any rights whatsoever against the Releasee.
- I have read the above release and waiver of liability and fully understand all of the provisions of this release and I am freely, knowingly, and voluntarily entering into this Release agreeing to the terms and conditions stated above.
- This agreement shall be binding on my heirs, successors, assigns, administrators and executors. I agree that the exclusive jurisdiction and venue for any claim or dispute arising from my participation in the Chrysalis Method shall be in Williamson County, Tennessee.
- In signing via checkbox this waiver and release of all claims, I acknowledge and represent that I am 18 years of age or older, that I have read and understand the contents of this agreement, and that no oral representations, statements, or inducements, apart from the foregoing written agreement, have been made. I also agree that the above representations are not mere recitals and that they are binding.