Informed Consent, Liability, Photo & Video Release Form
Terms and Conditions
By registering for the course or courses provided through this website, I hereby agree to the following:
1. That I am participating in an education class, course, program, or workshop offered by Hemato Institute, Inc. DBA Excenter Learning™, (the “Company”), during which I will receive information and instruction about health and lifestyle. I recognize that, like all fitness programs, it may require physical exertion, which may be strenuous and may cause physical injury.
2. I understand that it is my responsibility to consult with a physician prior to and regarding my participation. I represent and warrant that I am physically fit, and I have no medical condition, which would prevent my full participation.
3. In partial consideration for my participation, I agree to assume complete risk of and responsibility for any injuries, or damages, known or unknown, which I might incur as a result of participating.
4. In further consideration of being permitted to participate, I, my heirs, and legal representatives forever release, waive, discharge, and covenant not to sue the Company and its employees, agents and other representatives for any claims, actions, damages, liabilities, injuries or death arising out of or resulting from the negligence of the Company or its employees, agents and other representatives (including their sole or concurrent negligence).
5. I hereby irrevocably permit, authorize and license the Company and its affiliates, successors and assigns, and their respective licensees, advertising agencies, promotion agencies and fulfillment agencies, and the employees, officers, directors and agents of each and all of them to display, publicly perform, exhibit, transmit, broadcast, reproduce, record, photograph, digitize, modify, alter, edit, adapt, create derivative works, exploit, sell, rent, license, otherwise use and permit others to use my name, image, likeness/appearance, and other personal characteristics and private information and all materials created by or on behalf of the Company that incorporate any of the foregoing on a perpetual basis throughout the world and in any medium or format whatsoever now existing or hereafter created, including but not limited to, in and on magazines, brochures and other print publications, electronic, magnetic and optical media, television broadcasts, radio broadcasts, display, point-of-sale and other advertising and promotional materials, press releases, the internet, and for any purpose, including but not limited to advertising, public relations, publicity, packaging and promotion of the Company and its affiliates and their businesses, products and services, without further consent from or royalty, payment or additional consideration to me.
I have read the above informed consent, waiver of liability, photo and video release and fully understand its contents. I voluntarily agree to the terms and conditions stated above.