Federal regulations allow the IRB to approve a waiver of consent in planned research in an emergency setting where there is more than minimal risk to participants, provided there is a prospect of direct benefit to participants and a number of other conditions are met. See the Research in Emergency Settings page for more info. Waiver I understand that work done with The Actors Gymnasium involves risk. In order to decrease the possibility of accident, I agree to use The Actors Gymnasium equipment only under the direction and supervision of Actors Gymnasium personnel.
There is little risk that occasional marijuana use, standing alone, will be diagnosed as a physical or mental disorder, although if you have exhibited harmful behavior resulting from your use of marijuana, you may be at risk of being found inadmissible. An occasional driver for insurance, also often referred to as a secondary driver, is a person who regularly drives the vehicle, but doesn't use it the most. They drive the vehicle less than 50% of the time. For example, an occasional driver is most commonly a spouse who uses the vehicle to run errands or visit family on the weekend.
MANHATCHET AXE THROWING
ASSUMPTION OF RISK – RELEASE & WAIVER OF LIABILITY – PUBLICITY RELEASE
IN CONSIDERATION of being permitted to participate in the MANHATCHET and related events and activities ('collectively the 'Activities') provided and facilitated by The KJ Experience LLC DBA Manhatchet('Facilitator'), I HEREBY AGREE for myself, my heirs and legal representatives:
I fully understand the risks and totally assume all risks, known and unknown, of participating in Activities, including the risk of death or minor or serious bodily injury. I represent that I am in good health and physically able and ready to participate in the Activities, and do not have any physical illness, injury or disability that would make my participation in these Activities unwise or unnecessarily risky or dangerous to myself or others.
I accept and assume all such inherent dangers and risks of bodily injury, permanent disability, death, and/or property damage, even if caused, in whole or in part, by the negligence of the Facilitator, and all of their respective members, staff, managers, officers, directors, shareholders, affiliated organizations and entities, representatives and sponsors, and all volunteers, contractors, agents, members, and employees (collectively the 'Facilitator Parties'). Recognizing the possibility of death and serious bodily injury associated with participating in the Activities, I hereby agree to waive, release, hold harmless and/or discharge the Facilitator Parties from any and all claims, demands, damages, losses, injuries, liabilities, obligations, costs or expenses of any kind which are made or could be made by me, or on my behalf, or by my heirs or legal representatives as a result of my participation in the Activities, even though such claims may arise due to the negligence, carelessness or recklessness of such Facilitator Parties.
I agree and understand any and all alcohol on the premises must be authorized and provided by the Facilitator and outside alcoholic beverages are not permitted on the premises to include within any rented booth space. If I elect to consume alcohol prior to or during my participation in the Activities, I agree to assume all risks, known and unknown, related to consuming such alcohol and agree to be fully responsible and liable for any and all claims, demands, damages, losses, injuries, liabilities, obligations, costs or expenses of any kind which may arise due to my consumption of such alcohol (collectively the 'Claims'). I hereby agree to indemnify, defend, and hold harmless the Facilitator Parties from any such Claims.
This release and waiver of claims is binding on me, my heirs, executors, administrators, legal representatives, assigns and successors in interest. I understand that I am giving up my right to sue the Facilitator Parties and giving up other valuable and substantial rights in exchange for being permitted to participate in the Activities.
I agree and understand that following all instructions and rules at all times while participating in the Activities is a requirement for participation. I agree that if I fail to follow such instructions and rules and act reasonably and responsibly, I waive any and all right to continue participating in the Activities and any benefits associated with being a participant. I also agree to leave the premise if asked to do so because of my actions.
I hereby grant to the Facilitator the right to photograph, videotape or otherwise capture my image, appearance or likeness and to use such images for any legitimate purposes, commercial or otherwise. I also agree to waive any right to compensation from the use of my image, appearance or likeness.
By signing this Release, or digitally acknowledging acceptance of its terms, I agree that I have read the terms, agree to be bound by the terms and do so voluntarily and knowingly. If I am signing on behalf of my minor child, I hereby execute this Release on behalf of my minor child with a full and complete understanding that I am executing a release and waiver of potential claims on behalf of my minor child and myself.
FDA Waiver
I acknowledge that I am 18 years of age or older and that I have been advised by Audicus that the Food and Drug Administration (FDA) has determined that my best health interest would be served if I had a medical evaluation by a licensed physician (preferably a physician who specializes in diseases of the ear) before purchasing a hearing aid/device. I do not wish a medical evaluation before purchasing a hearing aid/device.
Alta Occasional Use Waiver
Additional Considerations
If you have or think you may have any of the following conditions, Audicus advises you to consult promptly with a licensed physician (preferably an ear specialist) prior to purchase:
- Visible deformity of the ear
- Fluid or drainage from the ear within the past 90 days
- Sudden, rapidly progressing, or fluctuating hearing loss
- Spells of acute or chronic dizziness
- Hearing loss only on one side that worsened in the past 90 days
- Ear canal blockage, a lasting ear infection or a plugged up fullness feeling
- Excessive wax buildup, or a history of excessive wax buildup
- Pain or discomfort in the ear
- Ringing in one or both ears within last 90 days
Alta Occasional Use Waiver Form
Hearing Aids:
You are purchasing a hearing aid based upon the information you have submitted to Audicus. Any examination or representation made by a hearing aid provider or audiologist in connection with the practice of dispensing, fitting, or dealing in hearing aids is not an examination, diagnosis, or prescription by a person licensed to practice medicine and, therefore, must NOT be regarded as medical opinion or advice. Hearing aids will NOT restore normal hearing, nor will it prevent further hearing loss. It is also recommended that an Otoscopic exam is performed before the purchase of a hearing aid.
Listening Devices:
Listening Devices are intended to amplify sounds in situations that would be difficult for normal hearing individuals to hear. A listening device is NOT a hearing aid and is not intended to treat hearing loss. It is not intended to diagnose, treat, cure any disease or alter the structure or function of the body. It will not restore normal hearing and will not prevent or improve a hearing impairment resulting from organic conditions. Listening devices are designed for occasional and recreational use for amplifying and filtering sounds that are inherently difficult to hear. If you believe you have hearing loss, you are encouraged by Audicus to seek help from a qualified professional. To protect your hearing, avoid having the volume at high levels for extended periods of time. Permanent hearing loss can result from high sound volumes.
Alta Occasional Use Waiver
By purchasing from Audicus, you also agree that you are the person that will be the end user and wearer of these hearing devices, and that the reason for purchasing these hearing devices from Audicus is for the sole purpose of personal use only and not for competitive research, resale, or any other reason. You also agree that you have read, understand and agree to our Terms of Service and Privacy Policy.
