Parental Waiver & Release Form
Parental Waiver And Release for Children Under 18:
We understand that many concussion patients are under the age of eighteen, and we want to work with and help these patients just as we do adult patients. Every person who registers to access the restricted Content on this Site must read and acknowledge all the forms on the Registration Page, including the waiver. Every person under the age of 18 must also have a parent or guardian acknowledge the Parental Waiver.
I represent and affirm that I am the parent or legal guardian of a person registering this Account (my “Child”), who is a child under the age of 18. I represent that my Child will be using the Return to Life & Sport Progressions on this Site under the care of a medical practitioner who has provided an initial assessment of my Child’s condition.
I understand that it is critical for my Child to follow all directions on the Site carefully, that my Child and I must use sound judgment and accurately monitor my Child’s results. I understand and agree that Phoenix Concussion, LLC (“Phoenix”) is relying on my willingness to oversee my Child’s use of the Site, and on the assessment of my Child’s medical practitioner of my Child’s physical and mental fitness, suitability, and capability to participate in the exercise progressions contained on the Site. I understand and agree that Phoenix has no obligation or ability to verify my Child’s suitability for the Return to Life & Sport Progressions, or to verify my Child’s progress during his or her use of the Site. I understand and agree that I and my Child’s medical practitioner remain solely responsible for determining and monitoring these things, and all consequences of my Child’s use of the Site and its Contents.
I acknowledge that all exercise involves inherent risks, and I assume full responsibility for all risks, injuries or damage to my Child, known or unknown which my Child might incur as a result of participating in the exercises included in this Site. I understand and acknowledge that such injuries may include, but are not limited to, worsening concussion damage, heart attacks, soft tissue injuries including muscle and tendon strains and tears, broken bones, shin splints, other illness or soreness, including death.
I expressly agree and contract, on behalf of my Child, myself, and my Child’s heirs, executors, administrators, successors and assigns, to release, hold harmless, defend and indemnify Phoenix, its employees, members, managers, affiliates, agents, officers, directors, insurers and their successors in interest (collectively “Phoenix”), from all liability for injury, death, property loss and damage which results to my Child from my Child’s use of the Site and the Contents, including, to the greatest extent allowed by law, all liability which results from the negligence or gross negligence of Phoenix or any other person or cause, for myself, my Child and any other person having any claim through my Child or any authority over the welfare of my Child.
By creating an Account and joining the Return to Life & Sport Progression, I affirm and represent that:
- I am the parent or legal guardian of the person who is registering for an Account on this website, who is under the age of 18;
- I consent to my Child’s use of the Site at his or her own risk;
- I and my Child’s medical practitioner will oversee my Child’s use of the Site and its Content as we find appropriate;
- I knowingly and voluntarily give the releases and waivers above on behalf of my Child, myself and all other persons having authority over the welfare of my Child.
- I have read and agree to the Terms and Conditions for use of this Site