StrokeOT, Inc. Group Registration and Informed Consent and Waiver

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Participant Information:

TERMS AND CONDITIONS

Informed Consent for StrokeOT, Inc. Group Participation:

I acknowledge that there is an inherent risk associated with any exercise program that may result in injury, including my voluntary participation in the virtual and in-person groups led by StrokeOT, Inc. and Carolyn Brown, OTD, OTR/L. I have consulted with my physician or other healthcare providers prior to starting this group and have been given permission to participate. I understand that I am solely responsible for monitoring my own condition, both physical and mental, throughout the group participation and for knowing my own limitations, ensuring my own safety and deciding if the instructions provided during the StrokeOT, Inc. groups are appropriate for me. I also understand that the instructor cannot watch me individually and I take responsibility for my movement decisions. Should any unusual symptoms occur, I will cease my participation and consult a physician. These include but are not limited to risk of injury, exacerbation of a pre-existing condition, or over-exertion (pain, muscle strain, blood pressure changes, heart rate changes).

I further understand that I can voluntarily remove my audio and video during the virtual group meeting to maintain my privacy.

Agreement and Waiver/Release of Liability:

The exercises and instruction provided by StrokeOT, Inc. and Carolyn Brown, OTD, OTR/L are not to be intended as recommendations for a specific treatment plan, product, course of action, or a substitute for medical consultation.

1. I, my executors, administrators, heirs, next of kin, successors and assigns hereby agree to waive release, and discharge StrokeOT, Inc., Carolyn Brown, OTD, OTR/L, any appointed instructor, and any other affiliates or representatives and their respective directors, employees and agents from any and all liability and responsibility for my death, disability, personal injury, accident, illness, property damage, medical fees or actions of any kind sustained now or in the future resulting from my participation in the online groups led by StrokeOT, Inc. and Carolyn Brown, OTD, OTR/L.

2. Indemnify, defend and hold harmless StrokeOT, Inc., Carolyn Brown, OTD, OTR/L, and any appointed instructor, and any other affiliates or representatives and their respective directors, employees and agents, from and against any and all liabilities, claims causes of action, damages, judgments, costs or expenses, including reasonable attorney fees, arising out of or in connection with my participation in the online groups led by StrokeOT, Inc. and Carolyn Brown, OTD, OTR/L.

I acknowledge that I am voluntarily agreeing to the terms set in this Informed Consent and Waiver in order to participate in the StrokeOT, Inc. virtual and in-person groups and by checking this box, I intend it to be a complete and unconditional release of liability to the fullest extent allowable by law.

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