GENERAL RELEASE & WAIVER OF LIABILITY
**READ CAREFULLY – THIS AFFECTS YOUR LEGAL RIGHTS**
Elevation Corporate Health, LLC (Elevation) is the management company who oversees the supervision and activities of Terumo BCT Fitness Center, fitness programs, and sponsored activities which are featured on the Wellness Portal and in the Fitness Center.
Because physical exercise and activity can be strenuous and subject to risk of serious injury, the undersigned User is urged to consult with their physician prior to engaging in exercising, using any exercise equipment, or participating in any exercise activity that Elevation offers. User agrees that in participating in any physical exercise or activity of the Fitness Center or Wellness Program, on or off premises, that the User does so entirely at their own risk. User agrees to assume all risks of accident, injury, illness, or even death. Elevation will not be responsible for any loss of User personal property.
This waiver and release of liability includes, without limitation, all injuries which may occur as a result of; (a) use of the Terumo BCT Fitness Center exercise equipment in the facility and user participation in any Terumo BCT activity, class, program, personal training or instruction, (b) sudden and unforeseen malfunctioning of any equipment due to misuse or abuse, (c) our instruction, training, supervision, or education, and (d)User slipping and/or falling while in the facilities, the premises, including indoor and outdoor events and parking areas.
User acknowledges careful review of this "waiver and release” and fully understands that it is a release of liability. User expressly agrees to release and discharge Terumo BCT and Elevation Corporate Health, and all affiliates, employees, agents, representatives, successors, or assigns, from any and all claims or causes of action and user agrees to voluntarily give up and waive any right that User may otherwise have to bring a legal action against Terumo BCT or Elevation for personal injury or property damage.
1. User agrees to indemnify and defend Terumo BCT and Elevation, Elevation’s managing agent, each of their respective directors, officers, employees, partners, shareholders, members, authorized agents, representatives, successors and assigns against all claims, causes of action, damages, judgments, costs or expenses, including attorney fees and other litigation costs, which may in any way arise from user’s use of or presence upon the Properties or Facilities.
2. User agrees to pay for all damages to the facilities caused by User’s negligent, reckless or willful actions.
3. User understands that User may be subject to photograph and/or videotaping on Properties and Facilities, and agrees to allow User’s photo, video or likeness to be used for legitimate purposes by Terumo BCT or Elevation, Elevation’s managing agent, and local media sources for the purpose of publicizing educational programs or any other lawful purpose, to use their photographic likeness in publications–including websites ,magazines, newspapers, annual challenges/incentive programs, exhibits and educational publications–without (i) prior notice, consent or authorization or (ii) payment, royalties, the right to approve the finished product, or any other consideration.
4. Any legal or equitable claim that may arise from participation in the above shall be resolved under Colorado law.
HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT AUTHORIZATION FOR USE OR DISCLOSURE OF INFORMATION
I hereby authorize the use or disclosure of my Protected Health Information described below. I understand that this authorization is voluntary. I understand that the released information will no longer be protected by federal privacy regulations.
Persons/Organizations providing the information:
- Kaiser Permanente
- Quest Diagnostics
- Personal Health Care Provider
Persons/Organizations Receiving the information:
- Elevation Corporate Health
Specific description of information:
- Blood Pressure
- Waist Circumference
- Intake survey
This authorization for release of information covers the period from:
01 January 2019 to 01 January 2020
This medical information may be used by the persons/organizations I authorize to receive this information for consultation or referral, or other purposes as I may direct.
I understand that I have the right to revoke this authorization, in writing, at any time. I understand that a revocation is not effective to the extent that any person or entity has already acted in reliance on my authorization.
I understand my enrollment or eligibility for benefits will not be conditioned on whether I sign this authorization