Attendance at the Academy for Injection Anatomy course does not guarantee
that the enrolled licensed healthcare professional will be competent to perform a procedure. The certificate of completion provided to attendees who complete the course does not bestow any special credentialing. It is the responsibility of the licensed health care professional to understand and adhere to the laws and guidelines of the state in which they practice medicine or otherwise perform healthcare services. Attendees must also understand the scope of what their professional license allows or disallows in regards to the newly learned procedures.
For and in consideration of permitting me to attend and participate in the
Academy for Injection Anatomy course, I voluntarily release, discharge, waive and forever relinquish any and all actions or causes of action for damages occurring to me, my patients, heirs, personal representatives and assigns, arising as a result of receiving instruction in the field of facial injection for facial aesthetic rejuvenation. I, for myself and my patients, heirs, personal representatives, and assigns, release, waive, discharge and relinquish any action or causes of action whatsoever which may later arise, and I agree that under no circumstances will I or my heirs, personal representatives, or assigns prosecute or present any claims for damages against Surek, LLC or Christopher C. Surek, D.O. for any cause of action arising out of the Academy for Injection Anatomy course, whether the same shall arise by the negligence of any person or otherwise.
I, for myself and my heirs, personal representatives, and assigns, agree that in
the event any claim for damages shall be prosecuted against Surek, LLC or Christopher C. Surek, D.O., or their respective members, managers, officers, employees, agents, or affiliates (collectively, "Indemnitees") as a result of my actions, omissions, or negligence, to indemnify and hold harmless Indemnitees from any losses, liabilities, or negative results or outcomes whatsoever that a patient may suffer from my action or procedure, including the cost and expense of defending the same. Indemnitees may not in any way be blamed or held liable for violations committed by an attendee.
I agree not to copy or distribute in printed or digital format any course materials without the written permission of Surek, LLC. Further, I agree not to record, publish, or transmit (by means of video, audio, or any other means) any online or electronic course content or webinars without the written permission of Surek, LLC.
I ACKNOWLEDGE THAT I HAVE READ THE ABOVE AND AM FULLY AWARE
OF THE LEGAL CONSEQUENCES OF SIGNING THIS INSTRUMENT.