Transportation Consent Form

Transportation Consent Form
Client's Name*

First NameLast Name
Client's Date of Birth*

MonthDayYear
Date
I hereby acknowledge and agree to the terms outlined below for transportation services provided by HWS Best Health, LLC.
1. Acknowledgment of Risks: I understand and appreciate that being transported by HWS Best Health Counseling and/or its employees, despite all reasonable precautions implemented for safety, carries a risk of serious injury, including death.
2. Voluntary Assumption of Risk: By my continued participation, or the continued participation of my children or wards, I voluntarily and knowingly assume the risk of injury resulting from transportation.
3. Release and Waiver: I hereby release, discharge, and forever waive any causes of actions, suits, claims, and demands whatsoever, in law or equity, which I and/or any of my children or wards may have or which our heirs, executors, or administrators may hereafter have against HWS Best Health, LLC, its employees, subcontractors, officers, and/or director. This release excludes any such causes of actions, suits, claims, or demands resulting from intentional misconduct or gross negligence. I understand that this waiver will preclude me from suing in the event of accidental injury during transportation.
4. Indemnification: I agree to indemnify and hold harmless HWS Best Health Counseling, its employees, officers, and directors against any and all liability, loss, damage, costs, or expenses that I and/or any of my children or wards may cause while being transported by HWS Best Health Counseling and/or one of its employees.
Signer's Name*

First NameLast Name
Signer's Relationship to Client*
Signature*

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Did an HWS Best Health provider or staff member assist you with completing this form?*

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HWS Staff/Provider's Email Address*
example@hwsbesthealth.com
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