Transportation Waiver

Transportation Waiver
Client Name

First NameLast Name
Transportation is not a service to be provided

Need TransporationDo not need
In directing and authorizing an employee of Brightstar Care to carry me as a passenger in either their automobile or my own, I recognize and accept the risks inherent in transportation. BrightStar Care offers this service as an occasional client accommodation, not as a primary component of our service.

If the employee is transporting me in his/her vehicle, I will wear my seatbelt and provide minimal distraction to and from our intended destination.

If the employee is to drive my vehicle, I understand there is reasonable concern about the employee's unfamiliarity with my vehicle, its drivable condition, and its regular maintenance.
I hereby certify my vehicle:

Is currently insured for BOTH liability and physical damageHas recieved regular maintenanceIs in drivable condition
Initials:

Clear
Further, I accept responsibility for any deductibles on my personal automobile insurance coverage incurred as a result of this service.

I specifically accept these risks and waive any claim that I might otherwise have against Brightstar Care with respect to bodily injury or property damage sustained by me in connection with said transportation, and hereby expressly release Brightstar Care and their employees from any and all liability therewith.
Client Signature

Clear
Date

MonthDayYear
Date
Signature

Clear
Marketer Name

First NameLast Name
Marketer Email
example@example.com
Should be Empty: