AUTHORIZED REPRESENTATIVE Signature:
By signing below, I acknowledge that I have read Clallam Mosaic's 2025 Health Liability Release Waiver and understand its contents; that I am at least eighteen (18) years old and fully competent to give my consent; that I have been sufficiently informed of the risks involved and give my voluntary consent in signing it as my own free act and deed with full intention to be bound by the same, and free from any inducement or representation.