Confidentiality Agreement
CHES Foundation (a 501c3 organized and existing out of the State of Massachusetts and all of its affiliates used to facilitate the program) shall be referred to in this agreement as “CHES”. I, (Participant) acknowledge and agree by signing and initialing that:
I have come to LadyBugs to learn and to share information about bleeding disorders, and in that spirit, I recognize that there may be discussions that are personal in nature (e.g., specifics relating to a patient’s condition). I will keep anything that I hear confidential and will not discuss it outside of the meeting.
If, along with being a person with a bleeding disorder, caregiver, family member, or healthcare provider I have a commercial interest in the supply of products (e.g., am employed by a home care company or similar organization) or services related to patient care, I agree to:
Respect the confidentiality of the consumer participants and will not promote my company’s/organization’s products or services now or in the future. My relationships will be strictly as consumer to consumer.
I will not steer conversation in the direction of bleeding disorders business. If I am asked directly about my company’s products or services,
I will state that this educational event is not the place for me to discuss any commercial interest and will notify CHES staff immediately about this inquiry.
In attending this meeting, I recognize that information regarding my disease-state may be made available to other participants. This information will not be used in a commercial manner by CHES (or their agents) without my expressed permission.
I understand I may be asked to cease from participation of LadyBugs if I do not honor the Confidentiality Statement in its entirety.
Release of Images
I hereby authorize representatives of CHES to photograph, or video record images of all accompanying family members and myself.
I also agree that the program and persons may use, and permit other persons to use the negatives, prints, digital photos, or video prepared in such a manner as either may deem appropriate. I grant CHES the absolute right and permission to copyright and/or use pictures of us in which they may be included in whole or in part, in advertising, business, or trade or any other lawful purpose whatsoever including publication to the CHES websites and marketing materials.
The term "photograph" as used in the foregoing agreement, shall mean motion picture or still photography in any format, as well as videotape, videodisc and any other mechanical means of recording and reproducing images. I have entered into this agreement willfully and hereby waive any right to compensation for such uses by reason of the foregoing authorizations.
Acknowledgment and Assumption of Risks
Understanding the nature of the activities and their risks, and that other risks may beencountered which cannot be reasonably anticipated, I acknowledge and expressly assume all risks of CHES Foundation activities, whether or not described in this agreement, known or unknown and inherent or not. I take full responsibility for any injury or loss, including death, which I may suffer, arising in whole or part out of my enrollment or participation in the activities of a CHES Foundation program.
Release and Indemnity
If I am an adult Participant, I hereby agree, for myself and additional guest, TO RELEASE, INDEMNIFY (that is, defend, protect and pay claims, including costs and attorneys’ fees), AND HOLD HARMLESS CHES, their owners, officers, partners, agents, and employees, (“Released Parties”), with respect to any and all claims of injury, disability, death, or other loss or damage to person or property suffered by me, by any member of my family, rescuers, co-participants, or any other person, arising in whole or part from my participation in CHES program activities or any related activity, WHETHER ARISING FROM THE NEGLIGENCE OF A RELEASED PARTY OR OTHERWISE, and to the fullest extent permitted by law.
Additional Provisions
I, an adult Participant, and/or the guardian/parent of a minor child, authorize CHES Foundation to provide or obtain for me and/or my child(ren) such medical care as it considers necessary and appropriate, and I agree to pay all costs associated with such care and related transportation. CHES Foundation and any third-party medical caregiver are authorized to exchange medical information concerning my, or the minor’s, medical condition. Any dispute between a Released Party and Parent or Participant will be governed by the substantive laws of the State of Massachusetts only. If the dispute cannot be resolved by mutual agreement, I agree to submit it to an arbitrator recognized by the Courts of that State and County. I will pay all costs and attorney's fees incurred by any Released Party in defending a claim or suit brought by me if the claim or suit is withdrawn or to the extent a court or arbitrator determines that the Released Party is not responsible for the claimed injury or loss.
This agreement is entered into voluntarily, and after careful consideration. Its terms cannot be supplemented or amended except in writing. I understand and agree that it is binding, to the fullest extent allowed by law, upon all persons signing below, their respective heirs, executors, administrators, wards, minor children (whether or not they are Participants) and other family members. If any part of this agreement is found by a Court or other appropriate authority to be invalid, the remainder of this agreement nevertheless shall be in full force and effect.