WAIVER, RELEASE, AND EMERGENCY CONTACT AUTHORIZATION
This Waiver, Release, and Indemnification Agreement ("Release") is executed by the undersigned participant ("Attendee") because the Attendee intends to participate in the lecture class and wet laboratory offered at the
Veterinary Education Center of Excellence, c/o the Hospital for Veterinary Dentistry and Oral Surgery.
As an Attendee of the lecture class and wet laboratory, I acknowledge that veterinary dentistry and oral surgery involve certain inherent risks and dangers. During the wet laboratory sessions, participants may utilize sharp instruments including, but not limited to, scalpels, elevators, and needles; power equipment such as drills; and chemical agents including cleaning solutions and disinfectants. These instruments and materials are similar to those routinely used in veterinary medical practice. I confirm that I have received at least basic instruction in the safe use of this equipment and understand that improper use may result in injury.
I understand that radiology procedures may be demonstrated or performed during the wet laboratory sessions. If I have signed a
Declared Letter of Pregnancy
with my employer, I agree to notify the course instructor so that appropriate protective measures and precautions may be implemented during radiographic procedures.
I further understand that the wet laboratory sessions will utilize prepared cadaver specimens obtained from professional sources after humane euthanasia. Prior to each wet laboratory session, instructors will review the equipment used and explain proper and safe operation. I agree that if I have questions regarding the safe use of any instrument, equipment, or procedure, I will ask the instructor before proceeding.
Protective equipment will be provided for each attendee, including but not limited to gloves, masks, and protective eyewear. I understand that this protective equipment must be worn at all times during laboratory activities. I further agree to wear appropriate professional clothing and closed-toe footwear suitable for a veterinary medical facility while attending the lecture and wet laboratory sessions.
I acknowledge that snacks and refreshments may be provided to attendees as a courtesy by the lecture class and wet laboratory sponsors. While reasonable precautions are taken, I understand that it is not possible to completely eliminate all risks of food-borne illness or allergic reactions.
RELEASE AND ASSUMPTION OF RISK
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In consideration for being permitted to participate in the lecture class and wet laboratory, I hereby release, waive, discharge, and hold harmless the
Veterinary Education Center of Excellence
, the
Hospital for Veterinary Dentistry and Oral Surgery
, their staff, affiliates, directors, officers, employees, independent contractors, sponsors, agents, and representatives (collectively referred to as the "Class and Wet Lab Hosts") from any and all claims, demands, liabilities, damages, injuries, losses, costs, or expenses, including attorney's fees, that may arise from or be related to my participation in or attendance at the lecture class and wet laboratory activities.
This release includes, but is not limited to, any injury, illness, property damage, or other harm that may occur as a result of my participation in wet laboratory sessions, including injuries resulting from the use of instruments, equipment, or laboratory materials. I acknowledge that accidents may occur during instructional laboratory activities and that participants may sustain personal injury or property damage. I voluntarily assume all risks associated with participation in these educational activities.
For the purposes of this agreement, the term
Lecture Class and Wet Lab Sponsors
includes the owners or lessees of the facilities used for the activities, as well as vendors, suppliers, caterers, and any individuals or organizations providing food, beverages, equipment, or materials associated with the event.
ATTORNEY'S FEES AND GOVERNING LAW
If any legal action or proceeding arises regarding this Release, the prevailing party shall be entitled to recover reasonable attorney's fees and costs incurred in connection with such action. This Release shall be governed by and interpreted in accordance with the laws of the
State of North Carolina
.
This document constitutes the entire agreement between the parties and supersedes any prior discussions or agreements relating to participation in the lecture class and wet laboratory. If any portion of this agreement is determined to be invalid or unenforceable, the remaining provisions shall remain in full force and effect.
Permission to participate in the lecture class and wet laboratory is subject to any rules, regulations, or conditions imposed by the Veterinary Education Center and may be revoked for good cause at any time.
I further acknowledge that the releases, waivers, discharges, and assumptions of risk contained in this document are intended to remain in effect indefinitely and shall continue from the date of signing without limitation.
By signing below, I acknowledge that I have carefully read this Release and understand that I am giving up certain legal rights. I voluntarily agree to be bound by its terms.
PHOTO AND VIDEO RELEASE
I grant permission to the Veterinary Education Center of Excellence, its representatives, employees, and authorized agents to take photographs and video recordings of me in connection with the educational activities described above. I authorize the Veterinary Education Center to use, reproduce, publish, and
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distribute these photographs or recordings in print, electronic media, websites, social media platforms, marketing materials, and educational publications.
I understand that these images may be used with or without my name for lawful purposes including publicity, advertising, educational promotion, and website or social media content.
PARTICIPANT INFORMATION
Attendee Signature:
Print Name:
Hospital/Practice Name:
Date:
-
Month
-
Day
Year
Date
EMERGENCY CONTACT INFORMATION
Emergency Contact Info
I voluntarily provide the following emergency contact information and authorize The Veterinary Education Center of Excellence and its representatives to contact the listed individual(s) on my behalf in the event of an emergency.
I choose not to provide emergency contact information at this time.
Emergency Contact Name:
Relationship:
Address:
City / State / ZIP:
Home Phone:
Format: (000) 000-0000.
Cell Phone:
Format: (000) 000-0000.
Participant Signature:
Date:
-
Month
-
Day
Year
Date
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