DR. DANIEL'S WEIGHT LOSS PROGRAM

105 SOUTH LOCUST STREET INGLEWOOD, CA 90301

TELEPHONE: 310-256-4380

FAX: 310-256-4381

www.drdanielweightloss.com
 

RELEASE OF LIABILITY

READ CAREFULLY - THIS AFFECTS YOUR LEGAL RIGHTS

In exchange for participation in the activity of HCG pre-filled injections organized by Dr.DanielWeight Loss Program, of 105 S. Locust Street, Inglewood, California, 90301 and/or use of the property, facilities and services of Dr.Daniel Weight Loss Program,

Fill in your name below.

Above named, agree for myself and (if applicable) for the members of my family, to the following:

1. AGREEMENT TO FOLLOW DIRECTIONS. I agree to observe and obey all posted rules and warnings, and further agree to follow any oral instructions or directions given by Dr.Daniel Weight Loss Program, or the employees, representatives or agents of Dr.Daniel Weight Loss Program.

2. ASSUMPTION OF THE RISKS AND RELEASE. I recognize that there are certain inherent risks associated with the above described activity and I assume full responsibility for personal injury to myself and (if applicable) my family members, and further release and discharge Dr.Daniel Weight Loss Program for injury, loss or damage arising out of my or my family's use of or presence upon the facilities of Dr.Daniel Weight Loss Program, whether caused by the fault of myself, my family, Dr.Daniel Weight Loss Program or other third parties.

3. INDEMNIFICATION. I agree to indemnify and defend Dr.Daniel Weight Loss Program against all claims, causes of action, damages, judgments, costs or expenses, including attorney fees and other litigation costs, which may in any way arise from my or my family's use of or presence upon the facilities of Dr.Daniel Weight Loss Program.

4. FEES. I agree to pay for all damages to the facilities of Dr.Daniel Weight Loss Program caused by any negligent, reckless, or willful actions by me or my family.

5. APPLICABLE LAW. Any legal or equitable claim that may arise from participation in the above shall be resolved under California law.

6. NO DURESS. I agree and acknowledge that I am under no pressure or duress to sign this Agreement and that I have been given a reasonable opportunity to review it before signing. I further agree and acknowledge that I am free to have my own legal counsel review this Agreement if I so desire.

7. ARM'S LENGTH AGREEMENT. This Agreement and each of its terms are the product of an arms' length negotiation between the Parties. In the event any ambiguity is found to exist in the interpretation of this Agreement, or any of its provisions, the Parties, and each of them, explicitly.