Must be a Florida resident to qualify for services.

Brain Based Healing Liability Consent
Before participating in any service, program, treatment or retreat with Operation Warrior Resolution (OWR), please read this document carefully and provide your signature and/or initials as an indication of your understanding and acknowledgment of these terms.

Personal Information

Emergency Contact Information

Insurance Details

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DD214

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State of Health Declaration

State of Health Declaration
Before participating in OWR programs, I understand that I am required to provide a comprehensive declaration regarding my current health status and physical ability. This allows OWR to better ensure my safety and the suitability of OWR’s exercises and programs to my individual condition. I understand and acknowledge the following:
• I am in good physical health and there are no physical impairments that would hinder my participation.
• OWR does not provide medical services or diagnosis of my physical health.
• I do not have any infectious diseases, health issues, or physical disabilities that I am aware of, which could adversely affect my ability to safely participate in the activities or could potentially lead to my being more susceptible to injury.
• I have received clearance from a licensed medical professional stating that I am able to participate in physical activities, following a thorough physical examination.
• I commit to immediately informing OWR if my health status changes at any point during my participation.
• I understand and acknowledge that OWR has not given me medical advice regarding my physical condition, and any statements by OWR or its staff relating as to possible benefits of the activities are not intended as substitutes for proper medical advice.
• I agree to cooperate fully and follow all safety rules and staff instructions during activities, and acknowledge my right to discontinue participation at any time if I feel uncomfortable or strained.

General Liability Waiver & Injury Terms

By participating in OWR's programs, I acknowledge the inherent risks involved, including those that could result in physical or psychological injury, pain, suffering, illness, temporary or permanent disability, and death. I understand these risks can arise from both my own and others' actions, omissions, or carelessness, and from conditions in the facilities or the equipment used.
Despite understanding these risks, I assert that I am voluntarily participating in these activities and agree to accept all related risks, including those foreseeable or not. I hereby waive, release, absolve and agree to indemnify and hold harmless OWR, their principals, agents, affiliates, employees, other participants, any sponsoring agencies, sponsors, and advertisers, from any claims arising out of my participation, to the fullest extent of the law.
I understand that OWR does not offer any medical services including the diagnosis of my physical condition. I verify that I am in good health and do not suffer from any condition that would restrict my ability to participate safely. I accept personal responsibility for any medical expenses incurred as a result of my participation.
My agreement to these terms serves forever as a release and assumption of risk for my heirs, estate, executor, administrator, assignees, and all members of my family.

Authorization and Release for Medical Treatment

In the event of a medical emergency, I authorize OWR and its authorized personnel to render or order rendered medical assistance as it deems necessary. This includes, but is not limited to, providing or arranging for any medical operations, treatments, and/or medications that OWR might deem necessary for my safety and well-being.
I understand and acknowledge that:
• I will remain financially responsible for any medical treatment and/or transportation provided.
• OWR's insurance does not cover personal injury, accidents, illnesses, or loss of personal belongings.
I release, waive, indemnify, hold harmless, and discharge OWR from any claim for personal injury, accident or illness that might occur during my participation in OWR programs and from any claim for loss or damage to your personal property.

Release of Information or Records

I understand that this program receives funding from Manatee County Government, Sarasota County Government and the State of Florida, and that representatives may request access to any or all Agency records related to the program for the purpose of evaluating or monitoring the delivery of services. I understand any records provided to these representatives will not include names or any other identifying information and shall become public records and may be subject to applicable state or federal exemptions and may be copied and inspected by third persons.

Liability Disclaimer for Retreats and Physical Activities

OWR's retreats and yoga activities offer a range of physical and mental exercises. As a participant, I acknowledge and agree to the following before participating:
• Activities offered during retreats may include but are not restricted to: physical activities, group exercises, meditation sessions, and yoga classes. Each of these activities comes with inherent risks, which can lead to physical or mental injury, pain, stress, or even severe health problems. Some of the more strenuous activities like yoga or hiking could have potential risks such as falls, fractures, or other injuries.
• OWR, its employees, representatives, volunteers, and contracted professionals, are not responsible for any injuries or health problems I may experience during or after participating in these activities. I assume full responsibility for any risks, injuries, or damages, known or unknown, voluntarily incurred while participating.
• It is my responsibility to comprehend my physical and mental capabilities and limits. I must ensure not to exceed my limits while participating in these activities.
• Prior to my participation, I should obtain a comprehensive medical examination and clearance from a qualified healthcare provider. If I experience any discomfort, pain, dizziness, or shortness of breath at any time during the activities, I should stop immediately.
• OWR, its facilitators, volunteers, or contractors cannot offer medical advice or consultation before, during, or after any retreat activities.
I release and discharge OWR, its officers, directors, employees, agents, yoga instructors, coaches, volunteers, independent contractors, and any other persons or entities acting on OWR’s behalf, from all liability arising out of or in connection with my participation in OWR's retreats or physical activities while participating in a retreat.

Infectious Disease Exposure

Due to the nature of social contact during OWR activities, there is a potential risk of infectious diseases, including but not limited to COVID-19. I confirm my understanding and acceptance of this risk.

Professional Liability Release

I understand that any meetings I have with a therapist, practitioner, Licensed Mental Health Professionals, coaches, or any other independent contractor of Operation Warrior Resolution is not traditional mental health therapy and is solely for educational purposes. I also understand that if I am receiving brain-based healing, that it is one or a combination of modalities such as Rapid Resolution Therapy and The Cortina Method. I am meeting with them at my own risk.

Independent Contractors

OWR includes programming facilitated by independent contractors, including but not limited to therapists, licensed mental health professionals, yoga instructors and coaches. My signature of this form indicates my understanding and agreement to the following terms relating to my involvement:
• OWR carefully selects independent contractors based on their credentials, expertise, and experience. However, these professionals work in a capacity independent of OWR and do not represent the organization or its views.
• I acknowledge and agree to the fact that OWR does not exercise any control over the advice, recommendations, or guidance provided by such independent contractors. As such, OWR cannot be held responsible for the consequences of any such counsel or the methods utilized by these contractors.
• If I choose to follow the advice or recommendations of these independent contractors, I do so entirely at my own risk. OWR expressly disclaims any liability arising from my interactions with independent contractors and from any act, error, omission, injury, loss, accident, damage, delay, non-performance, irregularity, or any consequence thereof, which may be occasioned through the acts or omissions of these professionals, whether negligent, intentional, wrongful, or otherwise.
• Any disputes, complaints or issues that arise from the services rendered by independent contractors must be resolved directly with the contractor. OWR cannot intervene in such matters or provide assistance in resolving such disputes.
Notwithstanding anything to the contrary herein, I release OWR, its officers, board members, agents, employees, and volunteers from any and all claims, demands, damages, costs, expenses, actions, and causes of action in respect of death, injury, loss or damage to my person or property, however, caused, arising or to arise by reason of or during my participation in the services provided by an independent contractor. It is understood and agreed that this agreement is to be binding on me, my heirs, executors, administrators, and assigns.
• Independent Contractors create, receive, maintain, and/or transmit protected health information, and are required to appropriately safeguard Protected Health Information while performing business operations. I understand that they may share my information among each other to provide services in accordance with HIPAA.

Third-Party Liability

Participation in OWR's programs often involves interactions with fellow participants, OWR staff, independent contractors, and others, as well as the use of shared facilities and equipment.
• As a participant, I am fully responsible for my actions during OWR's programs. This includes my compliance with local laws, ordinances, and regulations, and the respect of the rights, well-being, and property of others. Any damage or harm inflicted on third-party individuals or property due to my actions is solely my responsibility. OWR cannot and will not be held liable for any claims, legal actions, injuries, damages, or losses caused directly or indirectly by my acts or omissions.
• OWR aims to provide a secure environment, but the safety of personal belongings always involves risk. OWR is not responsible for the safety, loss, or damage of my personal items. As a participant, I have been advised to avoid bringing unnecessary valuables to the program and to keep a close watch over my possessions.
• OWR's insurance coverage does not include participants' personal belongings or actions towards third parties. For personal coverage, consider seeking personal insurance.
• In the event damage or loss to OWR or third-party property is incurred as a result of my actions, I accept responsibility for all associated repair and replacement costs.
In addition to the above, as a participant, I agree to indemnify and hold harmless OWR, its officers, directors, employees, agents, volunteers, and each of them, from any loss, liability, damage, or cost they may incur due to my presence in, upon, or about the OWR premises or due to my participation in any of the programs whether caused by the negligence of me or otherwise.

Acts of God

OWR will not be responsible for any damages or disruptions caused by unforeseen circumstances that are out of OWR’s control, such as natural disasters and pandemics.

Jurisdiction and Governing Law

This agreement will be governed by and construed in accordance with the laws of the State of Florida, and any disputes relating to this agreement shall be subject to the exclusive jurisdiction of the courts of Florida.

Ability to Revise

OWR reserves the right to revise the terms and conditions of the agreement within the constraints of the law. I will be notified in such a case.

Signature and Date

By signing and dating here, I am indicating that I have read, understand, and acknowledge all of the details in this Waiver. I have either sought independent legal advice prior to signing this form, or I have voluntarily chosen not to do so.
My rights to personal data privacy are protected under HIPAA policies.
Please remember, our contractors and staff are bound by duty to report any risk of harm to you or others, based on their interaction with you.

If you are filling out this form on behalf of someone else, please provide your name and relationship to the veteran.

Internal: If submitted via print file, include file permalink.

Must be a Florida resident to qualify for services.

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