In consideration of my participation in the Peer Support Services Program (the “Program”), I, the undersigned, acknowledge and agree that:
There are potentially significant risks of serious injury and possibly death from participation in the Program due to the nature of the Program and the emotions that may arise in me or from others as a result of participation in the Program. I knowingly and freely assume all such risks, both known and unknown, even if arising from the negligence of others, and hereby assume full responsibility for my participation in the Program.
I agree that I will call 9-1-1 if I feel like I am in imminent or immediate danger to myself or others. Additionally, if I am in need of crisis services for myself or others, I will contact a crisis hotline, such as the Hope Center at 970-306-4673.
Because of the risks of my voluntary participation in the Program, I hereby release, discharge, and hold harmless SpeakUp ReachOut where I am receiving peer support services under the Program, and their respective affiliates, and their respective directors, officers, employees, agents, and volunteers, as well as any independent Program instructors, from any and all claims, liabilities, rights, causes of action, damages, or losses that I or others may have or may assert, either now or in the future, against the released parties listed above.
I HAVE READ THIS WAIVER AND RELEASE OF LIABILITY, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.
By typing your name you acknowledge this waiver and release of liability.