As a member of Gilda’s Club Grand Rapids, I understand the following:
I have been advised that Gilda’s Club staff will make every attempt to respect my privacy and boundaries. I understand that since Gilda’s Club Grand Rapids is a community of many people, my confidentiality cannot be guaranteed. Gilda’s Club adheres to mandated reporting guidelines when the safety of an individual or others is at risk.
Without consideration, I consent and give permission to Gilda’s Club Grand Rapids to use a photograph(s) of myself and/or to use video of myself for presentation, advertising or publication in any manner. I waive the opportunity and right to inspect or approve any photograph(s) and/or videotape or any use to which it might be put. I release Gilda’s Club Grand Rapids, its directors, employees, agents and those acting under its authority, from all claims and liabilities of any kind arising out of or in connection with the use of photograph(s), and/or video tape, and further agree to hold Gilda’s Club Grand Rapids harmless from any and all liability, of whatever nature, which at any time may arise out of or result from any of the foregoing uses.
PARTICIPATION IN WORKSHOPS
I take this as advisement to consult my physician before participating in any physical activities and to follow my physician’s advice with respect to such activities. I understand that any activity at Gilda’s Club Grand Rapids may involve some risk of injury, whether apparent or no t, and by participating in any such activity, I assume all risks, known or unknown, whether foreseeable or not. I release Gilda’s Club Grand Rapids of responsibility for any injury or damages that may result from my participation in any such activity.
I HAVE READ & UNDERSTAND THE SUPPORT GROUP COMMITMENT.
Type your full name as the person completing this agreement: