miih image  

In consideration of participating in the activity on in Boca Raton, Florida hosted by the Marcus Institute of Integrative Health at FAU Medicine of Florida Atlantic University (the “Activity”), I hereby agree as follows:

I, for myself and my estate, heirs, administrators, executors, and assigns, hereby release and hold harmless the State of Florida, the Florida Atlantic University Board of Trustees, and their officers, directors, employees, representatives, agents, and volunteers (collectively, the “Releasees”), from any and all liability and responsibility whatsoever, however caused, for any and all damages, claims, or causes of action that I, my estate, heirs, administrators, executors, or assigns may have for any loss, illness, personal injury, death, or property damage arising out of, connected with, or in any manner pertaining to the Activity, whether caused by the negligence of Releasees or otherwise.

I fully understand that there are potential risks and hazards associated with the Activity, including, but not limited to, possible injury or loss of life. I further understand that while participating in the Activity, I will be interacting with persons, places or objects that are not associated with or under the control or supervision of the Releasees. Despite the potential risks and hazards associated with the Activity, I wish to proceed, and freely accept and assume all risks and hazards that may arise from my participation in the Activity and that could result in loss, illness, personal injury, death, or property damage, whether caused by the negligence of releasees or otherwise.

I give the Releasees authority to: (i) record my likeness and voice on a video, audio, photographic, digital, electronic or any other medium in connection with these recordings; and (ii) use, reproduce, exhibit or distribute these recordings in whole or in part in perpetuity in any and all media throughout the universe (including, but not limited to, print publications, video tapes, non-theatrical, home video, CD-ROM, internet and any other electronic or other medium presently in existence or invented in the future) for any purpose that the Releasees, and those acting pursuant to its authority, deem appropriate, including promotional, recruiting, advertising and any commercial or non-commercial use. I understand and agree that all such recordings, in whatever medium, shall remain the property of the Releasees.

I further hereby agree to defend, indemnify and hold harmless the Releasees from any judgment, settlement, loss, liability, damage, or costs, including court costs and attorney fees for both the trial and appellate levels, that Releasees may incur as a proximate result of any act or omission on my part during my participation in the Activity, or for any violation of any personal or proprietary right I may have in connection with such use of my likeness, voice, or name in any medium, and expressly waive any rights to privacy I may have under the Family Educational Rights and Privacy Act ("FERPA"), §1002.22, Fla. Stat., and/or any other applicable law.

In signing this agreement, I acknowledge and represent that I have read and understand it and that I sign it voluntarily and for full and adequate consideration, fully intending to be bound by the same.