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Notice of Privacy Practices

This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.


Notice of Informed Consent

Fresh & Fit Program - Waiver and Release of Liability and Authorization for Use of Media

I understand and authorize my participation in the Fresh & Fit Program (“Program”) presented by Indiana University Health (“IU Health”) in partnership with The Max Challenge from February 25, 2019 through May 31, 2019 (the “Event”). I understand that this is a physical event and affirm that I am medically able to participate.

1. Release and Indemnification: I release both Program and IU Health, and agree not to sue Program or IU Health, their respective employees, contractors, officers, owners, sub-contractors, sponsors, agents, and affiliates (collectively the “Released Parties”) from all present and future claims that may be made on my behalf by me, my family, estate, heirs, or assigns for property damage, personal injury or wrongful death resulting from my participation in the Event including, without limitation, claims caused by the negligence of any of the Released Parties, wherever, whenever, or however the damage, injury, or death may occur. I understand and agree that the Released Parties are not responsible for any injury or property damage arising out of or in any way related to the Event, even if caused by their negligence. I further agree to indemnify the Released Parties for any claims made by, or on behalf of, me for any claim of property damage, personal injury, or wrongful death arising as a result of my participation in the Event. Such indemnity extends to the costs of defending or settling a claim made against a Released Party (including, without limitation, reasonable attorney’s fees).

2. Voluntary Participation; Assumption of Risk: I understand that my participation in this event involves certain risks, including, but not limited to, those of serious injury or death. I am voluntarily participating in the Event with knowledge of the danger involved and agree to accept and assume all risks of my participation in the Event and all related activities. Program and IU Health have not undertaken to determine whether I may have any medical condition that may cause me to be unfit to participate, and I acknowledge that neither Program nor IU Health have a duty to make such an assessment.

3. Media: I agree to let Program and IU Health use my likeness, name, portrait, recorded voice, and biographical material, free of charge, to advertise, promote, and publicize, but not as an endorsement of any product or service of any advertiser.

4. Miscellaneous: I understand that this document is intended to be as broad and inclusive as permitted by the laws of the State of Indiana and agree that if any portion of this agreement is invalid, the remainder will continue in full legal force and effect. I further agree that any legal proceedings related to this waiver will take place in Indianapolis, Indiana.


Signed at {{participant.informed_consent.signed_at}}

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