ALLERGY DISCLAIMER: Bridge to Health, LLC makes every attempt to identify all ingredients in their recipes.
Every effort is made to instruct our certified cooking instructors on the severity of food allergies. In addition, we label recipes with possible allergen-containing ingredients; however, there is always a risk of contamination. You must make the decision of enrolling your child based on this information and the possible health risk. There is also a possibility that manufacturers of the commercial foods we use could change the formulation at any time, without notice. Customers concerned with food allergies need to be aware of this risk. I understand that Bridge to Health, LLC will seek to eliminate exposure and risk to my child, but agree that Bridge to Health, LLC and its instructors assume no liability for adverse reactions for food consumed or items that my child may come in contact with while participating in this course.
I HEREBY ASSUME ALL OF THE RISKS FOR MY CHILD(s) OF PARTICIPATING IN THIS ACTIVITY, including by way of example and not limitation, any risks that may arise from negligence or carelessness on the part of the persons or entities being released, from dangerous or defective equipment or property owned, maintained, or controlled by them, or because of their possible liability without fault. I certify that there are no health-related reasons or problems, which preclude my child (s) participation in this activity. I acknowledge that this Allergy Disclaimer, Accident Waiver and Release of Liability Form will be used by the event holders, sponsors, and organizers of the activity in which my child(s) may participate, and that it will govern my child(s)' actions and responsibilities at said activity. In consideration of my application and permitting my child(s) to participate in this activity, I hereby take action for myself, my executors, administrators, heirs, next of kin, successors, and assigns as follows:
I WAIVE, RELEASE, AND DISCHARGE from any and all liability, including but not limited to, liability arising from the negligence or fault of the entities or persons released, for my child(s) death, disability, personal injury, property damage, property theft, or actions of any kind which may hereafter occur to my child (s) from this activity. I acknowledge that Bridge to Health LLC and its members, directors, officers, employees, volunteers, representatives, and agents are NOT responsible for the errors, omissions, acts, or failures to act of any party or entity conducting a specific activity on their behalf. I acknowledge that this activity may involve certain risks and carries with it the potential for death, serious injury, and property loss. The risks include, but are not limited to, those caused by trade tools, facilities and actions of other people including, but not limited to, participants, volunteers, monitors, and/or producers of the activity.
These risks are not only inherent to participants, but are also present for volunteers. I hereby consent my child(s) to receive medical treatment that may be deemed advisable in the event of injury, accident, and/or illness during this activity. The Allergy Disclaimer, Accident Waiver and Release of Liability Form shall be construed broadly to provide a release and waiver to the maximum extent permissible under applicable law.
I CERTIFY THAT I HAVE READ THIS DOCUMENT AND I FULLY UNDERSTAND ITS CONTENT. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT AND I SIGN IT OF MY OWN FREE WILL. THIS RELEASE SHALL BE GOVERNED AND CONSTRUED IN ACCORDANCE WITH THE LAWS OF THE STATE OF CALIFORNIA.
List of Food Allergies:
Parent’s or Guardian’s Name:
Parent’s or Guardian’s Email:
Parent’s or Guardian’s Telephone:
DISCLAIMER: By typing your name below, you are signing this application electronically. You agree that your electronic signature is the legal equivalent of your manual signature on this Waiver and Release of Liability Form.
HealthBridge Kauai200 N. Vineyard Blvd Suite A325-5052, Honolulu, HI 96817(808) 582-0147
Telemedicine visits throughout California and Hawaii.
In person available on Kauai, HI and in Newport Beach, CA.
HealthBridge Newport 20301 SW Birch St. Suite 100, Newport, 92660 (949) 715-9321 Ext 2