By registering for Building Your Toolbox (“BYT”), I acknowledge that I have agreed to participate in a BYT interactive webinar organized by Pain Connection, a program of U.S. Pain Foundation, Inc. I understand that the webinar will include discussion of healthcare, work and family issues and the management of chronic pain and that the level of my participation in this webinar and any related activities must be determined by me, in consultation with my physician or other qualified healthcare provider. I further understand that the BYT webinar leaders are volunteers and people with pain who have undergone training with U.S Pain Foundation, Inc. and that they may not be physicians, psychiatrists, psychologists or other trained healthcare professionals. The webinars are provided for information, education and support - they are not therapy groups. U.S. Pain Foundation, Inc. is dedicated to serving those who live with pain conditions and their care providers, but does not advocate any one particular treatment for any one type of pain.
I acknowledge that the webinar leaders and/or U.S. Pain Foundation, Inc., by making this webinar available, are not undertaking any responsibility regarding my medical condition(s). If I feel that my medical condition(s) are adversely affected by my participation in the webinar, l understand that it is my responsibility to discontinue participation and to immediately consult with my healthcare provider about continuing or resuming participation.
I agree that all information obtained in the webinar is to be considered confidential and I shall hold the same in confidence, shall not disclose, publish or otherwise reveal any of the confidential information received from any participants in the webinar and/or U.S. Pain Foundation, Inc. to any other party whatsoever.
I acknowledge that a webinar conducted by video and/or telephone-conferencing (including Zoom) may be less secure than in-person support groups, and I fully understand the nature and extent of the potential risks involved with participation in the webinar using these forms of electronic media. I agree not to make any type of recording (audio and/or video) of the webinar.
I hereby, on behalf of myself, my heirs, executors, administrators, and assigns, assume the risks associated with participation in the webinar and release, indemnify and hold harmless the webinar leaders, U.S. Pain Foundation, Inc. and it’s agents, officers, members, volunteers and employees from any and all claims, demands, for personal injuries, costs, expenses, and any other loss to person or property arising out of or resulting from my participation in the support group.
I have read this waiver and release and confirm that I am aged eighteen or over. I have been given the opportunity to ask any questions and I fully understand and agree to the above.
