MusiCares X Daniel Padmos, MM, PTA, Musician's Therapist

Please note, if you register and attend the clinic, you are agreeing to our general waiver below. Thank you.

General Agreement / Release from Liability:

I, the undersigned, (if applicant/participant is 18 years of age or older) or parent/guardian of the above listed minor applicant/participant, acknowledge and fully understand that each applicant/participant will be referred by MusiCares to independent physicians and other health care providers who have agreed to provide services to the applicant/participant (and for which MusiCares may compensate the providers). I recognize and agree that any such services may present the risk of serious injury, including permanent disability or death, and severe social and economic losses, including reputational harm, which might result not only from the providers’ actions, inactions or negligence, but action, inaction or negligence of others, or of any equipment used and further, that there may be other unknown risks not reasonably foreseeable at this time. I recognize and agree also that the use or misuse of the product at issue (i.e., ear impressions, ear plugs and related packaging) could cause or contribute to, or be alleged to cause or contribute to, such harm, injury or disability or death as described in the foregoing sentences. I assume all the foregoing risk and I accept personal responsibility for the damages following such injury, permanent disability or death. I hereby release, discharge, covenant to indemnify and not to sue the MusiCares Foundation, its affiliated organizations and sponsors, personnel, officers, directors, agents, volunteers all of which are hereinafter referred to as “releasees”, from any and all liability to each of the undersigned, his/her heirs or next of kin for any and all against any claim by or on behalf of the applicant as a result of the use of the product at issue or applicant’s referral from MusiCares and/or being transported to or from the referral, which participation, after careful consideration I hereby authorize, and which transportation I hereby authorize. I also agree to save and hold harmless and indemnify each and all parties herein referred to above as releasees from all liability, loss, cost, claim or damage whatsoever, including death or damage to property, which may be imposed upon said releasees because of any defect in or lack of such capacity to so act or cause or alleged to be caused in whole or in part by the negligence of the release or related to the care of the independent provider to the applicant or the use of the product. I have read the above waiver/release and understand that I (We) have given up substantial rights by registering for and attending this appointment.

Host or Publisher MusiCares South