Liability Form

Community Assessment Center
Liability Release Form

  • Assumption of Risk and Release of Liability

  • I acknowledge that I am voluntarily participating in the COVID-19 assessment center hosted by Meharry Medical College.

    I certify that I understand this is a legally binding Agreement and recognize the possible direct or inherent dangers and risks involved related to the activities. I acknowledge facts and circumstances surrounding the activities have been explained to me or I have been directed to the appropriate party or site that outlines said events and I fully understand the same.

    I certify that I am being allowed to participate in the service project without any coercion or any expectation of tangible or non-tangible compensation. I understand media outlets may be present and the information may be transmitted through various media genres.

    I understand that I assume all risk, associated with this experience, and I, on behalf of myself, my family, heirs and legal representatives release, waive and hold harmless Meharry Medical college, its affiliates employees, agents, officers and governing board from any liability for loss, damage, or injury to person or property that may incur while participating in the activity. I understand that this release covers liability, claims and actions caused entirely or in part by acts or failures to act of Meharry Medical College or its governing board, employees or agents.

    I grant permission to Meharry medical College, its agents or employees to obtain necessary medical attention in case of an emergency. I consent to any necessary medical examination, diagnosis, or treatment and agree to be responsible for costs of such medical services.

    I agree that this Agreement is intended to be broad and inclusive as permitted by the laws of the State of Tennessee, and that if any portion of this Agreement is held invalid, any such findings shall not affect the validity of the remaining provisions.

    I have read this entire Agreement. I fully understand it and I agree to be legally bound by it.
  • Date Format: MM slash DD slash YYYY