Acknowledgment of Risks
I understand and acknowledge that participation in the above activity/program at Ranken Jordan Pediatric Bridge Hospital, a Missouri nonprofit corporation (“Ranken Jordan”), may involve physical activity, hands-on learning, observation, or interaction with equipment, facilities, or patients, all of which carry inherent risks.
These risks may include, but are not limited to: slips, trips, falls, strains, exposure to medical equipment, exposure to infectious agents (including bacteria or viruses), or other unforeseen hazards. I acknowledge that these risks cannot be eliminated without compromising the essential qualities of the activity/program.
I understand that risks may vary depending on the activity or program. I have been given the opportunity to ask questions regarding the activity and its risks and may decline or withdraw from participation at any time.
Attendee/Participant Responsibility
I agree to:
- Participate within my personal abilities and limitations.
- Follow all safety rules, instructions, and directions given by Ranken Jordan staff.
- Comply with all applicable Ranken Jordan policies, including those related to patient privacy, confidentiality, and infection control.
- Immediately notify a facilitator if I experience discomfort, pain, illness, or injury.
- Disclose any relevant medical conditions that may affect my safe participation.
Release of Liability and Assumption of Risk
In consideration of being permitted to participate in this activity/program, I hereby agree as follows:
- Assumption of Risk: I voluntarily and knowingly assume all risks of personal injury, illness, or property damage that may arise from participation in this activity/program, including risks caused by the ordinary negligence of Ranken Jordan, its officers, employees, agents, or volunteers.
- Waiver and Release: To the maximum extent permitted by Missouri law, I release, discharge, and agree to hold harmless Ranken Jordan, its officers, employees, agents, volunteers, representatives, and assigns from any and all claims, demands, liabilities, or damages arising from participation in this activity/program—except to the extent caused by gross negligence or willful misconduct of Ranken Jordan or its representatives. This release applies to me and is binding on my heirs, representatives, executors, administrators, and next of kin.
- Scope: I understand that this Waiver and Release is intended to be as broad and inclusive as permitted by the laws of the State of Missouri. If any portion is held invalid, the remainder shall continue in full legal force and effect.
- Voluntary Participation: I understand that my participation is completely voluntary and is not a condition of receiving medical care, employment, or other benefits from Ranken Jordan.
Medical Treatment Authorization
In the event of illness or injury, I authorize Ranken Jordan and its representatives to obtain emergency medical treatment deemed necessary. I acknowledge that Ranken Jordan does not provide health or accident insurance for participants and that I am solely responsible for all medical expenses incurred.
I further acknowledge that Ranken Jordan personnel are not responsible for ongoing medical monitoring beyond emergency response.
Choice of Law and Venue
This Agreement shall be governed by and construed in accordance with the laws of the State of Missouri, without regard to its conflict-of-law principles. Any disputes arising under or related to this Agreement shall be resolved exclusively in the state or federal courts located in St. Louis County, Missouri.
Acknowledgment of Understanding
I have read this Agreement carefully, fully understand its terms, and have had the opportunity to ask questions regarding the activity/program and this Agreement. I acknowledge and agree to all responsibilities and conditions described above. My signature below constitutes a legally binding acknowledgment, assumption of risk, and waiver of liability.
