I UNDERSTAND AND AGREE THAT Clause Samples

I UNDERSTAND AND AGREE THAT. ▇▇▇ ▇▇’▇ activities may be very dangerous and physically and mentally demanding, and that my participation in this activity may involve risks. Such risks include, but are not limited to, SERIOUS INJURY, PERMANENT DISABILITY, DEATH, and loss of or damage to personal property, which may occur due to the negligence or other actions or inactions of myself or others, and that injuries sustained may be compounded or increased by rescue or other emergency procedures. I am also aware that the weather and sea conditions, including surf conditions, are unpredictable, uncontrollable, and may be dangerous. I FULLY ASSUME ALL RISKS, BOTH KNOWN AND UNKNOWN, AND ACCEPT SOLE RESPONSIBILITY for injury, death, expenses and property or other loss as a result of my participation in this activity. I acknowledge that I am PROCEEDING ENTIRELY AT MY OWN RISK in participating in Hui Wa’a activity.

I UNDERSTAND AND AGREE THAT. The person I have chosen to be my provider cannot be paid federal and/or state money for providing services to me until he/she completes all of the provider enrollment requirements. These requirements include completing, signing, and returning (in person) the Provider Enrollment Form (SOC 426), submitting fingerprints and being cleared of disqualifying crimes through a criminal background check, completing a provider orientation, and returning a signed Provider Enrollment Agreement (SOC 846). • The county will send me a notice telling me if the person I have chosen as my provider does not complete the provider enrollment requirements or if he/she is not eligible to be an IHSS provider. • If I choose to have this person provide services for me before he/she is enrolled as an IHSS provider, and the county sends me a notice telling me that he/she is not eligible to be an IHSS provider, I will have to pay him/her with my own money for the services that he/she provided before he/she was determined ineligible to be a provider and for any services he/she provides after the county notifies me that he/she is ineligible. • Neither the county nor the State will be held responsible for any claims and/or losses caused by the above-named person I choose to hire as my IHSS provider. I agree to hold harmless the State and county, their officers, agents, and employees, and to take responsibility for any and all claims and/or losses to any person caused by the named person I choose to hire as my IHSS provider. • The county can provide information about my authorized services and service hours to the person I have chosen as my provider. The county will send my provider the IHSS Provider Notice of Recipient Authorized Hours and Services (SOC 2271). • My total monthly authorized hours will be divided by 4 to determine my maximum weekly hours. The maximum weekly hours is a guideline telling me the highest number of hours my provider(s) will be able to work for me during a workweek. However, since most months are slightly longer than 4 weeks, I will work with my provider(s) to spread his/her hours throughout the month in order to make sure I have all the service hours I need for the month. • Sometimes I may need my provider to work more than my maximum weekly hours. I must ask for county approval to adjust my maximum weekly hours only if the change requires my provider to work:

I UNDERSTAND AND AGREE THAT a. my electronic Digital Signature will have the same value, force and effect as my written signature; b. when my association with SAFE ends, my Certificate may be revoked and my ability and authorization to use my Private Key for any new Digital Signatures will cease; c. upon expiration or notice of revocation of my Certificate, I shall no longer use the Certificate for any purpose; d. upon receipt by SAFE of any notice from me regarding erroneous information in my Certificate, SAFE may revoke my Certificate and issue a corrected Certificate; e. if needing to rely upon a SAFE-signed electronic record, I shall: (i) verify the accompanying Digital Signature; and (ii) reject the such record if the Digital Signature is invalid; and f. any device with which I will interact to apply a SAFE signature has appropriate security controls installed and activated, and that the latest updates are applied.

I UNDERSTAND AND AGREE THAT. My participation in the Activities entails known and unanticipated risks and may pose physical risk to me or damage to my property and I may suffer injury or loss, including, without limitation, soreness, ▇▇▇▇▇, serious injury to body, emotional or mental injury, paralysis, or death, to me or to third parties. Without limiting the foregoing, risks also include injury to me as a result of the participation in the Activities by others.

I UNDERSTAND AND AGREE THAT. I understand and agree that: (a) recreational and fitness activities and use of City facilities (cumulatively “recreational activities”) have inherent risks, dangers, and hazards and such exists in my use, and/or my minor child(ren)’s use, of any equipment and my participation in these activities; (b) my participation, and/or my minor child(ren)’s participation, in such activities and/or use of such equipment may result in injury or illness including, but not limited to bodily injury, disease, strains, fractures, partial and/or total paralysis, death, or other ailments that could cause serious disability; (c) City facilities are open and generally accessible to members of the public; (d) my and/or my minor child(ren)’s and/or other users access to City facilities and/or placement, storage or accessing of property left in City facilities puts such property at a risk of damage, destruction, loss, theft, fire or other casualty; (e) these risks and dangers may be caused by the negligence of the representatives, employees, or volunteers of the City of Coronado, the negligence of the participants, the negligence of others, accidents, breaches of contract, or other causes; and (f) by my participation, and/or my minor child(ren)’s participation, in recreational activities and/or use of equipment, I hereby assume all risks and dangers and all responsibility for any losses and/or damages whether caused in whole or in part by the negligence or conduct of the representatives, employees, or volunteers of the City of Coronado. My participation, or my minor child(ren)’s participation, in recreational activities may occasionally result in injury, death or property damage. Knowing the risk involved, nevertheless, I voluntarily request permission for myself or minor child(ren) to participate in the recreational activity. As lawful consideration for permission to enter City property and/or City facilities for any purpose, including but not limited to observation, use of facilities or equipment, leaving or storage of property, or participation in any way, I agree to release from any legal liability to me or to my personal representatives, assigns, heirs, and next of kin, and agree not to sue the City of Coronado, its elected and appointed officers, agents, representatives, volunteers and employees (the “Releasees”), for any loss or damage, including all injuries, death, or property damage caused by or resulting from any use of City facilities, or participation in, or observat...

I UNDERSTAND AND AGREE THAT. It is my legal and ethical responsibility to protect the privacy, confidentiality and security of all medical records, proprietary information and other confidential information relating to PIHMA/CPED and its affiliates, including business, employment and medical information relating to patients, staff, employees and health care providers. If I am away from my workstation, I must log off my computer system so that PHI cannot be accessed by unauthorized individuals. If provided, I will not disclose my password(s) to anyone or allow any other person to use my access/ID badge or user ID. I further understand that I must protect confidential information, patient information or any document that may contain PHI by securing it in a locked cabinet or office. I agree to discuss confidential information only in the classroom and only for study-related purposes and to not discuss such information outside of the classroom or within hearing of other people who do not have a need to know about the information. As a student or observer in Clinic, I hereby undertake to strictly comply with the following conditions concerning the following materials that may be provided: o All DVDs, CDs, Videotapes, or Video Files via Dropbox, Vimeo, YouTube, or any other hosting provider. o All Audiotapes or Audio Files via Dropbox or any other hosting provider. o All photographs or Image Files on any storage device, CD, or any online hosting provider.

I UNDERSTAND AND AGREE THAT. Novato Community Hospital Per Diem/Short Hour employees work either on the basis of covering for peak periods, illness, vacation relief, holidays, unplanned occurrences, or other staffing needs, or are regularly-scheduled to work less than ½ time.

I UNDERSTAND AND AGREE THAT. Only one loan may be outstanding at a time under the policy.

I UNDERSTAND AND AGREE THAT. I will not look at any protected data involved or interact with patients involved in the study until I have been approved as a researcher by the IRB. This information may include, but is not limited to, information on patients, employees, plan members, students, other workforce members, donors, research, or financial and business operations. Some of this information is made confidential by law (such as “protected health information” or “PHI” under the Federal Health Information may be in any form, e.g. written, electronic, oral, overheard or observed.) I also understand that access to all confidential information is granted on a need-to-know basis. A need-to-know is defined as information access that is required in order to engage in the research project that I am assigned to.