Department of Community Education & Outreach or Greenberg Academy for Successful Aging Exercise & Education Programs

Informed Consent, Release and Waiver

I wish to participate in the educational/exercise program offered by the Hospital for Special Surgery (“HSS”) Education Institute (the “Program”). The program may be offered to you in-person or digitally through a live streaming platform or recorded format.

I understand that the Program includes the engagement in physical tasks and the performance of various movements, exercises and activities which can be considered hazardous. These activities may include use of dangerous equipment, cardiovascular, flexibility, strengthening, stabilization, balance, plyometric, and agility exercises as well as activities that involve speed, balance and direction change. I understand that my engagement in these and other physical activities during the Program involves certain inherent risks, including but not limited to, minor injuries such as cuts, bruises, muscle strains and sprains, and even fractures. The reaction of the cardiorespiratory system and/or an individual person’s bones, joints or muscles to the activities undertaken in the Program cannot be predicted with complete accuracy and there exists the possibility during exercise of adverse changes including abnormalities of blood pressure, fainting, disorders of heart rhythm, and, in very rare instances, catastrophic injuries such as neck and spinal injury resulting in complete or partial paralysis, heart attack, injury to the bones, joints or muscles, or even death. I understand that engaging in the program remotely bears its own risks, and that I should ensure my environment is appropriate for the performance of Program activities. I am voluntarily participating in the Program with knowledge of the risks involved.

I understand that none of HSS or its affiliates or any employees, medical staff or agents of any of those entities, are offering medical advice by the offering of the Program. I also understand that I should consult with my physician(s) before my participation if I have any concerns or questions about the impact of my participation on my medical condition. I am not relying, and will at no time rely, on HSS, or its affiliates or any employees, medical staff or agents of any of those entities, to provide me with medical advice of any kind (including advice pertaining to my participation in its activities), or to advise me of the medical risks associated with my participation, regardless of whether any HSS affiliated medical professionals are also participating in the Program. I understand that if I am injured, I will not be entitled to medical treatment from HSS or its affiliates or any employees, medical staff or agents of any of those entities.

I understand that Program staff who conduct the Program (including third parties engaged by HSS to conduct the Program) are not necessarily trained medical professionals, and therefore will not be responsible for providing me with emergency medical treatment that I may require in the course of participating in the Program. I further understand that by performing in the Program remotely, the Program staff will be unable to recognize my experiencing a medical emergency, and that I am solely responsible for obtaining emergency medical treatment in such circumstances.

I also understand that there could be errors in the Program related to deficiencies or failures of the equipment and technologies.

I hereby further declare that I am not suffering from any impairment, disease, infirmity, or other illness that would prevent my participation in the Program or use of services, facilities, equipment or machinery in connection therewith. I acknowledge that I have either had a physical examination and have been given my physician's permission to participate, or that I have decided to participate in the Program voluntarily without the approval of my physician and do hereby assume all responsibility for my participation. I also agree to inform the instructor of any current physical or other limitations I may have in order to promote safe and effective participation in the programs for myself and all other participants. I will limit my participation in or withdraw from the programs if my physician advises me to do so or if I have any reason to believe I cannot fully participate in the programs.

Waiver and Release

I hereby waive, release, and forever discharge HSS and its affiliates, and their respective trustees, directors, principals, officers, employees, medical staff, agents and representatives, and all others affiliated with them, as well as other participants in the Program, from any and all responsibility or liability, damage, cost or expense, for or related to, any injury or damage, including death or emotional distress, or for loss or theft of, or damage to, property, in any way arising out of or related to my participation in any activities associated with or offered through the Program or my use of services, facilities, equipment and machinery in such activities.

I understand that this waiver is intended to be as broad and inclusive as permitted by applicable laws and regulations. I agree that if any provision of it is determined to be invalid, then such provision shall be deemed to be modified to the extent necessary to render it valid while most nearly preserving its original intent, and the remainder of the waiver will continue in full legal force and effect. I further agree that any disputes that may arise that are in any way related to my participation in the Program or this release are subject to the exclusive jurisdiction of the federal and state courts in the County of New York, State of New York, to whose jurisdiction I submit.

In consideration for my participation in the Program, I hereby release and discharge HSS and its affiliates, and their respective trustees, directors, principals, officers, employees, medical staff, agents and representatives, and all others affiliated with them from, and agree to hold harmless all of such released parties from and against, any and all claims, damages, liabilities, costs and expenses (including reasonable attorneys’ fees and court costs) arising out of my participation in any of the Program’s activities.

I understand that if I do not follow the rules of the Program, I may be removed from the Program.

Consent for Taking and Publishing Photographs, Videos and/or Other

I, the undersigned, a participant in the Program, hereby consent to the taking of any and all still photographs, motion pictures, digital video and images, television and/or videotapes, voice recordings, and/or other recordings (“Recordings”) of my/his/her person during the Program in which I participate and/or another such location(s) as I and HSS agree during the course of my/his/her participation in the Program, and agree to the use of the Recordings as follows:
By HSS and/or by any person(s) HSS may name, designate or authorize, in any medium whatsoever (including all digital and social media channels), for (i) educational and/or training purposes for other participants seeking to engage in a recorded version of the Program, including broadcast or public viewing of the Program, or (ii) HSS’s publicity, marketing, publications, and/or solicitation of contributions. Such Recordings may be used as described hereinabove, in full or edited form, may be incorporated into other recordings or formats, and may be copied for multiple distributions and/or broadcasts.

I agree that I will receive no compensation or other remuneration for the taking, production, use, broadcast, and/or distribution of such Recordings or for my participation in any manner in such Program, and I specifically release HSS and all others from any liability or other obligation arising from the taking, production, use, broadcast, and/or distribution of such Recordings and from my participation in the Program. I understand that I have the right to withdraw from participating in the Recordings at any time during the Program, and that I have the right to revoke this consent at any time to the extent that HSS has not relied upon it or has not submitted the Recordings for use in external media.

Cancellation Policy

HSS Education Institute reserves the right to change or cancel any program. Registrants will be notified by phone and/or email within 24 hours prior to the event. If you register for a multi-class session and are unable to attend all classes, no make-up classes will be offered. If you start a multi-session class and decide not to continue, no credit or refund will be given. Exercise class recordings will be available to view for 24 hours after the class end time pending no significant video or audio interruptions. A refund or credit is available if you cancel up to 7 days before the exercise class or program begins. A handling fee of $20 is deducted for all class or program cancelations. No refunds will be given if you do not attend a class or program without giving 7 days prior notice. Prior to the class or program, please ensure that you are able to connect via Zoom or phone, as we are unable to provide refunds for any technical difficulties encountered.

Refunds for the Live+ and on-demand library are available prior to the start of paid access. No refunds are available for Live+ and on-demand library cancelations once paid access has started.

I hereby affirm that I have read and fully understand this form, have had all of my questions answered, and give my informed consent to participate in the Program (including to the release and waiver above), consent for use and disclosure of my information, and my consent to the making of the Recordings as set forth above. I have read and understand all of the above terms and agree that these terms shall bind me and my heirs, executors, administrators, legal representatives and assignees. I further acknowledge that this is an important legal document in which I give up legal rights and remedies I would otherwise have and this document applies to all activities at the Program, regardless of whether specifically listed above or not.

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