PARTICIPANT’S WAIVER, RELEASE, AND HOLD HARMLESS AGREEMENT

(COORDINATED CARE PROGRAM)

 WHEREAS, the Undersigned has requested to enroll in clinical and coordinated care services provided by Lyn Health Practice Group or such other third-party through a program (the “Program”) administered by San Juan County Public Hospital District No. 1 (the “District”);

 WHEREAS, the Undersigned desires to partake in the Program, free of cost, by their own free choice;

 WHEREAS, due to the nature of the Program, the Undersigned acknowledges that the District has no control over the services performed through the Program.

 NOW THEREFORE, in consideration of the District allowing the Undersigned to participate in the Program, the Undersigned hereby agrees:

 1.         Assumption of Risk.  The Undersigned represents and warrants that he/she understands:  (i) that the Program could result in bodily injury, death, and/or personal injury; (ii) that participation in the Program is being arranged at the request of the Undersigned; and (iii) that the ability to participate in the Program is of substantial personal benefit to the Undersigned and thereby provides adequate consideration for this Agreement.  THE UNDERSIGNED HEREBY ASSUMES ALL RISK OF PROPERTY DAMAGE, INJURY, OR DEATH WHILE PARTICIPATING IN THE PROGRAM.

 2.         Release, Indemnification, and Hold Harmless.  FOR AND IN CONSIDERATION OF THE DISTRICT ALLOWING THE UNDERSIGNED TO PARTICIPATE IN THE PROGRAM, THE UNDERSIGNED FOR HIMSELF/HERSELF, THEIR MARITAL COMMUNITIES, HEIRS, EXECUTORS, SUCCESSORS AND ASSIGNS DOES HEREBY FOREVER RELEASE, INDEMNIFY, AND HOLD HARMLESS THE DISTRICT, ITS COMMISSIONERS, OFFICERS, EMPLOYEES, AND AGENTS FROM ALL CLAIMS, DAMAGES, DEMANDS, OR INJURIES OF ANY KIND (ANTICIPATED OR UNANTICIPATED) OR NATURE (UP TO AND INCLUDING DEATH), ARISING OUT OF OR RELATING TO THE UNDERSIGNED’S PARTICIPATION IN THE PROGRAM.

 3.         Entire Agreement.  This Agreement is the entire agreement between the District and the Undersigned regarding participation in the Activities.  There are no other oral or written agreements which have not been incorporated herein.  This Agreement may only be modified in writing and signed by the District and the Undersigned.  The representations, warranties, release, indemnification, and hold harmless shall survive the termination of this Agreement.

 4.         Severability.  If any section of this Agreement is adjudicated to be invalid, such action shall not affect the validity of any section not so adjudicated.

I, the Undersigned, acknowledge that I have carefully read this WAIVER, RELEASE, AND HOLD HARMLESS AGREEMENT and fully understand that I am waiving any right that I may now, or hereafter, have to bring a legal action to assert any claim against San Juan County Public Hospital No. 1 in connection with my participation in the Program.