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  • Acknowledgement & Assumption of Risk

  • I, (client or parent/guardian name) understand that I am being asked to carefully read each of the provisions in this form. I acknowledge and agree to have (client name) receive therapy services from Peak Pediatrics LLC and/or any employee or independent contractor employed by Peak Pediatrics LLC.
     

  • I acknowledge that there is some inherent risks associated with the use of therapy equipment that cannot be eliminated regardless of the care taken to avoid injuries.

     I understand the risks and I hereby assert that my participation is voluntary and that I knowingly assume such risks without holding Peak Pediatrics LLC and/or any employee or independent contractor employed by Peak Pediatrics LLC accountable for any losses, injuries or other damages occurring to the client and/or myself. I further understand that I am fully responsible for my own safety.

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