Animal PEMF Liability Release and Waiver Form

I hereby state that I am at least 18 years of age and have read, understand and agree to this Waiver and Liability Release Statement, that it is an informed release and that I intend to be legally bound by it.

No chemotherapy, pregnancies, no pacemakers or other implanted stimulators.
No chains, cell phones, electronic watches or credit cards (other jewelry is OK).
No car keys with intelligent chips.
I agree to be fully responsible for any damages, if I do not follow the above instructions.
I know that I am using a magnetic pulse generator and that it is not FDA approved to treat or cure any disease or condition.
I understand that this is an experimental device.

Full Name*

First NameLast Name

E-mail*

Phone Number*

Area CodePhone Number

State / Zip*

Street Address

Street Address Line 2

CityState

Zip Code

Is an Animal being treated?*

YesNo

Type Animal*

Name of Animal 1

Name of Animal 2

Name of Animal 3

Name of Animal 4

By my signature below, I acknowledge that I have read the following, understand it and agree to the terms:

No one has made any representations or claims to me of any treatment or cure of any disease or condition; or any promise of any specific or general results of any kind regarding treatments on myself or on the horse I own or am in control of. I release from all general, medical and any other liability or claims of any kind; and, I indemnify and hold harmless, Magnus Magnetica,llc. and its respective officers, directors, agents, servants, employees, divisions, subsidiaries, shareholders, partners, members, affiliated companies, successor and assigns, the magnetic pulse generator, the manufacturer, distributor, dealer and any of their employees or agents, (the "Company") from any claim arising from or related to my use of the magnetic pulse generator. Should anyone acting on Signatory's behalf be required to incur attorney's fees and costs to enforce this agreement, I agree to indemnify and hold harmless the Company, for all such fees and costs. I agree that this liability shall be interpreted and governed by the laws that the attending Practitioner resides in at the time of treatment.

Photo Release:

I also grant permission to Magnus Magnetica, LLC and it's registered Practitioners to Publish pictures & videos of myself on all related websites, social media sites, in promotional videos, press releases, or any other form of public publicity.

Client's Signature*

Sign then take your Photo and Submit

PEMF Treatment