Acknowledgement, Consent, Agreement And Release From Liability Form (Page 2 of 2) in pdf

Acknowledgement, Consent, Agreement And Release From Liability Form Page 2

Memorial Hermann Medical Missions

Acknowledgement, Consents, Agreement and Release From

Liability (Collectively, "The Release")

Continued Page 2

If any provision of this Release is, becomes or is deemed invalid, illegal or unenforceable in any

jurisdiction under applicable laws, such provision shall be deemed amended to conform to

applicable laws so as to be valid and enforceable thereunder, but if it cannot be so amended

without materially altering the intention of the parties, it shall be stricken and the remainder of

this Release shall remain in full force and effect. Memorial Hermann Medical Missions is part of

Memorial Hermann Healthcare System and headquartered in Texas.

This Release shall be governed by the laws of the State of Texas (exclusive of any conflicts of

laws that would result in application of foreign law) and venue shall lie exclusively in federal or

state courts located in Harris County, Texas.

I have carefully read this agreement and fully understand its contents. I am aware that this is a

release of liability and a contract between myself and Memorial Hermann Medical Missions

and/or its agents, affiliates, officers, directors, employees, and volunteers, and I sign it of my own

free will.

Executed at _____________________ on ___________________. (month/day) (year)

RELEASOR

_______________________________ Signature

_______________________________ Printed Name

Acknowledgement, Consent, Agreement And Release From Liability Form Page 2